Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

Eyal Shemesh, Jeffrey Mitchell, Katie Neighbors, Susan Feist, Andre Hawkins, Amanda Brown, Yin Wanrong, Ravinder Anand, Margaret L. Stuber, Rachel A. Annunziato

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: It is very hard to recruit and retain non-adherent patients in research efforts. This manuscript presents recruitment strategies and results from the MALT (Medication Adherence in children who had a Liver Transplant) multisite prospective cohort study. MALT sites recruited 400 pediatric liver transplant patients who agreed to be followed for 2 years. The primary purpose was to determine whether a marker of adherence, the Medication Level Variability Index (MLVI), predicts rejection outcomes. The present manuscript describes methods used in MALT to ensure that a representative sample was recruited, and presents detailed recruitment results. MALT sites were able to recruit a nationally representative sample, as determined by a comparison between the MALT cohort and a national sample of transplant recipients. Strategies that helped ensure that the sample was representative included monitoring of the outcome measure in comparison with a national sample, drastically limiting patient burden, and specific recruitment methods. We discuss the importance of a representative sample in adherence research and recommend that future efforts to study adherence pay special attention to sample characteristics.

Original languageEnglish
Article numbere13067
JournalPediatric Transplantation
Issue number8
StatePublished - Dec 2017


  • adherence
  • pediatric
  • recruitment
  • transplant


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