Comparison of stool collection on site versus at home in a population-based study : feasibility and participants' preference in Pretest 2 of the German National Cohort

Abstract

Background: For certain laboratory investigations it is necessary to obtain native stool samples and process them within a narrow time window at the point of contact or a nearby laboratory. However, it is not known whether it is feasible to obtain stool samples from asymptomatic individuals during an appointment in a study center (SC). We therefore compared participants' preference, feasibility and acceptance of stool sample collection during the appointment at the study center (on-site sampling) to collection at home after the appointment.

Methods: The study was conducted at two sites in Northern Germany (Bremen, n = 156; Hannover, n = 147) during the Pretest 2 phase of the German National Cohort (GNC), drawing upon a randomly selected population supplemented by a small convenience sample. In the study center, the participants were given the choice to provide a stool sample during the appointment or to collect a sample later at home and return it by mail.

Results: In all, 303 of the 351 participants (86 %) of Pretest 2 at these sites participated in this feasibility study. Only 7.9 % (24/303) of the participants chose on-site collection, whereas 92 % (279/303) chose at-home collection. There were significant differences between the two study sites in that 14 % (21/147) of participants in Hannover and 2 % (3/156) of participants in Bremen chose on-site collection. Compliance was high in both groups, as 100 % (24/24) and 98 % (272/279) of participants in the on-site and at-home groups, respectively, provided complete samples. Both methods were highly accepted, as 92 % of the participants in each group (22/24 and 227/248) stated that stool collection at the respective site was acceptable.

Conclusion: When given a choice, most participants in this population-based study preferred home collection of stool samples to collection in the study center. Thus, native stool samples for immediate processing in the study center may potentially be obtained only from a subpopulation of participants, which may lead to selection bias. Home collection, on the other hand, proved to be a highly feasible method for studies that do not require freshly collected native stool.

Fig. 1

Flow chart of the recruitment for the feasibility study.

Fig. 2

Stool collector used for on-site and home collection made of water-soluble recycling paper (Med Auxil)]

Fig. 3

Variation in time elapsed between sample collection and initiation of frozen storage. a On-site collection. The data were calculated using the time of collection recorded by the participants and the time of placement in the laboratory freezer recorded by the laboratory staff. b Home collection. The data were calculated using the time of collection recorded by the participants and the time of receipt of the shipped package in the laboratory of the Helmholtz Center for Infection Research. c Storage condition at home. The data were calculated using the time of collection recorded by the participants and the time of receipt of the shipped package in the laboratory of the Helmholtz Center for Infection Research (base: all responses given in regard of storage condition of sample at home before shipping, n = 211/261).