Use of online recruitment strategies in a randomized trial of cancer survivors

Enhancing patient engagement and understanding: is providing direct access to laboratory results through patient portals adequate?

Objectives

To explore patients' use of patient portals to access lab test results, their comprehension of lab test data, and factors associated with these.

Materials and Methods

An online survey was administered to 276 adults 18+ years. Multivariate logistic regression was used to determine factors associated with patient portal use to view lab test results and lab test comprehension.

Results

The sample was predominantly White (72.5%), female (55.4%), with mean age 50.7 ± 15.5 years. Overall, participants had low numeracy (10.79 ± 2.71) and eHealth literacy skills (23.91 ± 5.29), and moderate lab test comprehension scores (18 ± 2.3). White participants with greater eHealth literacy were more likely to access lab test results via patient portals, whereas those with a college education were less likely to do so (χ2 [3]=31.23, P < .001). The regression showed that older age, fewer chronic conditions, and use of patient portals were significantly related to higher lab test comprehension scores (F [22, 250]=8.73, P <.001). Older adults performed better on comprehension tests but reported having difficulty understanding lab tests, expressing a preference for their doctors to explain them.

Discussion

The findings shed light on the experiences and needs of different user groups that must be addressed to enhance their ability to effectively use patient portals for obtaining lab test results.

Conclusion

More research is needed to determine patient barriers to comprehending lab test results online and to develop tailored strategies to improve patients' self-efficacy to meaningfully use medical information in patient portals.

Overcoming challenges of recruiting cancer patients into clinical trials: insights from a randomized trial of app-based smoking cessation interventions

Behavioral clinical trials among cancer patients often fail to meet recruitment goals - especially for underrepresented groups. Comparing recruitment strategies on participant accrual and cost can inform the use of cost-effective recruitment strategies for enrollment of diverse populations of cancer patients. In this study, we compared social media, internet sites, and clinic-based recruitment on accrual, cost, and characteristics of cancer patients (i.e., sociodemographic, cancer type/stage, and smoking habits) enrolled in a randomized trial of app-based smoking cessation interventions. Fisher's exact tests for categorical variables and analysis of variance for continuous variables were used to compared data between recruitment strategies. In 35 months, 427 cancer patients from 45 US states enrolled in the trial out of 3,936 screened (rate of participation, 10.8%). Social media recruited over eight times the number of enrolled participants (n=340, 79.6%) compared with Internet sites (n=43, 10.1%) and clinics (n=42, 9.8%). Most (80.1%) participants were women, with mean age 52.3 years. About 20.4% of participants were from underrepresented racial/ethnic backgrounds, 23.0% were rural residents, and 23.7% were uninsured. Over 32 cancer types and all cancer stages were represented. Breast cancer was the most common diagnosis (n=129/427, 30.2%), followed by lung cancer (n=96/427, 23.8%). Internet recruitment generated a higher proportion of men (30.2% vs. 26.2% clinics vs. 17.4% social media, P=.005). Clinics generated a higher proportion of Hispanic participants (9.5% vs. 7.0% Internet vs. 2.6% social media, P=.04) and cancer patients aged 65 and older (28.6% vs. 11.5% social media vs. 4.7% Internet, P=.01). Social media recruited a higher proportion of participants with low income (<$20,000: 39.1% vs. 23.3% Internet vs. 19.0% clinics, P<.001), who tended to have later stage cancers (stage IV: 17.4% vs. 14.0% Internet vs. 7.1% clinics, P=.05). Cost per randomized participant ranged from $270 via social media to $454 via Internet sites to $2,240 via clinic-based recruitment. In conclusion, social media was the most efficient and cost-effective method for recruiting a quality sample of racially/ethnically, geographically, socioeconomically, and clinically diverse sample of cancer patients into a smoking cessation clinical trial. Social media has solid potential for recruiting cancer patients into behavioral clinical trials.

Challenges and Opportunities in Recruiting Research Participants Using Facebook: Lessons Learned from an Exemplar Study

BACKGROUND

Facebook is a prominent social medial platform frequently used for business marketing. Researchers are starting to recognize the utility of this platform for developing research awareness, information dissemination, and more recently participant recruitment.

PURPOSE

This paper will provide an overview of methods used in Facebook recruitment through an exemplar study. It will highlight successes and challenges and provide insight into future opportunities for its' use.

METHODS

Two methods of Facebook recruitment are outlined in this paper: the use of Facebook groups and paid advertising. A step-by-step guide highlights how researchers can implement these specific methods of Facebook recruitment.

RESULTS

Facebook was successfully utilized to recruit participants in the exemplar study. Recruitment was completed over a period of 82 days with a total cost of $157.09 Canadian dollars.

CONCLUSION

Facebook is a viable method of recruiting research participants. This method can be cost-effective, timely, and efficient in comparison to traditional research recruitment methods. However, one must balance the benefits and challenges of this type of recruitment.

Behavioral Weight Loss Programs for Cancer Survivors Throughout Maryland: Protocol for a Pragmatic Trial and Participant Characteristics

BACKGROUND

Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland.

OBJECTIVE

The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants.

METHODS

Participants were aged ≥18 years, residing in Maryland, with a BMI ≥25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program.

RESULTS

Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor's degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024.

CONCLUSIONS

Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54126.

Metformin and Breast Cancer: Current Findings and Future Perspectives from Preclinical and Clinical Studies

Over the last several decades, a growing body of research has investigated the potential to repurpose the anti-diabetic drug metformin for breast cancer prevention and/or treatment. Observational studies in the early 2000s demonstrated that patients with diabetes taking metformin had decreased cancer risk, providing the first evidence supporting the potential role of metformin as an anti-cancer agent. Despite substantial efforts, two decades later, the exact mechanisms and clinical efficacy of metformin for breast cancer remain ambiguous. Here, we have summarized key findings from studies examining the effect of metformin on breast cancer across the translational spectrum including in vitro, in vivo, and human studies. Importantly, we discuss critical factors that may help explain the significant heterogeneity in study outcomes, highlighting how metformin dose, underlying metabolic health, menopausal status, tumor subtype, membrane transporter expression, diet, and other factors may play a role in modulating metformin's anti-cancer effects. We hope that these insights will help with interpreting data from completed studies, improve the design of future studies, and aid in the identification of patient subsets with breast cancer or at high risk for the disease who are most likely to benefit from metformin treatment.

Strategies for recruitment and retention of adolescent and young adult cancer patients in research studies

We conducted a literature review to identify commonly used recruitment and retention strategies in research among adolescent and young adult (AYA) cancer survivors 15-39 years of age and examine the effectiveness of these strategies based on the reported recruitment and retention rates. We identified 18 publications published after 2010, including 14 articles describing recruitment strategies and four articles discussing retention strategies and addressing reasons for AYA cancer patients dropping out of the studies. In terms of recruitment, Internet and social networking strategies were used most frequently and resulted in higher participation rates of AYA cancer survivors compared to other conventional methods, such as hospital-based outreach, mailings, and phone calls. In terms of retention, investigators used monetary incentives in all four studies and regular emails in two studies. There was no association between the number of strategies employed and the overall recruitment (p = 0.09) and retention rates (p = 0.33). Future research and planned studies testing recruitment and retention strategies are needed to identify optimal, modern communication procedures to increase AYA participation and adherence. More education should be provided to AYAs to increase their knowledge of research studies and strengthen the connection between AYA cancer survivors and their health providers.

Enhancing Efficiency and Reach Using Facebook to Recruit Breast Cancer Survivors for a Telephone-Based Supportive Care Randomized Trial During the COVID-19 Pandemic

PURPOSE

Evidence supporting social media-based recruitment of cancer survivors is limited. This paper describes how we used Facebook during the COVID-19 pandemic to augment our recruitment of breast cancer survivors for our two-site telephone-based randomized clinical trial (RCT) at Dartmouth-Hitchcock Medical Center and the University of Alabama at Birmingham.

METHODS

Originally a two-site RCT of a telephone-delivered breast cancer survivorship intervention, we extended our clinic-based recruitment to Facebook. Participant characteristics, geographic reach, and baseline outcomes were compared across recruitment sources (ie, two clinics and Facebook) using descriptive statistics and effect sizes.

RESULTS

Enrollment rates (20%-29%) were comparable across recruitment sources. The 21-month Facebook marketing campaign accounted for 59% (n = 179/303) of our total sample and had the greatest geographic reach, recruiting women from 24 states. The Facebook campaign reached a total of 51,787 unique individuals and cost $88.44 in US dollars (USD) per enrolled participant. Clinic samples had a greater proportion of women who were widowed (8% v 1%; P = .03) and Facebook had a higher proportion of women with a household income over $40,000 USD (83% v 71%; P = .02). There were no statistically significant differences between Facebook and the two clinics on baseline survey scores.

CONCLUSION

Augmenting traditional recruitment with Facebook increased our RCT's geographic and sociodemographic reach and supported meeting recruitment goals in a timely way. In the wake of the COVID-19 pandemic, cancer survivorship researchers should consider using social media as a recruitment strategy while weighing the advantages and potential biases introduced through such strategies.

Rationale and Design of the Groceries for Black Residents of Boston to Stop Hypertension Among Adults Without Treated Hypertension (GoFresh) Trial

BACKGROUND

Poor diet quality significantly contributes to hypertension disparities affecting Black adults. While the Dietary Approaches to Stop Hypertension (DASH) eating pattern lowers blood pressure (BP), access to DASH-patterned groceries is a major barrier for residents of urban food deserts.

METHODS

The Groceries for Black Residents of Boston to Stop Hypertension among Adults without Treated Hypertension (GoFresh) study is one of five projects in the RESTORE Network, an AHA-funded initiative focused on hypertension prevention. GoFresh is testing whether online, dietitian-assisted, home-delivered, DASH-patterned groceries lowers BP among Black adults with elevated BP. This individual-level, parallel-arm trial will enroll up to 176 Black adults with SBP (systolic blood pressure) between 120 and <150 mm Hg residing in Boston-area communities with reduced grocery store access. Following randomization, half of the participants will be assigned to weekly sessions with a dietitian who will assist participants in ordering DASH-patterned groceries online for home delivery; the remainder will receive a $500 monthly stipend. Both interventions will last 3 months, followed by a 9-month maintenance phase.

RESULTS

The primary outcome is the difference in SBP after 3 months. Secondary outcomes include a change in 24-hour ambulatory BP, body mass index, 24-hour urine sodium and potassium, hemoglobin A1C, lipids, fruit and vegetable intake, and saturated fat intake. Qualitative interviews with 45 participants 6 months after baseline assessments will determine barriers and facilitators to long-term maintenance of DASH-patterned grocery shopping.

DISCUSSION

Findings from this study will inform ongoing work on scalable interventions to prevent hypertension among Black adults with implications for public and healthcare-based food supplementation programs.

TRIAL REGISTRATION

NCT05121337. Registered on 16 November 2021, at ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT05121337.

Returning individual research results in international direct-to-participant genomic research: results from a 31-country study

This paper summarizes the results of a 31-country qualitative study of expert perspectives on the regulation of international "direct-to-participant" (DTP) genomic research. We outline how the practice of directly recruiting participants for genomic studies online complicates ethics and regulatory considerations for the return of individual research results. As part of a larger project supported by the National Human Genome Research Institute, National Institutes of Health, we prepared and distributed to 31 global legal experts a questionnaire intended to ascertain opinions and perspectives on the way international DTP genomic research is likely to be regulated. We found significant disagreement across jurisdictions on the most favorable approach to managing such results, with some countries favoring return by default and others preferring to return only with the express consent of research participants. We conclude by outlining policy considerations that should guide researcher practices in this context. As international DTP genomic research evolves, jurists and ethicists should be attentive to the ways novel approaches to subject recruitment align with existing ethical and regulatory norms in research with human participants. This paper is a preliminary step toward documenting such alignment in the context of the return of individual research results.

Social Media Use for Research Participant Recruitment: Integrative Literature Review

BACKGROUND

Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research.

OBJECTIVE

This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method.

METHODS

An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format.

RESULTS

A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment.

CONCLUSIONS

This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area.

Recruiting an underserved, difficult to reach population into a cancer trial: Strategies from the Restore-2 Rehabilitation Trial for gay and bisexual prostate cancer patients

BACKGROUND/AIMS

Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a "hidden population," the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published.

METHODS

In 2019, we conducted a naturalistic, three-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population.

RESULTS

There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in dropout during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6 months into the trial.

CONCLUSION

For sexual minority cancer research, more research on how to use sexual orientation and gender identity electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.

Utilizing Social Media Advertisements and Participant Social Networks to Recruit African American Breast Cancer Survivors: Design and Rationale

Purpose

Our objective is to pilot an advertisement-driven sampling procedure among African American (AA) breast cancer survivors living in Maryland. These pilot study methods will inform a future population-based study of AA breast cancer survivors at high risk of poor outcomes due to biological differences and social inequities.

Methods

This cross-sectional study utilizes an innovative, social media-based advertisement campaign with an associated social media study page to recruit 100 AA breast cancer survivors. Participants are biologically female, aged 18 and older, identify as AA/Black, have a diagnosis of breast cancer, and reside in Maryland. A preset "Audience" was created via Meta (formerly Facebook) to automatically target potential interest in the online study via geolocation and public social media interests (estimated range = 101,000 women). Eligible participants complete an online survey including demographic and clinical characteristics, cancer screening, healthcare access, and utilization, COVID-19 impact, quality of doctor-patient communication, and preferences for future study participation.

Results

Recruitment began on 5 January 2022 and remains ongoing. As of 7 June 2002: 124 completed the screener, 110/124 (88.7%) consented passively, 24/110 (21.8%) started but did not complete survey, 86/110 (78.1%) completed the survey.

Conclusions

Results from this study will inform a statewide multilevel prospective population-based study to improve health behaviors, disease management, and self-efficacy of chronic disease management among AA breast cancer survivors.

Targeting Mitochondrial OXPHOS and Their Regulatory Signals in Prostate Cancers

Increasing evidence suggests that tumor development requires not only oncogene/tumor suppressor mutations to drive the growth, survival, and metastasis but also metabolic adaptations to meet the increasing energy demand for rapid cellular expansion and to cope with the often nutritional and oxygen-deprived microenvironment. One well-recognized strategy is to shift the metabolic flow from oxidative phosphorylation (OXPHOS) or respiration in mitochondria to glycolysis or fermentation in cytosol, known as Warburg effects. However, not all cancer cells follow this paradigm. In the development of prostate cancer, OXPHOS actually increases as compared to normal prostate tissue. This is because normal prostate epithelial cells divert citrate in mitochondria for the TCA cycle to the cytosol for secretion into seminal fluid. The sustained level of OXPHOS in primary tumors persists in progression to an advanced stage. As such, targeting OXPHOS and mitochondrial activities in general present therapeutic opportunities. In this review, we summarize the recent findings of the key regulators of the OXPHOS pathway in prostate cancer, ranging from transcriptional regulation, metabolic regulation to genetic regulation. Moreover, we provided a comprehensive update of the current status of OXPHOS inhibitors for prostate cancer therapy. A challenge of developing OXPHOS inhibitors is to selectively target cancer mitochondria and spare normal counterparts, which is also discussed.

A/B design testing of a clinical trial recruitment website: A pilot study to enhance the enrollment of older adults

INTRODUCTION

Online tools are increasingly utilized in clinical trial recruitment. A/B testing is an effective technology used in political campaigns and commercial marketing to improve contributions or sales. However, to our knowledge, A/B has not been described in the context of clinical trial recruitment.

METHODS

Two A/B testing experiments were implemented on the recruitment website of the Study To Understand Fall Reduction and Vitamin D in You (STURDY), a response-adaptive, two-stage, randomized controlled trial. Commercial A/B platforms randomized web-users to different versions of the trial's website landing page; Experiment 1 included two infographic versions and Experiment 2 included three video versions. We compared web-user engagement metrics between each version and the original landing page. We determined the effect of each version compared to the original landing page on the likelihood of a web-user to (1) request more information about the trial, (2) complete a screening visit, or (3) enroll in the trial.

RESULTS

A total of 2605 and 374 web-users visited the trial's website during Experiment 1 and 2, respectively. Response to the online interest form significantly differed by infographic version in Experiment 1. The number of individuals who engaged with website content and pages significantly differed by video in Experiment 2.

CONCLUSION

In a pilot study implementing A/B testing of a clinical trial recruitment website, different versions of the website led to differences in web-user engagement and interest in the trial. A/B testing tools offer a promising approach to test the effectiveness of clinical trial recruitment materials and to optimize recruitment campaigns.

CLINICAL TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov. The trial registration number is NCT02166333. The URL is: https://clinicaltrials.gov/ct2/show/NCT02166333 Trial Registration Number: NCT02166333 Trial Register: ClinicalTrials.gov.

Effects of Behavioral Weight Loss and Metformin on IGFs in Cancer Survivors: A Randomized Trial

CONTEXT

Higher levels of insulin-like growth factor-1 (IGF-1) are associated with increased risk of cancers and higher mortality. Therapies that reduce IGF-1 have considerable appeal as means to prevent recurrence.

DESIGN

Randomized, 3-parallel-arm controlled clinical trial.

INTERVENTIONS AND OUTCOMES

Cancer survivors with overweight or obesity were randomized to (1) self-directed weight loss (comparison), (2) coach-directed weight loss, or (3) metformin treatment. Main outcomes were changes in IGF-1 and IGF-1:IGFBP3 molar ratio at 6 months. The trial duration was 12 months.

RESULTS

Of the 121 randomized participants, 79% were women, 46% were African Americans, and the mean age was 60 years. At baseline, the average body mass index was 35 kg/m2; mean IGF-1 was 72.9 (SD, 21.7) ng/mL; and mean IGF1:IGFBP3 molar ratio was 0.17 (SD, 0.05). At 6 months, weight changes were -1.0% (P = 0.07), -4.2% (P < 0.0001), and -2.8% (P < 0.0001) in self-directed, coach-directed, and metformin groups, respectively. Compared with the self-directed group, participants in metformin had significant decreases on IGF-1 (mean difference in change: -5.50 ng/mL, P = 0.02) and IGF1:IGFBP3 molar ratio (mean difference in change: -0.0119, P = 0.011) at 3 months. The significant decrease of IGF-1 remained in participants with obesity at 6 months (mean difference in change: -7.2 ng/mL; 95% CI: -13.3 to -1.1), but not in participants with overweight (P for interaction = 0.045). There were no significant differences in changes between the coach-directed and self-directed groups. There were no differences in outcomes at 12 months.

CONCLUSIONS

In cancer survivors with obesity, metformin may have a short-term effect on IGF-1 reduction that wanes over time.

A comparison of two mail-based strategies to recruit older cancer survivors into a randomized controlled trial of a lifestyle intervention

Purpose

To compare response rates to business letter versus greeting card invitations used to recruit older cancer survivors to a randomized controlled clinical trial of a lifestyle intervention

Methods

Capitalizing upon recruitment efforts for a lifestyle intervention trial among older cancer survivors, we explored response rates to study invitations formatted as greeting cards versus standard business letters. Survivors were identified from cancer registries and medical records and randomly assigned with strata defined by gender and racial/ethnicity to one-of-the-two invitations. Both groups received telephone follow-up.

Results

Contact was verified among 708 survivors with an average age of 72 years with most being non-Hispanic White (NHW), urban dwelling, and female. Survivors assigned to the business letter (n = 360) as compared to the greeting card (n = 348) were significantly more likely to express interest in participation (OR 1.73, 95% CI 1.11–2.70). With the exception of racial/ethnic minorities (OR 0.73; 95% CI 0.26–2.11), all other subgroups favored the business letter with significance observed in females (OR 1.66, 95% CI 1.00–2.74), NHWs (OR 2.12; 95% CI 1.29–3.49), and rural dwellers (OR 3.61; 95% CI 1.49–8.76). Moreover, the business letter costs were substantially lower than the card.

Conclusion

Clinical trial recruitment is significantly more effective if solicitations are formatted as standard business letters as compared to greeting cards, though this may not generalize to racial/ethnic minorities where more research is warranted.

Implications for Cancer Survivors

These study findings are not only valuable to researchers but also have the potential to improve recruitment and engagement of older cancer survivors in clinical trials.

Clinical Trial Registration

Harvest for Health for in Older Cancer Survivors, ClinicalTrials.gov Identifier: NCT02985411

Effects of a Behavioral Weight Loss Intervention and Metformin Treatment on Serum Urate: Results from a Randomized Clinical Trial

Background: Lower body mass index (BMI) has been associated with lower serum urate (SU), but only in observational studies. We sought to determine the effects of behavioral weight loss and metformin treatment on SU in a randomized trial. Methods and Findings: The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a parallel three-arm randomized controlled trial of overweight/obese adult cancer survivors without gout at a single center in Maryland, United States. Participants were randomized to: (1) coach-directed weight loss (behavioral telephonic coaching), (2) metformin (up to 2000 mg daily), or (3) self-directed weight loss (informational brochures; reference group). SU and BMI were assessed at baseline and at 3, 6, and 12 months post-randomization. The 121 participants had a mean ± standard deviation (SD) age of 60 ± 9 years, 79% were female, and 45% were Black. At baseline, BMI was 35 ± 5 kg/m², and SU was 5.6 ± 1.3 mg/dL. Compared to the self-directed group, at 12 months, the coach-directed group reduced BMI by 0.9 kg/m² (95% confidence interval (CI): -1.5, -0.4) and metformin reduced BMI by 0.6 kg/m² (95% CI: -1.1, -0.1). However, compared to the self-directed group, the coach-directed group unexpectedly increased SU by 0.3 mg/dL (95% CI: 0.05, 0.6), and metformin non-significantly increased SU by 0.2 mg/dL (95% CI: -0.04, 0.5); these effects were attenuated when analyses included change in estimated glomerular filtration rate (eGFR). Conclusions: In this randomized trial of cancer survivors without gout, reductions in BMI either increased or did not change SU, potentially due to effects on eGFR. These results do not support a focus on BMI reduction for SU reduction; however, long-term studies are needed. ClinicalTrials.gov Registration: NCT02431676.

Efficacy and Cost-effectiveness of Promotion Methods to Recruit Participants to an Online Screening Registry for Alzheimer Disease Prevention Trials: Observational Study

Background

Web-based screening may be suitable for identifying individuals with presymptomatic latent diseases for recruitment to clinical studies, as such people do not often visit hospitals in the presymptomatic stage. The promotion of such online screening studies is critical to their success, although it remains uncertain how the effectiveness of such promotion can differ, depending on the different promotion methods, domains of interest, or countries of implementation.

Objective

The Japanese Trial-Ready Cohort (J-TRC) web study is our ongoing online screening registry to identify individuals with presymptomatic Alzheimer disease (AD), aimed at facilitating the clinical trials for AD prevention. Within the first 9 months of its 2019 launch, the J-TRC web study recruited thousands of online participants via multiple methods of promotion, including press releases, newspaper advertisements, web advertisements, or direct email invitations. Here, we aimed to quantitatively evaluate efficacy and cost-effectiveness of each of these multimodal promotion methods.

Methods

We applied the vector-autoregression model to assess the degree of contribution of each type of promotion to the following target metrics: number of daily visitors to the J-TRC website, number of daily registrants to the J-TRC web study, daily rate of registration among visitors, daily rate of eligible participants among registrants, and median age of daily registrants. The average cost-effectiveness for each promotion method was also calculated using the total cost and the coefficients in the vector-autoregression model.

Results

During the first 9 months of the reviewed period from October 31, 2019 to June 17, 2020, there were 48,334 website visitors and 4429 registrations (9.16% of 48,334 visitors), of which 3081 (69.56%) were eligible registrations. Initial press release reports and newspaper advertisements had a marked effect on increasing the number of daily visitors and daily registrants. Web advertisements significantly contributed to the increase in daily visitors (P<.001) but not to the daily registrants, and it also lowered the rate of registrations and the median age of daily registrants. Website visitors from the direct email invitation sent to other cognitive registries seem to have registered with the highest reliability. The calculated average cost-effectiveness for the initial press release was US $24.60 per visitor and US $96.10 per registrant, while the calculated average cost-effectiveness for the newspaper advertisements was US $28.60 per visitor and US $227.90 per registrant.

Conclusions

Our multivariate time-series analysis showed that each promotion method had different features in their effect of recruiting participants to the J-TRC web study. Under the advertisement condition settings thus far, newspaper advertisements and initial press releases were the most effective promotion methods, with fair cost-effectiveness that was equivalent to earlier online studies. These results can provide important suggestions for future promotions for the recruitment of presymptomatic participants to AD clinical trials in Japan.

Metformin Affects Gut Microbiome Composition and Function and Circulating Short-Chain Fatty Acids: A Randomized Trial

OBJECTIVE

To determine the longer-term effects of metformin treatment and behavioral weight loss on gut microbiota and short-chain fatty acids (SCFAs).

RESEARCH DESIGN AND METHODS

We conducted a 3-parallel-arm, randomized trial. We enrolled overweight/obese adults who had been treated for solid tumors but had no ongoing cancer treatment and randomized them (n = 121) to either 1) metformin (up to 2,000 mg), 2) coach-directed behavioral weight loss, or 3) self-directed care (control) for 12 months. We collected stool and serum at baseline (n = 114), 6 months (n = 109), and 12 months (n = 105). From stool, we extracted microbial DNA and conducted amplicon and metagenomic sequencing. We measured SCFAs and other biochemical parameters from fasting serum.

RESULTS

Of the 121 participants, 79% were female and 46% were Black, and the mean age was 60 years. Only metformin treatment significantly altered microbiota composition. Compared with control, metformin treatment increased amplicon sequence variants for Escherichia (confirmed as Escherichia coli by metagenomic sequencing) and Ruminococcus torques and decreased Intestinibacter bartlettii at both 6 and 12 months and decreased the genus Roseburia, including R. faecis and R. intestinalis, at 12 months. Effects were similar in comparison of the metformin group with the behavioral weight loss group. Metformin versus control also increased butyrate, acetate, and valerate at 6 months (but not at 12 months). Behavioral weight loss versus control did not significantly alter microbiota composition but did increase acetate at 6 months (but not at 12 months). Increases in acetate were associated with decreases in fasting insulin. Additional whole-genome metagenomic sequencing of a subset of the metformin group showed that metformin altered 62 metagenomic functional pathways, including an acetate-producing pathway and three pathways in glucose metabolism.

CONCLUSIONS

Metformin, but not behavioral weight loss, impacted gut microbiota composition at 6 months and 12 months. Both metformin and behavioral weight loss altered circulating SCFAs at 6 months, including increasing acetate, which correlated with lower fasting insulin. Future research is needed to elucidate whether the gut microboime mediates or modifies metformin's health effects.

Prevalence and risk factors for acute posttraumatic stress disorder during the COVID-19 outbreak

BACKGROUND

To examine the prevalence of and risk factors for acute posttraumatic stress disorder (PTSD) shortly after the massive outbreak of COVID-19 in China.

METHODS

An online anonymous survey was conducted between 30 January and 3 February, 2020. The survey included two self-administered questionnaires: one collected personal information (gender, age, education background), current location, recent epidemic area contact history, the classification of population, and subjective sleep quality; the other was the PTSD Checklist for DSM-5 (PCL-5).

RESULTS

A total of 2091 Chinese participated in the current study. The prevalence of PTSD among the Chinese public one month after the COVID-19 outbreak was 4.6%. Multiple linear regression analysis revealed that gender (p < 0.001), epidemic area contact history (p = 0.047), classification of population (p < 0.001), and subjective sleep quality (p < 0.001) could be regarded as predictors for PTSD.

LIMITATIONS

First, the majority of participants in this study were the general public, with confirmed or suspected patients being a small part. Second, the measurement of PTSD in this study might be vulnerable to selection bias because of an online self-report study, such as participants' recruitment. Third, the prevalence of PTSD in this study was estimated by an online questionnaire rather than a clinical interview.

CONCLUSIONS

The results suggested that some Chinese showed acute PTSD during the COVID-19 outbreak. Therefore, comprehensive psychological intervention needs further implementation. Furthermore, females, people who had recent epidemic area contact history, those at high risk of infection or with poor sleep quality deserve special attention.

"Include me if you can"-reasons for low enrollment of pediatric patients in a psychopharmacological trial

BACKGROUND

Low recruitment in clinical trials is a common and costly problem which undermines medical research. This study aimed to investigate the challenges faced in recruiting children and adolescents with obsessive-compulsive disorder and autism spectrum disorder for a randomized, double-blind, placebo-controlled clinical trial and to analyze reasons for non-participation. The trial was part of the EU FP7 project TACTICS (Translational Adolescent and Childhood Therapeutic Interventions in Compulsive Syndromes).

METHODS

Demographic data on pre-screening patients were collected systematically, including documented reasons for non-participation. Findings were grouped according to content, and descriptive statistical analyses of the data were performed.

RESULTS

In total, n = 173 patients were pre-screened for potential participation in the clinical trial. Of these, only five (2.9%) were eventually enrolled. The main reasons for non-inclusion were as follows: failure to meet all inclusion criteria/meeting one or more of the exclusion criteria (n = 73; 42.2%), no interest in the trial or trials in general (n = 40; 23.1%), and not wanting changes to current therapy/medication (n = 14; 8.1%).

CONCLUSIONS

The findings from this study add valuable information to the existing knowledge on reasons for low clinical trial recruitment rates in pediatric psychiatric populations. Low enrollment and high exclusion rates raise the question of whether such selective study populations are representative of clinical patient cohorts. Consequently, the generalizability of the results of such trials may be limited. The present findings will be useful in the development of improved recruitment strategies and may guide future research in establishing the measurement of representativeness to ensure enhanced external validity in psychopharmacological clinical trials in pediatric populations.

TRIAL REGISTRATION

EudraCT 2014-003080-38 . Registered on 14 July 2014.

Electronic medical record-based cohort selection and direct-to-patient, targeted recruitment: early efficacy and lessons learned

OBJECTIVE

The study sought to characterize institution-wide participation in secure messaging (SM) at a large academic health network, describe our experience with electronic medical record (EMR)-based cohort selection, and discuss the potential roles of SM for research recruitment.

MATERIALS AND METHODS

Study teams defined eligibility criteria to create a computable phenotype, structured EMR data, to identify and recruit participants. Patients with SM accounts matching this phenotype received recruitment messages. We compared demographic characteristics across SM users and the overall health system. We also tabulated SM activation and use, characteristics of individual studies, and efficacy of the recruitment methods.

RESULTS

Of the 1 308 820 patients in the health network, 40% had active SM accounts. SM users had a greater proportion of white and non-Hispanic patients than nonactive SM users id. Among the studies included (n = 13), 77% recruited participants with a specific disease or condition. All studies used demographic criteria for their phenotype, while 46% (n = 6) used demographic, disease, and healthcare utilization criteria. The average SM response rate was 2.9%, with higher rates among condition-specific (3.4%) vs general health (1.4%) studies. Those studies with a more inclusive comprehensive phenotype had a higher response rate.

DISCUSSION

Target population and EMR queries (computable phenotypes) affect recruitment efficacy and should be considered when designing an EMR-based recruitment strategy.

CONCLUSIONS

SM guided by EMR-based cohort selection is a promising approach to identify and enroll research participants. Efforts to increase the number of active SM users and response rate should be implemented to enhance the effectiveness of this recruitment strategy.

Effectiveness of social media (Facebook), targeted mailing, and in-person solicitation for the recruitment of young adult in a diabetes self-management clinical trial

BACKGROUND/AIMS

Research is needed to identify promising recruitment strategies to reach and engage diverse young adults in diabetes clinical research. The aim of this study was to examine the relative strengths and weaknesses of three recruitment strategies used in a diabetes self-management clinical trial: social media advertising (Facebook), targeted mailing, and in-person solicitation of clinic patients.

METHODS

Strategies were compared in terms of (1) cost-effectiveness (i.e. cost of recruitment/number of enrolled participants), (2) ability to yield participants who would not otherwise be reached by alternative strategies, and (3) likelihood of participants recruited through each strategy to adhere to study procedures. We further explored the appeal (overall and among age and gender subgroups) of social media advertisement features.

RESULTS

In-person recruitment of clinic patients was overall the most cost-effective strategy. However, differences in demographic, clinical, and psychosocial characteristics of participants recruited via different strategies suggest that the combination of these approaches yielded a more diverse sample than would any one strategy alone. Once successfully enrolled, there was no difference in study completion and intervention adherence between individuals recruited by the three recruitment strategies.

CONCLUSIONS

Ultimately, the utility of a recruitment strategy is defined by its ability to effectively attract people representative of the target population who are willing to enroll in and complete the study. Leveraging a variety of recruitment strategies appears to produce a more representative sample of young adults, including those who are less engaged in diabetes care.

Online Patient Recruitment in Clinical Trials: Systematic Review and Meta-Analysis

Background

Recruitment for clinical trials continues to be a challenge, as patient recruitment is the single biggest cause of trial delays. Around 80% of trials fail to meet the initial enrollment target and timeline, and these delays can result in lost revenue of as much as US $8 million per day for drug developing companies.

Objective

This study aimed to conduct a systematic review and meta-analysis examining the effectiveness of online recruitment of participants for clinical trials compared with traditional in-clinic/offline recruitment methods.

Methods

Data on recruitment rates (the average number of patients enrolled in the study per month and per day of active recruitment) and conversion rates (the percentage of participants screened who proceed to enroll into the clinical trial), as well as study characteristics and patient demographics were collected from the included studies. Differences in online and offline recruitment rates and conversion rates were examined using random effects models. Further, a nonparametric paired Wilcoxon test was used for additional analysis on the cost-effectiveness of online patient recruitment. All data analyses were conducted in R language, and P<.05 was considered significant.

Results

In total, 3861 articles were screened for inclusion. Of these, 61 studies were included in the review, and 23 of these were further included in the meta-analysis. We found online recruitment to be significantly more effective with respect to the recruitment rate for active days of recruitment, where 100% (7/7) of the studies included had a better online recruitment rate compared with offline recruitment (incidence rate ratio [IRR] 4.17, P=.04). When examining the entire recruitment period in months we found that 52% (12/23) of the studies had a better online recruitment rate compared with the offline recruitment rate (IRR 1.11, P=.71). For cost-effectiveness, we found that online recruitment had a significantly lower cost per enrollee compared with offline recruitment (US $72 vs US $199, P=.04). Finally, we found that 69% (9/13) of studies had significantly better offline conversion rates compared with online conversion rates (risk ratio 0.8, P=.02).

Conclusions

Targeting potential participants using online remedies is an effective approach for patient recruitment for clinical research. Online recruitment was both superior in regard to time efficiency and cost-effectiveness compared with offline recruitment. In contrast, offline recruitment outperformed online recruitment with respect to conversion rate.

The Role of Social Media in Enhancing Clinical Trial Recruitment: Scoping Review

BACKGROUND

Recruiting participants into clinical trials continues to be a challenge, which can result in study delay or termination. Recent studies have used social media to enhance recruitment outcomes. An assessment of the literature on the use of social media for this purpose is required.

OBJECTIVE

This study aims to answer the following questions: (1) How is the use of social media, in combination with traditional approaches to enhance clinical trial recruitment and enrollment, represented in the literature? and (2) Do the data on recruitment and enrollment outcomes presented in the literature allow for comparison across studies?

METHODS

We conducted a comprehensive literature search across 7 platforms to identify clinical trials that combined social media and traditional methods to recruit patients. Study and participant characteristics, recruitment methods, and recruitment outcomes were evaluated and compared.

RESULTS

We identified 2371 titles and abstracts through our systematic search. Of these, we assessed 95 full papers and determined that 33 studies met the inclusion criteria. A total of 17 studies reported enrollment outcomes, of which 9 achieved or exceeded their enrollment target. The proportion of participants enrolled from social media in these studies ranged from 0% to 49%. Across all 33 studies, the proportion of participants recruited and enrolled from social media varied greatly. A total of 9 studies reported higher enrollment rates from social media than any other methods, and 4 studies reported the lowest cost per enrolled participant from social media.

CONCLUSIONS

While the assessment of the use of social media to improve clinical trial participation is hindered by reporting inconsistencies, preliminary data suggest that social media can increase participation and reduce per-participant cost. The adoption of consistent standards for reporting recruitment and enrollment outcomes is required to advance our understanding and use of social media to support clinical trial success.

Use of electronic recruitment methods in a clinical trial of adults with gout

BACKGROUND/AIMS

Electronic-based recruitment methods are increasingly utilized in clinical trials to recruit and enroll research participants. The cost-effectiveness of electronic-based methods and impact on sample generalizability is unknown. We compared recruitment yields, cost-effectiveness, and demographic characteristics across several electronic and traditional recruitment methods.

METHODS

We analyzed data from the diet gout trial recruitment campaign. The diet gout trial was a randomized, controlled, cross-over trial that examined the effects of a dietary approaches to stop hypertension (DASH)-like diet on uric acid levels in adults with gout. We used four electronic medical record and four non-electronic medical record-based recruitment methods to identify and recruit potentially eligible participants. We calculated the response rate, screening visit completion rate, and randomization rate for each method. We also determined cost per response, the screening, and randomization for each method. Finally, we compared the demographic characteristics among individuals who completed the screening visit by recruitment method.

RESULTS

Of the 294 adults who responded to the recruitment campaign, 51% were identified from electronic medical record-based methods. Patient portal messaging, an electronic medical record-based method, resulted in the highest response rate (4%), screening visit completion rate (37%), and randomization rate (21%) among these eight methods. Electronic medical record-based methods ($60) were more cost-effective per response than non-electronic medical record-based methods ($107). Electronic-based methods, including patient portal messaging and Facebook, had the highest proportion of White individuals screened (52% and 60%). Direct mail to non-active patient portal increased enrollment of traditionally under-represented groups, including both women and African Americans.

CONCLUSION

An electronic medical record-based recruitment strategy that utilized the electronic medical record for participant identification and postal mailing for participant outreach was cost-effective and increased participation of under-represented groups. This hybrid strategy represents a promising approach to improve the timely execution and broad generalizability of future clinical trials.

Recruitment of Older Kidney Transplant Recipients to a Longitudinal Study

BACKGROUND

Currently, limited information is available regarding selection of the most successful strategies for recruitment of older adult kidney transplant recipients as research participants.

OBJECTIVE

The aim of this study was to explore multiple modes of recruitment strategies to enroll older kidney transplant recipients in a 1-year longitudinal study.

METHODS

We used a feasibility design to explore the following recruitment methods: face-to-face contact in the transplant clinic, paper flyers placed in the transplant clinic, Facebook, an online transplant newsletter, and a university website listing of research studies.

RESULTS

Enrollment was open for 9 months, during which time websites and the Facebook portal were active, 142 newsletters were e-mailed, and 424 patients were approached in the transplant clinic. Among patients approached in the clinic, 12 did not own a smartphone required for the study. The sample consisted of 60 participants (39 men, 21 women), with a mean age of 64.5 ± 4.7 years. Of the participants who enrolled in the study, the largest number (75%, n = 45) was recruited using the face-to-face method in the transplant clinic. The online transplant newsletter was the second-best recruitment source (18%, n = 11).

DISCUSSION

Recruitment strategies using face-to-face contact and the online newsletter associated with the transplant clinic organization appeared to be more effective than strategies not associated with the transplant clinic (Facebook and university website). Findings suggest that using a familiar organization communication method to recruit older chronic disease population may be the most beneficial.

Digital tools for the recruitment and retention of participants in randomised controlled trials: a systematic map

BACKGROUND

Recruiting and retaining participants in randomised controlled trials (RCTs) is challenging. Digital tools, such as social media, data mining, email or text-messaging, could improve recruitment or retention, but an overview of this research area is lacking. We aimed to systematically map the characteristics of digital recruitment and retention tools for RCTs, and the features of the comparative studies that have evaluated the effectiveness of these tools during the past 10 years.

METHODS

We searched Medline, Embase, other databases, the Internet, and relevant web sites in July 2018 to identify comparative studies of digital tools for recruiting and/or retaining participants in health RCTs. Two reviewers independently screened references against protocol-specified eligibility criteria. Included studies were coded by one reviewer with 20% checked by a second reviewer, using pre-defined keywords to describe characteristics of the studies, populations and digital tools evaluated.

RESULTS

We identified 9163 potentially relevant references, of which 104 articles reporting 105 comparative studies were included in the systematic map. The number of published studies on digital tools has doubled in the past decade, but most studies evaluated digital tools for recruitment rather than retention. The key health areas investigated were health promotion, cancers, circulatory system diseases and mental health. Few studies focussed on minority or under-served populations, and most studies were observational. The most frequently-studied digital tools were social media, Internet sites, email and tv/radio for recruitment; and email and text-messaging for retention. One quarter of the studies measured efficiency (cost per recruited or retained participant) but few studies have evaluated people's attitudes towards the use of digital tools.

CONCLUSIONS

This systematic map highlights a number of evidence gaps and may help stakeholders to identify and prioritise further research needs. In particular, there is a need for rigorous research on the efficiency of the digital tools and their impact on RCT participants and investigators, perhaps as studies-within-a-trial (SWAT) research. There is also a need for research into how digital tools may improve participant retention in RCTs which is currently underrepresented relative to recruitment research.

REGISTRATION

Not registered; based on a pre-specified protocol, peer-reviewed by the project's Advisory Board.

Google AdWords and Facebook Ads for Recruitment of Pregnant Women into a Prospective Cohort Study With Long-Term Follow-Up

Objectives Several types of epidemiologic studies suffer from decreasing participation rates, resulting in potential selection bias and delay or termination of studies. We aimed to determine the feasibility of online methods for recruitment of pregnant women into a prospective cohort study. Methods In addition to traditional recruitment through prenatal care providers, we advertized participation in the PRegnancy and Infant DEvelopment (PRIDE) Study, an ongoing prospective cohort study with long-term follow-up in The Netherlands enrolling women in early pregnancy, through Google AdWords (30 days) and Facebook Ads (31 and 27 days) campaigns between September 2016 and January 2017. We calculated costs per eligible participant and compared demographics, health-related characteristics, and follow-up rates between participants recruited through online methods and prenatal care providers. Results During the study period, we recruited six women through AdWords (€54.28 per participant), 59 through Facebook (€10.17 per participant), and 327 through prenatal care providers (no valid cost estimate available). Facebook participants seemed to be younger (29.0 vs. 30.7 years), to have a higher body mass-index and/or low/intermediate education (27.0 vs. 24.0 kg/m² and 41 vs. 25%, respectively), and to start prenatal care in secondary care more often (12 vs. 5%) than participants recruited through prenatal care providers. Item non-response and loss to follow-up rates were higher among women recruited online than among those recruited through prenatal care providers. Conclusion Google AdWords did not contribute substantially, but Facebook Ads may complement traditional recruitment methods of pregnant women into prospective cohort studies, despite challenges that may threaten internal validity.

The accuracy of self-reported blood pressure in the Medication adherence Improvement Support App For Engagement-Blood Pressure (MedISAFE-BP) trial: Implications for pragmatic trials

Self-report of health conditions and behaviors is one potential strategy to increase the pace of enrollment into pragmatic clinical trials. In this study, we assessed the accuracy of self-reported poorly controlled hypertension among adults in the community who were screened for participation in the MedISAFE-BP trial. Of individuals who self-reported poorly controlled hypertension using the online trial enrollment platform, 64% had a systolic blood pressure less than 140 mm Hg when measured at home. Although we identified several characteristics associated with accurate self-report including older age (odds ratio [OR] 1.02 per year, 95% CI 1.01-1.03), diabetes (OR 1.59, 95% CI 1.17-2.14), and low health activation (OR 1.56 95% CI 1.17-2.07), we were unable to identify patients for whom self-reported hypertension would be a reliable method for their inclusion in a pragmatic trial.

Cost and Effectiveness of Using Facebook Advertising to Recruit Young Women for Research: PREFER (Contraceptive Preferences Study) Experience

BACKGROUND

Social media is a popular and convenient method for communicating on the Web. The most commonly used social networking website, Facebook, is increasingly being used as a tool for recruiting research participants because of its large user base and its ability to target advertisements on the basis of Facebook users' information.

OBJECTIVE

We evaluated the cost and effectiveness of using Facebook to recruit young women into a Web-based intervention study (PREFER). The PREFER study aimed to determine whether an educational video could increase preference for and uptake of long-acting reversible contraception (LARC).

METHODS

We placed an advertisement on Facebook over a 19-day period from December 2017 to January 2018, inviting 16- to 25-year-old women from Australia to participate in a Web-based study about contraception. Those who clicked on the advertisement were directed to project information, and their eligibility was determined by using a screening survey.

RESULTS

Our Facebook advertisement delivered 130,129 impressions, resulting in over 2000 clicks at an overall cost of Aus $918 (Aus $0.44 per click). Web-based project information was accessed by 493 women. Of these, 462 women completed the screening survey, and 437 (437/463, 95%) women were eligible. A total of 322 young women participated in Surveys 1 and 2 (74% response rate), and 284 women participated in Survey 3 (88% retention rate), with an advertising cost of Aus $2.85 per consenting participant.

CONCLUSIONS

Facebook proved to be a quick, effective, and cost-efficient tool for recruiting young Australian women into a study that was investigating contraceptive preferences. However, Web-based recruitment may result in sociodemographic biases. Further research is required to evaluate whether Facebook is suitable for recruiting older study populations.

Integrative Review of Recruitment of Research Participants Through Facebook

BACKGROUND

Facebook (FB) has been widely used recently to recruit participants for adult health research. However, little is known about its effectiveness, cost, and the characteristics of participants recruited via FB when compared to other recruitment methods.

OBJECTIVES

The purpose of this integrative review was to examine the published evidence concerning the use of FB in participant recruitment for adult health research, as compared to other social media, online, and traditional recruitment methods.

METHODS

In this integrative review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, SCOPUS, and Web of Science were the electronic databases used to identify the published articles. In regard to language, the search was limited.

RESULTS

The efficacy and cost-effectiveness of using FB for recruitment in healthcare research as compared to more traditional forms of recruitment remain unclear. Reporting of recruitment strategies is inconsistent, and costs are often not included. FB is being used for recruitment frequently with other methods and, although often effective, can be costly.

DISCUSSION

FB is used to recruit participants for a variety of studies, with researchers using both free and paid ads to reach potential participants. Reporting of recruitment methods needs to be more rigorous, streamlined, and standardized in scientific papers.

Advancing the Science of Recruitment for Family Caregivers: Focus Group and Delphi Methods

Background

Successful recruitment of participants is imperative to a rigorous study, and recruitment challenges are not new to researchers. Many researchers have used social media successfully to recruit study participants. However, challenges remain for effective online social media recruitment for some populations.

Objective

Using a multistep approach that included a focus group and Delphi method, researchers performed this study to gain expert advice regarding material development for social media recruitment and to test the recruitment material with the target population.

Methods

In the first phase, we conducted a focus group with 5 social media experts to identify critical elements for effective social media recruitment material. Utilizing the Delphi method with 5 family caregivers, we conducted the second phase to reach consensus regarding effective recruitment videos.

Results

Phase I utilized a focus group that resulted in identification of three barriers related to social media recruitment, including lack of staff and resources, issues with restrictive algorithms, and not standing out in the crowd. Phase II used the Delphi method. At the completion of Delphi Round 1, 5 Delphi participants received a summary of the analysis for feedback and agreement with our summary. Using data and recommendations from Round 1, researchers created two new recruitment videos with additions to improve trustworthiness and transparency, such as the university's logo. In Round 2 of the Delphi method, consensus regarding the quality and trustworthiness of the recruitment videos reached 100%.

Conclusions

One of the primary challenges for family caregiver research is recruitment. Despite the broad adoption of social media marketing approaches, the effectiveness of online recruitment strategies needs further investigation.

Early Check: translational science at the intersection of public health and newborn screening

Background

Newborn screening (NBS) occupies a unique space at the intersection of translational science and public health. As the only truly population-based public health program in the United States, NBS offers the promise of making the successes of translational medicine available to every infant with a rare disorder that is difficult to diagnose clinically, but for which strong evidence indicates that presymptomatic treatment will substantially improve outcomes. Realistic NBS policy requires data, but rare disorders face a special challenge: Screening cannot be done without supportive data, but adequate data cannot be collected in the absence of large-scale screening. The magnitude and scale of research to provide this expanse of data require working with public health programs, but most do not have the resources or mandate to conduct research.

Methods

To address this gap, we have established Early Check, a research program in partnership with a state NBS program. Early Check provides the infrastructure needed to identify conditions for which there have been significant advances in treatment potential, but require a large-scale, population-based study to test benefits and risks, demonstrate feasibility, and inform NBS policy.

Discussion

Our goal is to prove the benefits of a program that can, when compared with current models, accelerate understanding of diseases and treatments, reduce the time needed to consider inclusion of appropriate conditions in the standard NBS panel, and accelerate future research on new NBS conditions, including clinical trials for investigational interventions.

Trial registration

Clinicaltrials.gov registration #NCT03655223. Registered on August 31, 2018.

How different online recruitment methods impact on recruitment rates for the web-based coortesnaweb project: a randomised trial

Background

The number of web-based E-epidemiologic studies using online recruitment methods is increasing. However, the optimal online recruitment method in terms of maximizing recruitment rates is still unknown. Our aim was to compare the recruitment rates of three online recruitment methods and to describe how these rates differ according to individual’s socioeconomic and demographic factors.

Methods

A total of 2394 members of the 1993 Pelotas birth cohort that provided an e-mail address, a Facebook name, and a WhatsApp number during a face-to-face follow-up were randomly allocated to be recruited by e-mail, Facebook or WhatsApp (798 individuals per method). This was a parallel randomised trial applying a block randomisation (block size = 3). Between January and February 2018, we sent messages inviting them to register into the web-based coortesnaweb platform. Recruitment rates were calculated for each method, and stratified according to the individual’s socioeconomic and demographic characteristics. We also analysed absolute and relative inequalities on recruitment according to schooling and socioeconomic position.

Results

Out of the 2394 individuals analysed, 642 registered into the platform. The overall recruitment rate was 26.8%. Recruitment rates for women were almost 10 percentage points higher compared to men. Facebook was the most effective recruitment method, as 30.6% of those invited through the social network were recruited. Recruitment rates of e-mail and WhatsApp were similar (recruitment rate = 24.9%). E-mail and Facebook were the most effective recruitment methods to invite highly educated and wealthier individuals. However, sending e-mails to recruit individuals also reflected in the highest inequalities according to schooling and socioeconomic position. In contrast, the lowest inequalities according to socioeconomic position were observed using Facebook.

Conclusions

Facebook was the most effective online recruitment method, also achieving the most equitable sample in terms of schooling and socioeconomic position. The effectiveness of online recruitment methods depends on the characteristics of the sample. It is important to know the profile of the target sample in order to decide which online recruitment method to use.

Trial registration

Brazilian Registry of Clinical Trials, identifier: RBR-3dv7gc, retrospectively registered in 10 April 2018.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0767-z) contains supplementary material, which is available to authorized users.

Recruitment of men to a multi-centre diabetes prevention trial: an evaluation of traditional and online promotional strategies

Background

Effective interventions are required to prevent the current rapid increase in the prevalence of Type 2 diabetes. Clinical trials of large-scale interventions to prevent Type 2 diabetes are essential but recruitment is challenging and expensive, and there are limited data regarding the most cost-effective and efficient approaches to recruitment. This paper aims to evaluate the cost and effectiveness of a range of promotional strategies used to recruit men to a large Type 2 diabetes prevention trial.

Methods

An observational study was conducted nested within the Testosterone for the Prevention of Type 2 Diabetes (T4DM) study, a large, multi-centre randomised controlled trial (RCT) of testosterone treatment for the prevention of Type 2 diabetes in men aged 50–74 years at high risk of developing diabetes. Study participation was promoted via mainstream media—television, newspaper and radio; direct marketing using mass mail-outs, publicly displayed posters and attendance at local events; digital platforms, including Facebook and Google; and online promotions by community organisations and businesses. For each strategy, the resulting number of participants and the direct cost involved were recorded. The staff effort required for each strategy was estimated based on feedback from staff.

Results

Of 19,022 men screened for the study, 1007 (5%) were enrolled. The most effective recruitment strategies were targeted radio advertising (accounting for 42% of participants), television news coverage (20%) and mass mail-outs (17%). Other strategies, including radio news, publicly displayed posters, attendance at local events, newspaper advertising, online promotions and Google and Facebook advertising, each accounted for no more than 4% of enrolled participants. Recruitment promotions cost an average of AU$594 per randomised participant. The most cost-effective paid strategy was mass mail-outs by a government health agency (AU$745 per participant). Other paid strategies were more expensive: mail-out by general practitioners (GPs) (AU$1104 per participant), radio advertising (AU$1081) and newspaper advertising (AU$1941).

Conclusion

Radio advertising, television news coverage and mass mail-outs by a government health agency were the most effective recruitment strategies. Close monitoring of recruitment outcomes and ongoing enhancement of recruitment activities played a central role in recruitment to this RCT.

Trial registration

ANZCTR, ID: ACTRN12612000287831. Registered on 12 March 2012.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3485-2) contains supplementary material, which is available to authorized users.

Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care

Background

E-mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care.

Objective

This paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods.

Methods

Recruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required sample size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests.

Results

Between November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance.

Conclusions

Time, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.

Facebook advertising for recruitment of midlife women with bothersome vaginal symptoms: A pilot study

BACKGROUND

The MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network recruited into five randomized clinical trials (n = 100-350) through mass mailings. The fifth trial tested two interventions for postmenopausal vulvovaginal symptoms (itching, pain, irritation, dryness, or pain with sex) and thus required a high level of sensitivity to privacy concerns. For this trial, in addition to mass mailings we pilot tested a social media recruitment approach. We aimed to evaluate the feasibility of recruiting healthy midlife women with bothersome vulvovaginal symptoms to participate in the Vaginal Health Trial through Facebook advertising.

METHODS

As part of a larger advertising campaign that enrolled 302 postmenopausal women for the 12-week randomized, double-blind, placebo-controlled Vaginal Health Trial from April 2016 to February 2017, Facebook advertising was used to recruit 25 participants. The target population for recruitment by mailings and by Facebook ads included women aged 50-70 years and living within 20 miles of study sites in Minneapolis, MN and Seattle, WA. Design of recruitment letters and Facebook advertisements was informed by focus group feedback. Facebook ads were displayed in the "newsfeed" of targeted users and included a link to the study website. Response rates and costs are described for both online ads and mailing.

RESULTS

Facebook ads ran in Minneapolis for 28 days and in Seattle for 15 days, with ads posted and removed from the site as needed based on clinic flow and a set budget limit. Our estimated Facebook advertising reach was over 200,000 women; 461 women responded and 25 were enrolled at a cost of US$14,813. The response rate per estimated reach was 0.22%; costs were US$32 per response and US$593 per randomized participant. The social media recruitment results varied by site, showing greater effectiveness in Seattle than in Minneapolis. We mailed 277,000 recruitment letters; 2166 women responded and 277 were randomized at a cost of US$98,682. The response rate per letter sent was 0.78%; costs were US$46 per response and US$356 per randomized participant. Results varied little across sites.

CONCLUSION

Recruitment to a clinical trial testing interventions for postmenopausal vaginal symptoms is feasible through social media advertising. Variability in observed effectiveness and costs may reflect the small sample sizes and limited budget of the pilot recruitment study.

Facebook ads to the rescue? Recruiting a hard to reach population into an Internet-based behavioral health intervention trial

OBJECTIVE

Facebook (FB) ads are touted as a way to facilitate recruitment of hard to reach participants into digital health research but the evidence has been mixed. This study aimed to empirically evaluate the impact and cost-effectiveness of paid ads for recruitment into a national trial testing an Internet-based, coached intervention for parents of children with Fetal Alcohol Spectrum Disorders.

METHODS

Post hoc analysis of FB ad data and Google analytics on the online trial consent site (myStudies) were conducted on 11 campaigns employing static image/text ads. Standard metrics (e.g., click through rate, cost per 1000 impressions, cost per consent) were calculated and descriptive statistics comparing FB ad engagement and enrolled participants over time were conducted.

RESULTS

Ad campaigns were active for a combined 115 days over 58 weeks resulting in 1533 links to the online recruitment site. During the ad campaigns, the mean rate of enrolment was 1 participant every 2 days. The first 3 ad campaigns were the most cost-effective. Mean cost per enrolment was $19.27 (Canadian dollars).

CONCLUSIONS

FB ads were efficient and cost-effective in broad dissemination of trial information, but more research is needed to explore the impact of saturation (how often ads are posted), design (what is in the ad), and individual determinants (who is likely to respond to an ad) on converting FB ad engagement into enrolment. Avoiding a reductionist approach to analytics will help ensure appropriate and targeted strategies remain the priority for digital health research recruitment through social media.

Recruitment strategies in randomised controlled trials of men aged 50 years and older: a systematic review

OBJECTIVES

To identify and review evaluations of strategies to recruit men aged 50 years and over to randomised controlled trials (RCTs).

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and ORRCA databases were searched to 1 December 2017.

ELIGIBILITY CRITERIA

Studies using quantitative methods to evaluate recruitment strategies to RCTs of men aged 50 years and older.

DATA EXTRACTION AND SYNTHESIS

A single reviewer extracted data (for each strategy, number of participants approached, screened and randomised, and cost). Study quality was assessed using National Heart, Lung and Blood Institute Quality Assessment Tools and considered study design, description of interventions, description and measurement of outcomes, completeness of outcome reporting, performance of statistical testing and consideration of confounders. Recruitment strategies were categorised by the recruitment stage they addressed.

RESULTS

Sixteen studies (n >14 000) were included: one good quality, ten fair quality and five poor quality. Studies evaluated strategies to identify prospective participants, and to improve the processes for assessing participant eligibility, providing participant information and seeking consent. In good and fair quality studies, the most effective strategies for identifying participants were referral from an affiliated health service provider (two studies), mass mailing (five studies) and media coverage (two studies). Community outreach activities such as displaying posters and attending local community events were not effective (two studies). Trial-specific training of site recruitment staff, developed using qualitative analysis of recruitment visits (two studies), and provision of study information to prospective participants at a multidisciplinary, group information session (one study) both improved recruitment.

CONCLUSION

Improved engagement of men aged 50 years and older in RCTs is needed. A gender-sensitised approach to RCT recruitment may help to address this need. We have identified several promising recruitment strategies that merit further evaluation.

PROSPERO REGISTRATION NUMBER

CRD42017060301.

Online recruitment of a non-help-seeking sample for an internet intervention: Lessons learned in an alcohol-exposed pregnancy risk reduction study

BACKGROUND

Recruiting a hidden population, such as the population of women at risk for alcohol-exposed pregnancy (AEP) who binge drink and are at risk of an unintended pregnancy, is challenging as this population is not typically seeking help or part of an identifiable group. We sought to identify affordable and efficient methods of recruitment for hidden populations.

METHODS

Several popular online social media and advertising sites were identified. Cities with high rates of binge drinking among women were targeted. We placed advertisements and study notices using Facebook, Twitter, Craigslist, University postings, and ClinicalTrials.gov.

RESULTS

For this study, 75 women at risk for AEP were recruited from across the U.S. within 7 months. Online advertising for study participants on Craigslist resulted in enrollment of the majority 51 (68%) of the study participants. While Craigslist advertising could be tailored to specific locations with high rates of binge drinking among women, there were challenges to using Craigslist. These included automated deletion due to repeated postings and mention of sexual behavior or drinking, requiring increased efforts and resources by the study team. Several strategies were developed to optimize advertising on Craigslist. Approximately 100 h of staff time valued at $2500 was needed over the 7-month recruitment period.

DISCUSSION

Despite challenges, the target sample of women at risk for AEP was recruited in the 7 month recruitment period using online advertising methods. We recommend that researchers consider online classified advertisements when recruiting from non-help seeking populations. By taking advantage of national data to target specific risk factors, and by tailoring advertising efforts, it is possible to efficiently and affordably recruit a non-treatment seeking sample.