The Use of Social Media in Recruitment for Medical Research Studies: A Scoping Review

Efficient Online Recruitment of Patients With Depressive Symptoms Using Social Media: Cross-Sectional Observational Study

BACKGROUND

Over 80% of trials worldwide fail to complete patient recruitment within the initially planned time frame. Over the past decade, the use of social media for recruitment in medical research has become increasingly popular. While Google and Facebook are well established, newer social media channels such as Instagram and TikTok garner less research attention as recruitment tools. Although some studies have investigated the advantages and disadvantages of using social media for recruitment, a considerable gap still exists in understanding the precise mechanisms and factors that make different social media platforms most effective and cost-efficient for patient recruitment in mental health studies.

OBJECTIVE

This study evaluates the effectiveness of recruitment strategies implemented during the investigative phase of a validation study for a new suicidality assessment questionnaire optimized for primary care.

METHODS

We describe how online recruitment contributed to the enrollment of patients with depressive symptoms for the validation of a suicidality questionnaire (Suicide Prevention in Primary Care), which required over 500 participants. To this end, we analyzed differences in sample demographics between traditionally recruited and online participants, compared advertising metrics and conversion rates, and conducted a cost-benefit analysis.

RESULTS

We found online recruitment to be a fast and efficient method of securing the required number of participants with depressive symptoms for the study and increasing patient diversity. Considering the distribution of gender, age, and Patient Health Questionnaire-9 scores, participants recruited offline and online were equally eligible for the study. Online recruitment demonstrated high advertising efficiency. For example, the study population responded well to video advertisements on social media; these performed 50% to 70% more cost-efficiently than the best image advertisements. Moreover, a long website copy proved slightly better than a short version. Pixel tracking for improved advertisement targeting reduced advertising costs per suitable participant by 83.3%, making the advertisements 6 times more cost-efficient.

CONCLUSIONS

Social media recruitment increased the diversity of patients in the studies and proved suitable for vulnerable and hard-to-reach populations. The total cost per patient recruited online was comparable to that achieved using offline methods, but overall recruitment progressed faster. In this study, implementing video advertisements and pixel tracking resulted in significant cost savings.

Parent experiences with genetic testing for pediatric hearing loss

The purpose of the current study was to assess parent perceptions and experiences of genetic testing, as well as barriers for not undergoing testing in a sample of families of children with hearing loss. A 44-item questionnaire, The Parent Perception of Genetic Testing Questionnaire developed by the research study team was administered. Participants were recruited from a pediatric otolaryngology/audiology practice and social media. A total of 146 parents of children with hearing loss participated. Approximately 47.6% of the children in our sample underwent genetic testing, 44.8% did not, and 7.6% of parents were unsure. For those that did not undergo testing, reasons included: unaware (6.2%), not interested (8.9%), cost (8.9%), time (3.4%), fearful of results (2.7%), and never offered (15.1%). For those that did undergo testing, over half of the parents reported that they did not receive counseling before (55.1%) and 41.7% reported they received counseling after the testing. Furthermore, parents were confused about the results with 18.3% reporting they were Very Confused, 28.3% Somewhat Confused, 20% A Little Confused, and 33.3% Not Confused at All about the variant of uncertain or unknown significance. Notably, less than half of parents (43.4%) remembered what they were told about the mode of inheritance. Overall, our study highlighted the low adoption rate of genetic testing and lack of integration into standard of care for otology/audiology practices. Collaboration between hearing healthcare professionals and geneticists is warranted to determine how to reduce barriers to access while improving pre- and post-counseling.

Brain Health Attitudes, Awareness and Actions in Middle-Aged Latinos

Alzheimer's disease and related dementias (ADRD) disproportionately impact Latinos in the US. Interventions that promote engagement in established protective behaviors throughout the life course may offer an opportunity to address disparities. To inform brain health promotion efforts, this study aimed to examine current brain health-related attitudes, awareness, and actions of middle-aged Latinos. A cross-sectional, online survey was completed by 200 Latinos 35-64 years old. Survey items assessed concern about ADRD, beliefs related to ways to support brain health, knowledge of protective behaviors, and actual engagement in protective behaviors. Multivariable analyses examined differences in knowledge, attitudinal, and behavioral outcomes by sociodemographic and psychosocial factors including health literacy and health activation. A third (36.0%) of participants were "very concerned" about ADRD. Nearly two thirds (61.0%) "strongly agreed" steps can be taken to reduce risk of ADRD. Less than a third (29.5%) were able to name three steps to support brain health, and 45.5% reported currently engaging in behaviors to support brain health. In multivariable analyses, participants with lower acculturation were more likely to be "very concerned" about ADRD and to "strongly agree" that steps can be taken to support brain health. Participants with low health activation were less likely to agree that steps can be taken. Those who were older and had a family member with ADRD were more likely to be able to name three steps that can be taken. Most middle-aged Latinos believed brain health is actionable, while concern for ADRD, awareness of ways to protect the brain, and engagement in science-based protective behaviors was variable. Opportunities exist for increasing education about well-established modifiable risk factors for ADRD, yet more research is needed to understand these factors in historically minoritized communities.

Household dietary gatekeepers' perceptions of home cooking and its associated factors: A qualitative inquiry from urban India

The high consumption of calorie-dense, nutrient-poor meals from out of home sources has been identified as a potential risk factor for the growing burden of obesity and diet-related chronic degenerative diseases among urban Indians. Consumption of home cooked meals is linked with positive dietary and health outcomes. However, little is known about the views of Indians regarding home cooking. Therefore, this investigation was designed to qualitatively explore urban Indian nutritional gatekeepers' perceptions of home cooking and the factors influencing it. The social constructivism theoretical framework was employed to inform this qualitative investigation. A purposive sample of 34 household dietary gatekeepers (28 women; 6 men) from the Kolkata metropolis participated in face-to-face/telephonic interviews. In-depth interviews were conducted in English/Hindi/Bengali (translated to English where necessary), digitally recorded and transcribed verbatim. Inductive thematic analysis was employed to code the transcripts in the NVivo software program. Emerging themes and sub-themes were: (i) Home cooking is a duty; (ii) Facilitators of home cooking (Home cooking is good for health; Home cooking is economical; Preservation of dietary heritage; Home Cooking is a source of happiness) ; (iii) Barriers to home cooking (Paid employment outside the home; Health issues associated with ageing; Limited culinary skills); (iv) Transformation in home cooking; (v) Decline in home cooking; (vi) Acquisition of cooking skills; (vii) Cooking skills are a necessity. These themes have the potential to inform the creation and development of public health policies and interventions aimed at stimulating home cooking for positive dietary and health outcomes. Future research should focus on developing family-based and school-based cooking interventions to inculcate culinary skills in children and adolescents. In addition, government could levy tax on ultra-processed convenience foods to minimize their utilization as well as subsidize sales of raw food ingredients to encourage 'cooking from scratch' using fresh and basic food ingredients.

Methods and lessons from conducting a national study of primary care nurse practitioners

BACKGROUND

Researchers often rely on survey data to assess quality, cost, and outcomes of nurse practitioner (NP) care delivery. Achieving sufficient response rates with traditional survey methods (email, mail, phone calls) has become increasingly challenging. Moreover, survey data collection requires significant financial and labor resources, calling into question the efficiency of current approaches to survey data collection.

PURPOSE

This study aims to describe survey data collection from a national sample of primary care NPs caring for persons living with dementia and discuss the methods and response rate in the context of challenges conducting survey-based research.

METHODOLOGY

This was a cross-sectional survey conducted from November 2021 to October 2023 in 3 waves using a modified Dillman approach. The first wave was sent through physical mailings, and the second wave through email. After low response rates, the sampling frame was updated to include NPs not originally captured in the sampling frame.

RESULTS

The sampling frame included 11,518 NPs. Between 3 data collection waves, 3 survey mailings with 8 postcard reminders and 2 email surveys with 12 email reminders were sent. The response rate was 16.4% (N = 968).

CONCLUSION

Data collection took over 2 years as the approaches were modified due to low response. By the time addresses were obtained and surveys sent, it was likely that many addresses were no longer accurate. Our response rate is consistent with declining survey response rates among other health professions.

IMPLICATIONS

Survey research may require more efficient data collection methods, such as targeted social media advertisements.

Association of Social Media Recruitment and Depression Among Racially and Ethnically Diverse Metabolic and Bariatric Surgery Candidates: Prospective Cohort Study

Background

Due to the widespread use of social media and the internet in today's connected world, obesity and depression rates are increasing concurrently on a global scale. This study investigated the complex dynamics involving social media recruitment for scientific research, race, ethnicity, and depression among metabolic and bariatric surgery (MBS) candidates.

Objective

This study aimed to determine (1) the association between social media recruitment and depression among MBS candidates and (2) racial and ethnic differences in social media recruitment engagement.

Methods

The analysis included data from 380 adult MBS candidates enrolled in a prospective cohort study from July 2019 to December 2022. Race and ethnicity, recruitment method (social media: yes or no), and depression status were evaluated using χ2 tests and logistic regression models. Age, sex, and ethnicity were adjusted in multivariable logistic regression models.

Results

The mean age of the candidates was 47.35 (SD 11.6) years, ranging from 18 to 78 years. Participants recruited through social media (n=41, 38.32%) were more likely to report past or current episodes of depression compared to nonsocial media-recruited participants (n=74, 27.11%; P=.03), with a 67% increased likelihood of depression (odds ratio [OR] 1.67, 95% CI 1.04-2.68, P=.03). Further analysis showed that participants with a history of depression who were below the mean sample age were 2.26 times more likely to be recruited via social media (adjusted OR [aOR] 2.26, 95% CI 1.03-4.95; P=.04) compared to those above the mean age. Hispanic (n=26, 38.81%) and non-Hispanic White (n=53, 35.10%) participants were significantly more likely to be recruited via social media than non-Hispanic Black (n=27, 18.37%) participants (P<.001). After adjusting for covariates, non-Hispanic Black participants were 60% less likely than non-Hispanic White participants to be recruited via social media (aOR 0.40, 95% CI 0.22-0.71; P=.002).

Conclusions

We found that individuals recruited through social media channels, especially younger participants, were more likely to report past or current episodes of depression compared to those recruited through nonsocial media. The study also showed that non-Hispanic Black individuals are less likely to engage in social media recruitment for scientific research versus other racial and ethnic groups. Future mental health-related studies should consider strategies to mitigate potential biases introduced by recruitment methods to ensure the validity and generalizability of research findings.

Collecting real-time infant feeding and support experience: co-participatory pilot study of mobile health methodology

BACKGROUND

Breastfeeding rates in the UK have remained stubbornly low despite long-term intervention efforts. Social support is a key, theoretically grounded intervention method, yet social support has been inconsistently related to improved breastfeeding. Understanding of the dynamics between infant feeding and social support is currently limited by retrospective collection of quantitative data, which prohibits causal inferences, and by unrepresentative sampling of mothers. In this paper, we present a case-study presenting the development of a data collection methodology designed to address these challenges.

METHODS

In April-May 2022 we co-produced and piloted a mobile health (mHealth) data collection methodology linked to a pre-existing pregnancy and parenting app in the UK (Baby Buddy), prioritising real-time daily data collection about women's postnatal experiences. To explore the potential of mHealth in-app surveys, here we report the iterative design process and the results from a mixed-method (explorative data analysis of usage data and content analysis of interview data) four-week pilot.

RESULTS

Participants (n = 14) appreciated the feature's simplicity and its easy integration into their daily routines, particularly valuing the reflective aspect akin to journaling. As a result, participants used the feature regularly and looked forward to doing so. We find no evidence that key sociodemographic metrics were associated with women's enjoyment or engagement. Based on participant feedback, important next steps are to design in-feature feedback and tracking systems to help maintain motivation.

CONCLUSIONS

Reflecting on future opportunities, this case-study underscores that mHealth in-app surveys may be an effective way to collect prospective real-time data on complex infant feeding behaviours and experiences during the postnatal period, with important implications for public health and social science research.

The (un)controlled body: A grounded theory analysis to conceptualise stigma for women with gestational diabetes mellitus

Health-related stigma is associated with adverse outcomes including depression, stress and reduced engagement in health behaviours which are particularly harmful in pregnancy and the postpartum. Women with gestational diabetes mellitus (GDM) report negative psychosocial experiences and may be at risk of stigma related to the condition. We aimed to understand women's experiences of GDM-specific stigma. Individual interviews were conducted with n = 53 women living in the UK with a current or past (within 4 years) GDM. Grounded theory methodology was used to analyse the data. Four themes were identified: (1) Preconceptions and misconceptions; (2) Locating, regaining, and negotiating agency; (3) Tension about and resisting the dominant discourse of stigma; and (4) Reclaiming control over the body. GDM-specific stigma was diverse and far reaching and may have broader implications for perinatal mental health and postnatal wellbeing. It is pertinent to investigate possible prospective associations between GDM-specific stigma, and biomedical and mental health outcomes.

Effectiveness of a mobile-based return to work program for decent return to work, fatigue, stress, and quality of working life among cancer survivors

PURPOSE

This study aimed to develop a smartphone mobile application-based supportive return to work (RTW) program for cancer survivors and evaluate its effects on their RTW, fatigue, stress, and quality of working life. This program was developed through a comprehensive process involving literature review, interviews with cancer survivors, and consultations with experts.

METHODS

A non-equivalent control group pre- and post-test design was used, with 41 participants assigned to the experimental (n = 18) and control (n = 23) groups based on recruitment timing. The experimental group received a 6-week smartphone mobile application-based supportive RTW program comprising "Counseling and Education" and "Self-Management." Participants completed assessments of decent RTW, fatigue, stress, and quality of working life at baseline and 6 months later. The experimental group completed an additional post-program completion survey.

RESULTS

During the 6-week program, no experimental group participants dropped out. The program's impact on decent RTW remains unclear. Fatigue (F = 2.52, p = 0.095) and quality of working life (F = 0.86, p = 0.434) did not show statistically significant differences. However, there was a significant reduction in stress (F = 4.59, p = 0.017).

CONCLUSION

The smartphone application-based RTW program, focusing on self-management and counseling, effectively reduced participants' stress levels. To further evaluate the effectiveness of the program, a more diverse range of interventions and ongoing programs should be implemented.

IMPLICATIONS FOR CANCER SURVIVORS

This study underscores the importance of tailored digital interventions to support the RTW of cancer survivors. The use of mobile smartphone applications allows temporal and spatial flexibility in program participation. Interventions involving various activities should be implemented to ensure ongoing participation.

A national survey of osteopaths' conceptions of practice in France: structural validity of the Osteo-TAQfr and the tendency toward technical rationality

BACKGROUND

Despite the growing popularity of osteopathy in France, little is known about how French osteopaths conceptualise key aspects of their practice, including skills, knowledge, and decision-making. This study aimed to adapt and validate the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) for use in a French osteopathic population (Osteo-TAQfr) and to examine the professional profile and core elements of clinical practice among French osteopaths. The first objective was to establish the psychometric properties of the Osteo-TAQfr within a French osteopathic population. The second aim was to explore French osteopaths' conceptions of practice and their approach to patient care, thereby contributing to a broader understanding of the profession in France and its relevance within the discourse on allied health professions (AHPs).

METHODS

A cross-sectional study was conducted to (1) adapt and validate the French version of the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQfr) and (2) explore osteopaths' conceptions of practice in France. The translation and cultural adaptation process was informed by cognitive interviews to ensure linguistic and contextual appropriateness. Exploratory Factor Analysis (EFA) was performed to assess the factor structure in the French osteopathic context and Confirmatory Factor Analysis (CFA) was used to test the validity of previously established constructs-Professional Artistry (PA) and Technical Rationality (TR). Internal consistency was evaluated using McDonald's omega (ω).

RESULTS

The survey yielded 1,703 complete responses. Analysis supported a two-factor model with PA andTR subscales, both showing strong reliability estimations (PA ω = 0.882; TR ω = 0.873). Minor theory-informed adjustments improved model fit. A moderate negative correlation was observed between the PA and TR subscales (r=-0.407). Respondents with additional health professions qualifications scored lower on the PA subscale and higher on the TR subscale.

CONCLUSIONS

The Osteo-TAQfr is an original tool that assesses conceptions of osteopathic practice in France. Findings reveal a predominance of TR among French osteopaths, characterised by biomedical, technique-driven approaches. These results have significant implications for aligning osteopathic education and practice with contemporary AHP paradigms, including patient-centred care and interdisciplinary collaboration. Further research should explore the transferability of the Osteo-TAQ across other healthcare systems and its potential impact on clinical outcomes and professional development.

Engaging Minoritized Communities in Clinical Trials Through Social Media: Recommendations from Community-Based Participatory Research

The current study aims to understand what Black and Latino community members know about clinical trials and develop effective messaging to generate interest, improve access, and encourage participation among minoritized populations through social media. Employing community-based participatory research, we formed a community research advisory team and conducted focus group interviews with Black and Latino community members about elements of social media messages that might reduce hesitancy about and increase engagement in clinical trials. From the interview transcripts, we extracted seven key themes: transparency, familiarity, altruism, adaptability, flexibility, recognition, and safety. We suggest leveraging these themes as strategies to craft targeted recruitment messages addressing barriers to participation in clinical trials among Black and Latino community members.

Power to the People: Measuring Social Media and Mass Media Impact for Promotion and Tenure in Social and Applied Sciences

Promotion and tenure (P&T) is the process by which academic faculty are evaluated on the trajectory and impact of their scholarly career. Faculty are typically assessed on their grants, publications, teaching, and service. Ethnically minoritized faculty face disparities in P&T, perhaps due to the lack of standards for quantifying their efforts in the community and scholarship that is relevant to issues of social justice and public concern. Efforts in social and mass media to translate research findings and to disseminate evidence-based prevention and intervention efforts, however, are not often considered in P&T despite their direct impact on the community and contribution to the field. This paper discusses how the academy can quantify and qualify the impact of social media and mass media work in existing P&T considerations, particularly for departments with faculty in social and applied sciences. We discuss how social media and mass media work can be evaluated within existing P&T review criteria, and we provide suggestions for committees to quantify the impact of online and media efforts. Last, we conclude with suggestions for departments, colleges, academic medical centers, and universities in higher education to support early career faculty who are engaging in this extremely important, often under-rewarded work.

Patients' preferences on atopic dermatitis skincare and social media use: a qualitative study

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory disease with a complex pathophysiology, necessitating strict therapeutic management. Over-the-counter products play a crucial role in AD treatment. The emergence of social media (SM) as a vast information source for skincare and healthy lifestyle has transformed its role from mere entertainment. This study aimed to explore the attitudes of AD patients towards SM as an information source for their AD products, understand their purchase behavior, and identify unmet needs.

METHODS

Qualitative semi-structured interviews were conducted with AD patients recruited from a university hospital in Southern Germany and social media networks. The interviews took place between November 2022 and January 2023. The recorded interviews were transcribed verbatim and analyzed using Mayring's qualitative content analysis.

RESULTS

A total of ten patients (3 men, 7 women) aged 23-42 years were interviewed. Participants reported new perspectives in four categories: opportunities and advantages of SM as information source for AD products, risks and disadvantages, important aspects for patients' choice of AD products, and extent and purpose of SM use in selecting AD skincare.

CONCLUSIONS

Patients exhibit diverse patterns of SM use when selecting daily products and critically evaluate the online content, demonstrating a greater trust in healthcare professionals or familial connections. Electronic word-of-mouth, disease severity and prior product experiences emerge as prevalent factors influencing patients' product selection. Furthermore, female patients express interest in complementary and alternative therapies as part of an integrative therapeutical approach. Understanding patients' needs and preferences regarding AD skincare can inform physicians in recommending more personalized therapies. Additionally, educational interventions on SM, addressing patients' questions and concerns with evidence-based information, hold the potential for beneficial outcomes.

Exploring Educators' Perceptions and Experiences of Online Teaching to Foster Caring Profession Students' Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study

BACKGROUND

Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators' perceptions and experiences of teaching caring profession students about virtual caring skills within online environments.

OBJECTIVE

This study aims to better understand caring profession educators' online teaching experiences to foster student development of virtual caring skills and competencies.

METHODS

We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators' online teaching experiences to foster student development of virtual caring skills and competencies. The survey's primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators' perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators' experiences and perspectives.

RESULTS

A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators' level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators' faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability).

CONCLUSIONS

Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions' programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts.

Recruiting participants for focus groups in health research: a meta-research study

BACKGROUND

Focus groups (FGs) are an established method in health research to capture a full range of different perspectives on a particular research question. The extent to which they are effective depends, not least, on the composition of the participants. This study aimed to investigate how published FG studies plan and conduct the recruitment of study participants. We looked at what kind of information is reported about recruitment practices and what this reveals about the comprehensiveness of the actual recruitment plans and practices.

METHODS

We conducted a systematic search of FG studies in PubMed and Web of Science published between 2018 and 2024, and included n = 80 eligible publications in the analysis. We used a text extraction sheet to collect all relevant recruitment information from each study. We then coded the extracted text passages and summarised the findings descriptively.

RESULTS

Nearly half (n = 38/80) of the studies were from the USA and Canada, many addressing issues related to diabetes, cancer, mental health and chronic diseases. For recruitment planning, 20% reported a specific sampling target, while 6% used existing studies or literature for organisational and content planning. A further 10% reported previous recruitment experience of the researchers. The studies varied in terms of number of participants (range = 7-202) and group size (range = 7-20). Recruitment occurred often in healthcare settings, rarely through digital channels and everyday places. FG participants were most commonly recruited by the research team (21%) or by health professionals (16%), with less collaboration with public organisations (10%) and little indication of the number of people involved (13%). A financial incentive for participants was used in 43% of cases, and 19% reported participatory approaches to plan and carry out recruitment. 65 studies (81%) reported a total of 58 limitations related to recruitment.

CONCLUSIONS

The reporting of recruitment often seems to be incomplete, and its performance lacking. Hence, guidelines and recruitment recommendations designed to assist researchers are not yet adequately serving their purpose. Researchers may benefit from more practical support, such as early training on key principles and options for effective recruitment strategies provided by institutions in their immediate professional environment, e.g. universities, faculties or scientific associations.

Decentralized clinical trials are better for the participants and for the planet: the case study of a double-blind randomized controlled trial in Singapore (PROMOTE study)

Introduction

Novel technologies have enabled the decentralization of many aspects of clinical trials, but little research has been done on the impact of these changes on the participant experience, trial operations, or the environment.

Methods

A fully decentralized clinical trial conducted in Singapore is used as a case study to evaluate the operational outcomes, environmental impact (via life cycle assessment), and participants experience (qualitative interviews) of the decentralized model compared to a traditional study with in-person visits.

Results

The decentralized study achieved high participant retention rates (97%) and high completion rates for clinical data, even for biological samples. Participants found the decentralized model to be convenient and safe, especially during the pandemic. Moreover, the decentralized model was found to be more environmentally friendly and less detrimental to human health compared to traditional face-to-face clinical trials, primarily by reducing participants' use of cars for site visits.

Discussion

While this study focused on the environmental impact, it is important to consider other factors such as participant safety, convenience, and data quality when evaluating the suitability of a decentralized clinical trial approach. Careful planning of data flow, database structure, and data protection measures is essential. This study contributes to improving the environmental footprint of clinical trials. Environmental sustainability should be among the factors that are evaluated when selecting trial models. Decentralized and hybrid clinical trials offer efficiency, effectiveness, and environmental benefits. Further research and adoption of these approaches are encouraged.

Women in academic radiology: Barriers and benefits of representation, mentorship, coaching, and advocacy

Gender diversity contributes to creativity and collective intelligence in the workplace. Women bring a unique perspective to the practice of medicine; however, there is a persistent underrepresentation of women in the field of radiology. Female radiologists face distinct challenges associated with underrepresentation and significant gender disparities. There are several obstacles contributing to women's underrepresentation in radiology, including suboptimal exposure to radiology during training, misconceptions about the field of radiology, the impact of social media, and a lack of women in leadership positions. Additional factors leading to widening the gender gap were also discussed, such as a lack of role models and mentors, unconscious biases, and other societal barriers, including but not limited to childbearing, lactation, and family-building. This review article emphasizes the value of representation, mentorship, coaching, and advocacy to address the current status of women in radiology. It also explores the challenges and strategies to promote a gender-diverse radiology practice essential to the future of radiology and medicine.

Comparison of targeted web-based advertising versus traditional methods for recruiting older adults into clinical trials

BACKGROUND

Recruiting older adults into clinical trials can be particularly challenging. Our objective was to determine if targeted web-based advertising is an effective recruitment strategy.

METHODS

We compared the recruitment rates of traditional and targeted web-based methods for three representative clinical trials involving older adults. All studies utilized traditional recruitment methods initially, but shifted toward primarily targeted web-based advertising after experiencing slow recruitment rates.

RESULTS

We found that web-based advertising reached more individuals compared to traditional methods. Compared to traditional methods, web-based methods also had at least twice the rate of expressed interest, completion of telephone and in-person screening, eligibility, and enrollment. Additionally, the proportion of individuals excluded after the telephone screening did not differ according to whether targeted web-based advertising (STAMINA: 51%; Berries and Steps: 62%; ISTIM: 20%) or traditional methods (STAMINA: 48%; Berries and Steps: 69%; ISTIM: 23%) were used within each study. Those recruited using web-based advertisements tended to be younger compared to traditional methods, but were similar in racial distribution and education.

CONCLUSION

Targeted web-based advertisements may be more effective in recruiting older adults for clinical trials at a faster rate than traditional recruitment methods, but need further evaluation of compatible study designs, potential population bias, and cost-effectiveness.

Perceptions of brain health and aging among middle-aged latinos: A qualitative paper

OBJECTIVES

Latinos living in the US are disproportionately impacted by Alzheimer's disease and related dementias (ADRD). To develop culturally-informed interventions, a first step is engaging with key stakeholders. The present study aimed to explore perspectives on brain health and aging among middle-aged Latinos living in Chicago, IL.

METHODS

Individual, semi-structured interviews were conducted with 30 English- or Spanish-speaking Latinos between 35 to 64 years old. Questions from a previously used interview guide were leveraged and addressed knowledge about the brain, perceptions of healthy and unhealthy aging, ideas of how to care for the brain, where knowledge was acquired, and suggestions for disseminating brain health education. Responses were analyzed using thematic analysis.

RESULTS

The following themes were identified: (1) Understanding of the brain is varied (including cognitive, behavioral, anatomical, and psychological descriptions); (2) Perceptions surrounding healthy aging are broad and demonstrate a depth of understanding (e.g., physical and cognitive abilities, independence, positive emotions, and sociability), yet understanding of signs of an unhealthy brain is somewhat limited (e.g., focus on memory); (3) Brain health promotion is largely viewed as actionable (spanning physical health, cognitively stimulating activities, emotional wellbeing, medical self-management, and social connectedness); (4) Suggestions for disseminating education included media, clinics, churches, libraries, and community centers, with consideration of possible barriers and facilitators to behavior change (e.g., finances, prioritizing family).

CONCLUSIONS

Results showed significant heterogeneity in understanding of the brain, albeit with promising attitudes that actions can be taken to protect one's brain from ADRD.

PRACTICE IMPLICATIONS

Takeaways include the need for increasing education on normative versus nonnormative memory loss and signs of ADRD beyond memory impairment. Messaging may benefit from utilizing analogies, considering familism and spirituality, and highlighting lifestyle changes that do not carry a financial burden or place blame on individuals.

The Ingestion Question: Public Knowledge of Safe Food Introduction in Children

OBJECTIVES

National guidelines advise delaying initiation of solid foods until after 4-6 months of age and avoiding "high-risk" foods under the age of 4 years. However, foreign body aspiration of food remains a common preventable pediatric emergency. Our primary aim was to investigate public knowledge regarding the safe age of introduction of different foods to children and determine if demographic factors affect this knowledge.

METHODS

An online survey was designed following a literature review and consultation with an expert panel. This was distributed via social media platforms. A review of our institutional data of bronchoscopy/foreign body retrievals was performed to identify trends.

RESULTS

There were 1000 survey responses: 79.4% of respondents cared for children and 21.5% were medical professionals; 37.7% of respondents (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. At our institution nuts (65.7%) were the most common food-related foreign body retrieved from a total of 265 over 21 years. Notably, 80% of respondents (n = 800) would offer whole nuts to children <4 years. Respondents with medical training were more likely to hold off on introducing nuts to children until a later age.

CONCLUSION

Although the public has an overall appreciation of food safety, a significant proportion would feel comfortable offering high-risk foods to children under 2 and 3 years. There is a poor understanding of the danger of nuts and the appropriate age of introduction. Further research into effective public education strategies on safe food introduction in children are warranted.

LEVEL OF EVIDENCE

5 Laryngoscope, 135:445-451, 2025.

Strategies to improve recruitment in mental health clinical trials: a scoping review (RE-MIND study)

BACKGROUND

Lower-than-expected recruitment continues to be one of the major causes of trial delays, and trials to improve mental health are no exception. Indeed, recruitment challenges in trials of vulnerable populations, such as those living with mental health illness, can even be exacerbated. To address this, researchers are turning to digital and online recruitment strategies, e.g. web-based approaches and multi-media in order to (1) increase recruitment efficiency (recruit to target and on time) and (2) improve diversity in mental health clinical trials to be more inclusive and reduce health inequity. There is, however, inconclusive evidence on the success of digital and online recruitment strategies in mental health clinical trials. The RE-MIND study comprised a scoping review to assess the impact of using such recruitment strategies in mental health clinical trials to inform a more systematic scoping review.

METHODS

A cohort of 191 recently published RCTs and randomised feasibility studies were identified from the NIHR Journals Library and top two mental health journals (based on citation metrics), Lancet Psychiatry and JAMA Psychiatry. Population characteristics including gender, ethnicity and age were summarised for inclusivity using descriptive statistics, and recruitment strategies were compared to examine differences in their success in recruiting to target.

RESULTS

After screening, 97 articles were included for review. The review findings showed no evidence that offline or mixed strategies were superior for achieving recruitment targets in mental health trials. However, there was a suggestion that trials using a mixed recruitment strategy improved inclusivity and tended to recruit closer to the target.

CONCLUSIONS

The key finding was that consideration should be given to a mixed methods approach to recruitment not only to enable wider and more diverse participation in mental health trials but also to realize greater efficiency.

Recruitment of Adolescents to Virtual Clinical Trials: Recruitment Results From the Health4Me Randomized Controlled Trial

Background

Preventive interventions are needed to provide targeted health support to adolescents to improve health behaviors. Engaging adolescents in preventive interventions remains a challenge, highlighting the need for innovative recruitment strategies. Given adolescents' lives are intertwined with digital technologies, attention should be focused on these avenues for recruitment. The evolving nature of clinical trials, including the emergence of virtual clinical trials, requires new recruitment approaches, which must be evaluated.

Objective

This study aimed to examine the effectiveness and cost of various digital recruitment strategies for recruiting adolescents to a virtual clinical trial, evaluate the progression of participants from screening to enrollment, and explore factors associated with nonparticipation. This was conducted using data from the Health4Me Study, a preventive digital health intervention to improve physical activity and nutrition behaviors among adolescents aged 12 to 18 years.

Methods

Participants were recruited into the Health4Me Study via social media advertisements on various contemporary platforms, emails to schools, emails to contacts within known networks, and emails to relevant youth organizations. Data were collected from social media advertisements, screening, and recruitment logs. Data analysis included summary and descriptive statistics, as well as chi-square tests to explore factors associated with nonparticipation.

Results

From 2369 expressions of interest, 390 (16.4%) participants were enrolled. A total of 19 advertisements were placed on social media, and 385 promotional emails were sent to schools, contacts within known networks, and relevant youth organizations. Social media advertisements reached 408,077 unique accounts. Advertisements mostly reached those living in populous states in Australia (306,489/408,077, 75.11% of unique accounts) and those identifying as female (177,698/408,077, 43.55% of unique accounts). A total of 24.97% (101,907/408,077) of advertisements were delivered to accounts with uncategorized genders. The total cost per participant enrolled was Aus $3.89 (approximately US $2.58). Most participants (1980/2305, 85.90%) found out about this study through Instagram. Differences in screening characteristics between eligible participants who did and did not enroll were found to be statistically significant for gender (P=.02), with fewer males and more individuals reporting their gender as "other" enrolling than expected by chance alone. The recruitment method also differed (P<.001), with fewer participants enrolling through Instagram and more enrolling through other methods (eg, known networks or word of mouth) than expected by chance alone.

Conclusions

This study found that virtual clinical trial recruitment was found to be low-cost, with the potential to increase trial participation. Social media was the most effective recruitment method, reaching all states and territories, including hard-to-reach populations. Future action is needed to explore recruitment methods that are more effective for males and to build trust among adolescents regarding clinical trial recruitment via social media.

Reddit for research recruitment? Social media as a novel clinical trial recruitment tool for adolescent and young adult (AYA) cancer survivors

PURPOSE

Adolescent and young adult cancer survivors (AYAs) have been considered a hard-to-reach population with low enrollment rates in cancer clinical trials. Race, ethnicity, socioeconomic status, and inaccessibility have been identified as barriers impacting research participation. Social media has the potential to overcome these barriers and increase AYA enrollment. This secondary analysis of a randomized controlled behavioral trial aims to (1) examine differences in participant characteristics and engagement as stratified by recruitment method and (2) offer considerations for using social media to recruit AYAs.

METHODS

Social media and traditional recruitment methods were employed to recruit 72 post-treatment AYAs (ages 16-29) for a virtual synchronous group-based resiliency intervention (Bounce Back). Screening surveys assessed sociodemographic, medical, and psychosocial characteristics. Feasibility was assessed via attendance and follow-up survey completion. Post-intervention program acceptability and treatment satisfaction ratings were collected.

RESULTS

A total of 61% of AYAs were recruited via social media; with 40% from Reddit, 18% from Facebook, and 3% from Twitter. Participants recruited via social media had greater sociodemographic and geographic diversity, completed cancer treatment more recently, and reported increased anxiety and prospective worry compared to participants recruited via traditional channels. No significant between-group differences in retention, engagement, acceptability, or treatment satisfaction ratings were detected. Challenges encountered included bots, malingerers, and scheduling considerations.

CONCLUSIONS

Recruiting via social media platforms, especially Reddit, enhanced participant diversity and intervention accessibility. Researchers should identify recruitment methods that promote inclusivity while preserving safety and research integrity.

IMPLICATIONS FOR CANCER SURVIVORS

Social media recruitment was a successful and comparable recruitment strategy for engaging early post-treatment AYAs in a behavioral intervention trial.

How (Cautious) Social Media Use May Improve Education and Pipeline Efforts of a Growing Postpandemic Forensic Pathologist Workforce Shortage

ABSTRACT

Many subspecialties of pathology have initiated novel methods and strategies to connect with medical students and residents, stimulate interest, and offer mentorship. Emerging concern about the future of forensic pathology has been highlighted in contemporary literature as recruitment of new fellows has stagnated and workforce shortage concerns have blossomed. Amidst these challenges, the potential role of social networking platforms like social media (SoMe) in enhancing autopsy pathology/forensics education has garnered attention, yet literature focusing specifically on its application in autopsy and forensic pathology remains limited. This review aims to provide a comprehensive narrative overview of the current literature on the established uses of SoMe in forensic pathology. It seeks to build upon existing recommendations, introducing a contemporary compilation of online resources designed to facilitate virtual engagement among pathologists, learners, patients, and families. The review supports the idea that strategic, ethical, and conscientious use of SoMe has a place in addressing the growing workforce shortages and closing educational gaps in forensic pathology by enhancing exposure to the field and dispelling antiquated stereotypes.

The skinny on skin: The role of skin-aware professionals in skin cancer surveillance

BACKGROUND

Licensed nonmedical, skin-aware professionals (e.g., hairdressers, massage therapists, etc.) have the potential to identify skin cancer, but baseline knowledge may not be sufficient to accomplish this goal. Following educational intervention, self-efficacy is one of the best surrogate metrics for behavior change. Curricula that increase knowledge and confidence levels can improve screening behaviors, but few have been tested for efficacy in this population AIMS: We assessed whether an online curriculum could reliably improve skin screening knowledge, attitudes, and behaviors of nonmedical professionals PATIENTS/METHODS: Skin-aware professionals were recruited through the Oregon Health Authority and IMPACT Melanoma TM. Participants completed a pre-survey, online training module, post-survey, and one-year follow-up survey. We evaluated participants' indicated levels of concern for suspicious and nonsuspicious lesions relative to "gold standard" physician ratings. We also assessed confidence and self-reported behavior change regarding talking to clients about skin cancer and recommending they see a provider to evaluate suspicious lesions RESULTS: The pre-survey was completed by 9872 skin-aware professionals; 5434 completed the post-survey, and 162 completed the one-year follow-up survey. Participants showed a significant improvement in ability to indicate the correct level of concern for all lesion types in concordance with "gold standard" physician ratings (p < 0.001). Participants reported increased comfort levels in discussing health-related topics with their clients posttraining CONCLUSIONS: Our training module effectively increased skin-aware professionals' knowledge, confidence, and concern for malignant lesions. Skin-aware professionals may serve as a valuable extension of the skin self-exam, but additional studies are needed to evaluate the impact of these curricula long-term, including potential downstream consequences.

Associations between stress, perfectionism, and imposter phenomenon among dental hygiene students

PURPOSE/OBJECTIVE

Imposter phenomenon (IP) depicts the feeling of being a fraud. Stress and perfection are associated with IP, impairing professional and academic performance and negatively impacting mental health. The purpose of this study was to explore the prevalence of IP and perfectionism in dental hygiene students and the relationship with stress.

METHODS

This study used cross-sectional survey research with a nonprobability sampling of dental hygiene students (n = 258). The study used three validated instruments: the Imposter Profile (IPP30) with six subscales, the Frost Multidimensional Perfectionism Scale Brief with two subscales, and the Perceived Stress Scale (PSS10). Descriptive, correlation, and linear regression were used for analysis.

RESULTS

The completion rate was 74.8% (n = 193). Linear regression analysis found the competence doubt (CD) subscale of the Imposter-Profile and perfectionistic striving (PS) were the only statistically significant predictors of stress (F = 10.01, p < .001, R2 = .16). CD (b = 0.36, p < 0.001) was twice as strong as PS (b = 0.15, p < 0.05) in predicting stress in dental hygiene students.

CONCLUSION

In this sample of dental hygiene students, the doubt about competence aspect of imposter phenomenon increased stress more than the striving for perfectionism. Faculty may minimize stress and support students by identifying the feelings associated with imposter phenomenon and highlighting student achievements to build confidence and feelings of self-efficacy.

"Our Community Comes First": Investigating Recruitment Ads That Represent and Appeal to Black Women for Online, HIV-Related Research Studies

BACKGROUND

Black women are underrepresented in health-related research. Consulting Black women in the creation of recruitment materials may help increase their representation in research studies, but few of these recruitment materials have been evaluated. This manuscript reports on the impact of two ads (one featuring older women and one featuring younger women) created through multiple focus group sessions with Black women. The purpose of the ads were to recruit Black women to participate in an online research study about HIV prevention and pre-exposure prophylaxis, PrEP.

MATERIALS AND METHODS

Questions about the ads were embedded in the eligibility screener for inclusion in the online parent research study. Respondents were asked which ad they saw, what they liked about it, and what about the ad piqued their interest in the study.

RESULTS

In total, 301 Black women completed the eligibility screener for the online study and answered questions pertaining to the two ads. Most participants reported seeing the ad with younger women (260/301, 86.4%). Representation of Black women (n = 70), ad design (n = 64), relevance to Black women and the Black community (n = 60), and comprehensiveness of ad content (n = 38) were the top 4 ad features respondents liked. Relevance to Black women and the Black community (n = 104) as well as ad content (n = 54) (i.e., study purpose, location, duration, images, incentive) were the top two reasons provided about ads that piqued respondent's interest in the online study.

CONCLUSION

Findings showcase how recruitment ads informed by Black women could help increase their interest and participation in research.

Therapeutic approaches and conceptions of practice of osteopaths in Australia - a national cross-sectional study and exploratory factor analysis of the Osteo-TAQ

BACKGROUND

Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia.

METHODS

A cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald's omega calculated as the reliability estimation statistic.

RESULTS

691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was 'only talking' with their patients.

CONCLUSIONS

This study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths' conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath's conception of practice, and their associations with other measures of practice including clinical outcomes.

Implementation of MyChart for recruitment at an academic medical center

Introduction

Recruitment of participants into research studies remains a major concern for investigators. Using clinical teams to identify potentially eligible patients can present a significant barrier. To overcome this, we implemented a process for using our patient portal, called MyChart, as a new institutional recruitment option utilizing our electronic health record's existing functionality.

Methods

To streamline the institutional approval process, we established a working group comprised of representatives from human subject protection, information technology, and privacy and vetted our process with many stakeholder groups. Our specific process for study approval is described and started with a consultation with our recruitment and retention function funded through our Clinical and Translational Science Award.

Results

The time from consultation to the first message(s) sent ranged from 84 to 442 days and declined slightly over time. The overall patient response rate to MyChart messages about available research studies was 23% with one third of those saying they were interested in learning more. The response rate for Black and Hispanic patients was about 50% that of White patients.

Conclusions

Many different types of studies from any medical specialty successfully identified interested patients using this option. Study teams needed support in defining appropriate inclusion/exclusion criteria to identify the relevant population in the electronic health records and they needed assistance writing study descriptions in plain language. Using MyChart for recruitment addressed a critical barrier and opened up the opportunity to provide a full recruitment consultation to identify additional recruitment channels the study teams would not have considered otherwise.

Parent Facilitation of Condom Access and HIV Testing Associated with Improved Sexual Health Outcomes for Sexual Minority Young Men

Sexual minority young men experience a high HIV incidence. Parent-based interventions are promising for prevention efforts, but further research is needed to identify specific, replicable parental behaviors associated with improved sexual health outcomes for sexual minority young men. We assessed parental behaviors in the domains of facilitating access to condoms, providing instruction in condom use, and supporting HIV testing, and tested whether parental behaviors were associated with sons' condom use self-efficacy and intentions to get tested for HIV. Data came from the baseline assessment of a pilot trial of a parent-based HIV prevention program, and participants were dyads (n = 61) of sexual minority young men (M. age: 16.87; 46% racial/ethnic minority) and their parents (M. age: 44.31; 26% racial/ethnic minority). Parents and sons reported on parental behaviors in each domain. Results indicated that parents' facilitation of access to condoms was associated with sons' condom use self-efficacy, and parents' facilitation of HIV testing was associated with sons' HIV testing intentions. Findings were robust across both parent and son reports of parental behaviors. Parental condom use instruction was unrelated to sons' condom use self-efficacy. Findings suggest that parent-based HIV prevention programs for sexual minority young men should encourage parents to provide instrumental assistance to their sons in accessing condoms and HIV testing. There is a need for further research to identify underlying mechanisms.

Engaging athletes as research participants. A document analysis of published sport science literature

Sport science practitioners utilise findings from peer reviewed research to inform practice. Fewer studies are conducted with high performance athletes, however, than those involving recreationally active participants. Noting that research findings from recreational athletes may not be generalisable to the elite, there is a need to engage the latter cohort in research with better potential to influence health and performance. This study identified methods used to engage and recruit highly trained, elite and world class athletes as research participants. A document analysis was conducted using a purposive sample of peer-reviewed sport science literature. All articles published in 2022 from 18 highly ranked sport science journals were screened for inclusion. Studies investigating athletes ranked as highly trained/national level or above were included. All details related to participant recruitment were extracted from included articles, with the content being coded and thematically analysed using an interpretivist approach. A total of 439 studies from the 2356 screened were included in the analysis. Five primary themes of recruitment strategies were identified, beneath an overarching strategy of purposeful, convenience sampling. Recruitment themes related to the use of a gatekeeper, the research environment providing convenient access to athletes, promoting the study electronically, utilising professional networks and recruiting at training or competition. Engaging athletes through a gatekeeper is a prominent strategy to involve elite athletes in research. It is suggested that researchers work collaboratively with team or organisation personnel to promote recruitment, creating co-designed approaches that address issues most relevant to athletes and staff.

Exploring the determinants of oral health care uptake among women with gestational diabetes mellitus: A qualitative study to develop a logic model and framework for an oral health intervention

INTRODUCTION

Gestational diabetes mellitus (GDM) is a condition of glucose intolerance in pregnancy. Oral health has been shown to mediate blood glucose management and pregnancy outcomes. There is also a greater prevalence of poor oral health in GDM pregnancies when compared to normoglycemic pregnancies. While current guidelines recommend an oral health review as part of diabetes and pregnancy management, it is under-considered in GDM care. Hence, it is important to understand how to improve oral health care in this context.

AIM

To explore the determinants of oral health care uptake among women with GDM to develop a logic model for an intervention to improve awareness and activation of oral health behaviours in this population.

METHODS

Semi-structured interviews were used to collect the data and the Theoretical Domains Framework inspired the interview guide. The study population consisted of UK-based women with GDM over 18 years of age. The data were analysed with Framework Analysis and the COM-B Model was used to orientate the data.

RESULTS

Seventeen women participated in the study. Five themes including knowledge about oral health; the health of the baby; the impact of the GDM diagnosis; social support and barriers and facilitators were found to influence the uptake of oral health care.

CONCLUSIONS

This study developed an evidence-based logic model of the determinants of oral health care uptake among women with GDM. This will serve as a framework for developing an oral health intervention. This study may be the starting point for initiating conversations about implementing oral health care in GDM management.

Barriers and facilitators of translating doctoral research findings into policy: The case of a selected health sciences school in a South African university

Background

Although the barriers and facilitators of translating health research into policy are generally well documented, not much has been reported for universities in low-and middle-income countries. We identified and analyzed barriers and facilitators of translating doctoral research findings into policy in a selected health sciences school in a South African university.

Methods

The study adopted a quantitative descriptive research design. We conveniently collected data through an online questionnaire administered to 47 PhD graduates, 11 PhD final year students and 21 PhD supervisors of the School of Nursing and Public Health. Descriptive statistics was performed, and data were summarized using percentages.

Results

More than half (72.4 %) of the students reported not involving Department of Health during formulation of research questions for their projects and 62.1 % reported not directly sharing research findings with the Department of Health. 53.4 % of the students indicated that they attended Department of Health research days and only 39.7 % said they presented research findings at the meetings. Only 39.7 % of the students who shared their research results to the Department of Health received feedback. About 52.4 % of the academic supervisors believed the introduction of the quartile system as a measure of impact of publications may reduce policy impact. An individual PhD supervisor supervises an average of 6 PhD students at any given time. 85.7 % of PhD supervisors reported that they consider stakeholders needs/interests when assisting students to identify research topics.

Conclusion

The study revealed the need for universities to make policymakers aware of available evidence, conduct research that is informed by the Department of Health's research agenda, involve the Department of Health in identifying research projects, and disseminate findings using platforms accessible to policymakers. Other key considerations are political will to utilize evidence, packaging evidence in a user-friendly manner and building the capacity of policymakers to use evidence.

Lessons learned from the MOMENT study on how to recruit and retain a target population online, across borders, and with automated remote data collection

Increasingly, studies use social media to recruit, enroll, and collect data from participants. This introduces a threat to data integrity: efforts to produce fraudulent data to receive participant compensation, e.g., gift cards. MOMENT is an online symptom-monitoring and self-care study that implemented safeguards to protect data integrity. Facebook, Twitter, and patient organizations were used to recruit participants with chronic health conditions in four countries (USA, Italy, The Netherlands, Sweden). Links to the REDCap baseline survey were posted to social media accounts. The initial study launch, where participants completed the baseline survey and were automatically re-directed to the LifeData ecological momentary assessment app, was overwhelmed with fraudulent responses. In response, safeguards (e.g., reCAPTCHA, attention checks) were implemented and baseline data was manually inspected prior to LifeData enrollment. The initial launch resulted in 411 responses in 48 hours, 265 of which (64.5%) successfully registered for the LifeData app and were considered enrolled. Ninety-nine percent of these were determined to be fraudulent. Following implementation of safeguards, the re-launch yielded 147 completed baselines in 3.5 months. Eighteen cases (12.2%) were found fraudulent and not invited to enroll. Most fraudulent cases in the re-launch (15 of 18) were identified by a single attention check question. In total, 96.1% of fraudulent responses were to the USA-based survey. Data integrity safeguards are necessary for research studies that recruit online and should be reported in manuscripts. Three safeguard strategies were effective in preventing and removing most of the fraudulent data in the MOMENT study. Additional strategies were also used and may be necessary in other contexts.

Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study

BACKGROUND

Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging.

OBJECTIVE

This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women.

METHODS

Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics.

RESULTS

We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%).

CONCLUSIONS

Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.

Pelvic Floor Physical Therapy is Self-Reported as a Minimally Effective, and Sometimes Harmful, Treatment for Pudendal Neuralgia: A Cross-Sectional Study

Objectives

Pudendal neuralgia (PN) is a sexual pain disorder characterized as pain of the genital and/or perineal regions, and despite the lack of clinical evidence supporting its use, pelvic floor physical therapy (PFPT) is a recommended treatment for PN.

Methods

An online anonymous cross-sectional survey was administered to participants through convenience sampling conducted on May 19 to September 19, 2023 to understand the self-reported efficacy of PFPT as a treatment for PN. Participants' measures included sociodemographics, Patient Global Impression of Change (PGIC), and satisfaction scores.

Results

The average self-reported PGIC score among participants was 4.6 ± 1.3 (n = 144), indicating no to minimal improvement in symptoms. Most participants (66%) scored 4 or 5, suggesting no change to minimal improvement. Twelve percent of participants scored 3 or lower, indicating worsening of symptoms, and only 22% scored 6 or 7, indicating much or very much improvement of symptoms. Participants who only participated in PFPT (n = 24) had a lower PGIC score of 4.4 ± 1.3. For self-reported satisfaction with PFPT as a treatment for PN, participants self-reported a score of 4.9 ± 3.0, indicating slight dissatisfaction. For those who experienced symptom improvement, the median number of sessions before noticing improvement was five sessions.

Conclusion

Based on self-reported results, PFPT is a minimally effective, and sometimes harmful, treatment for PN. Patients should receive greater transparency regarding the lack of efficacy of PFPT and its potential harm.

Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study

BACKGROUND

Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments.

OBJECTIVE

This study aims to better understand caring professional students' online learning experiences with developing virtual care skills and competencies.

METHODS

A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students' online learning experiences with developing virtual care skills and competencies.

RESULTS

A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies.

CONCLUSIONS

This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions' programs.

Protocol for a randomized controlled trial of an internet-based prevention intervention for young children at-risk for functional abdominal pain

BACKGROUND

Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children's expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs.

METHODS

Parents with IBS who have children ages 4-7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings.

DISCUSSION

This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05730491. Registered on February 15, 2023.

Successes and Challenges in Clinical Trial Recruitment: The Experience of a New Study Team

Participant recruitment is one of the most challenging aspects of a clinical trial, directly impacting both the study's duration and the quality of its results. Therefore, reporting successful recruitment strategies is crucial. This study aimed to document the recruitment tactics and experiences of a research team during a university-based randomized clinical trial, conducted as part of a clinical research immersion program. Recruitment took place from October 2021 to October 2022. Before the study commenced, study team members received formal training in clinical trial participant recruitment from the Principal Investigator. The recruitment strategies were integrated into initial study design, which was approved by the Institutional Review Board. A multimodal approach was employed, incorporating both direct and indirect recruitment methods. These strategies successfully met the enrollment target within the twelve-month period. Throughout the process, team members acquired valuable knowledge in recruitment design and implementation, along with transferable interpersonal and networking skills. In-person recruitment was the most efficient and cost-effective strategy, followed by personal referrals. The primary challenge was accommodating participants' availability. Other study teams should consider these recruitment strategies during their study designs. Additionally, the knowledge and skills gained by this study team underscore the value of experiential learning in research education.

Social media recruitment of participants in a female stress urinary incontinence trial: A feasibility study

OBJECTIVE

This study explores the opportunities of social media advertisements as a recruitment strategy in women with stress urinary incontinence (SUI).

STUDY DESIGN

This feasibility study was part of a larger clinical trial on the effects of a patient decision aid for SUI treatment. We started a 61-day social media advertisement campaign to recruit women for the trial. The primary outcome of our study was enrolment pace. Secondary outcomes involved cost per participant, baseline demographic comparison and ad campaign performance metrics. Additionally, we interviewed recruited participants to identify the facilitators and barriers of our approach.

RESULTS

Ten participants were recruited, of whom 8 completed the full study protocol (2 questionnaires 6 months apart). The enrolment pace, 4.0 study participants per month, was faster compared to the average of 2.7 participants per month through conventional methods. The campaign reached 87 clicks on the advertisement per day and 1 % of these women showed interest in our study by contacting us. The overall conversion rate from click to full participation was 0.2 %. The costs per participant were €112. Besides higher age, the demographics of the social media recruited participants were comparable to the conventional inclusions. Qualitative analysis identified more user-oriented enrolment procedures and potential participant benefit as facilitators of social media recruitment.

CONCLUSION

This study shows that social media recruitment can be feasible in trials for women with SUI. It can accelerate recruitment of eligible participants. Optimising the enrolment procedure to better meet participants' needs and recruitment benefits may improve participation and cost-effectiveness. Trial registration ID 2017-3540.

Social Media Use During Coronavirus Disease 2019 and the Impact on Adolescent Health

During the coronavirus disease 2019 lockdown, adolescents spent a great deal of time using social media. There have always been a host of positives and negatives associated with social media use. The negatives are more notable with heavier use. Once restrictions lifted and normalcy returned, social media usage appears to be returning to prepandemic rates in adolescents. Adolescents are reporting mostly positive and neutral personal effects of social media on their postpandemic lives.

Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial

BACKGROUND

Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations.

OBJECTIVE

This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer.

METHODS

This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn.

RESULTS

The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant.

CONCLUSIONS

The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed).

TRIAL REGISTRATION

ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492.

Community engagement through social media: A promising low-cost strategy for rural recruitment?

PURPOSE

For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasibility of using a free social media page to build a network of rural community members who may be interested in a research study. Here, we describe the rationale, process, and protocols of developing and implementing a social media approach to recruit rural residents to participate in an mHealth intervention.

METHODS

Informed by extensive formative research, we created a study Facebook page emphasizing community engagement in an mHealth behavioral intervention. We distributed the page to local networks and regularly posted recruitment and community messages. We collected data on the reach of the Facebook page, interaction with our messages, and initiations of our study intake survey.

FINDINGS

Over 21 weeks, our Facebook page gained 429 followers, and Facebook users interacted with our social media messages 3,080 times. Compared to messages that described desirable study features, messages that described community involvement resulted in higher levels of online interaction. Social media and other recruitment approaches resulted in 225 people initiating our in-take survey, 9 enrolling in our pilot study, and 26 placing their names on a waiting list.

CONCLUSIONS

A standalone social media page highlighting community involvement shows promise for recruiting in rural areas.

Stakeholders' experiences with school-based immunization programs during the COVID-19 pandemic in the Canadian Maritimes: A qualitative study

Background

School-based immunization programs (SBIP) support access to routine vaccines for adolescents. Across Canada, the COVID-19 pandemic and subsequent public health measures affected SBIP and vaccine uptake. The objectives of this study were to explore 1.) stakeholders' experiences with SBIP and changes to programs during COVID-19 in Nova Scotia, Prince Edward Island and New Brunswick, and 2.) how the pandemic affected parents' and adolescents' vaccine views.

Study design

Semi-structured interviews with decision makers, healthcare providers, teachers, parents and adolescents between February-August 2023.

Methods

The COM-B model and Theoretical Domains Framework informed interview guides. Deductive and inductive analyses saw participant quotes mapped to relevant model components and domains by two coders. Belief statements were generated within each stakeholder group then compared to identify themes and subthemes.

Results

Participants (n = 39) identified five themes: 1) enablers to SBIP delivery, 2) barriers to SBIP delivery, 3) desired changes to SBIP delivery, 4) student anxiety, and 5) vaccination views and changes since the COVID-19 pandemic. Public health measures facilitated more space for clinics, as did taking smaller cohorts of students. School staff-healthcare provider relationships could help or hinder programs, particularly with high turnover in both professions during the pandemic. Adolescents played a passive role in vaccine decision making, with mothers often being the sole decision maker. We did not identify any changes in hesitancy towards routine vaccines since the pandemic.

Conclusions

We identified a range of barriers and enablers to SBIP, many of which were exacerbated by the pandemic. Efforts are needed to ensure SBIP and catch-up programming remains accessible for all adolescents to catch-up on missed vaccines before graduation. Parents and adolescents' vaccination views suggest changes in vaccine coverage since the pandemic may be due to accessibility of services rather than vaccine hesitancy. Future research is needed to engage adolescents in their vaccine decisions.

Implications and Lessons Learned While Using Social Media Advertisements to Promote Longitudinal Social Network Study Participation in Latino Men Who Have Sex with Men (LMSM): A Brief Report

We assess the effectiveness of paid ads on social media platforms as a research recruitment tool with Latino men who have sex with men (LMSM). We deployed four paid ad campaigns July-September 2022 in English and Spanish on Meta and Grindr featuring happy or risqué images of LMSM, documenting engagement and cost metrics. The four campaigns generated a total of 1,893,738 impressions and 1078 clicks (0.057 click-through rate) with a total cost of $7,989.39. Of the 58 people who accessed the study screener, 31 completed it (53.4%), 13 were eligible (22.4%), but none enrolled. Comparing platforms, Meta had higher engagement metrics than Grindr, while Grindr had higher proportions of those who completed the screener (57.9%) and were eligible (26.3%) than Meta (52.6% and 21.0%, respectively). Challenges to using paid ads as an LMSM recruitment tool included intersecting pandemics (Mpox, COVID-19), and limited connection between platforms and staff for study enrollment.

Strength, power and aerobic capacity of transgender athletes: a cross-sectional study

OBJECTIVE

The primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes.

METHODS

19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men (TM) (age: 34±7 years), 23 transgender women (TW) (age: 34±10 years) and 21 cisgender women (CW) (age: 30±9 years) underwent a series of standard laboratory performance tests, including body composition, lung function, cardiopulmonary exercise testing, strength and lower body power. Haemoglobin concentration in capillary blood and testosterone and oestradiol in serum were also measured.

RESULTS

In this cohort of athletes, TW had similar testosterone concentration (TW 0.7±0.5 nmol/L, CW 0.9±0.4 nmol/), higher oestrogen (TW 742.4±801.9 pmol/L, CW 336.0±266.3 pmol/L, p=0.045), higher absolute handgrip strength (TW 40.7±6.8 kg, CW 34.2±3.7 kg, p=0.01), lower forced expiratory volume in 1 s:forced vital capacity ratio (TW 0.83±0.07, CW 0.88±0.04, p=0.04), lower relative jump height (TW 0.7±0.2 cm/kg; CW 1.0±0.2 cm/kg, p<0.001) and lower relative V̇O2max (TW 45.1±13.3 mL/kg/min/, CW 54.1±6.0 mL/kg/min, p<0.001) compared with CW athletes. TM had similar testosterone concentration (TM 20.5±5.8 nmol/L, CM 24.8±12.3 nmol/L), lower absolute hand grip strength (TM 38.8±7.5 kg, CM 45.7±6.9 kg, p=0.03) and lower absolute V̇O2max (TM 3635±644 mL/min, CM 4467±641 mL/min p=0.002) than CM.

CONCLUSION

While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.

The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale

OBJECTIVE

Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale.

METHODS

The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire.

RESULTS

The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis.

CONCLUSIONS

The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.

College students' motivations for using fitness related technology

Objective: The purpose was to understand college students' motivations for the use and discontinued use of fitness related technology (FRT) in relation to their physical activity behaviors. Participants: Participants were undergraduate students (n = 22) who were eligible if they were between 18-24 years of age (emerging adulthood) and current or previous users of FRT. Methods: Qualitative descriptive design was used with semi-structured interviews conducted virtually. Thematic analysis was used to analyze the data. Results: Participants discussed four themes; (1) Motivations for physical activity, (2) Motivations for using FRT, (3) Social connection improves accountability for physical activity, and (4) The ups and downs of FRT goal setting and data display. Conclusions: Best practice guidelines need to be established for the use of FRT along with approaches to promote physical activity among this population. Additional research is needed to identify reasons for discontinuation of use and to develop potential interventions to promote sustained engagement with FRT.

Implementation and Process Evaluation of Alcohol Free for 40: Community-Based Programming to Reduce Alcohol Consumption

Alcohol consumption is known to increase risk for chronic diseases and other negative health outcomes. Abstinence, even temporary, from alcohol consumption can have positive health impacts. In this article, we describe implementation and process evaluation of Ochsner Eat Fit's Alcohol Free for 40 (AFF40), an annual, 40-day voluntary alcohol abstinence challenge that takes place in six regions of Louisiana. Participants are challenged to abstain from alcohol consumption for 40 days to promote behavior change. To support participants' success, staff conduct pre and post metrics (physical and laboratory) and host community-based events to encourage replacement behaviors. Process evaluation included measures of reach, recruitment, dose, and fidelity through tracking of participant registrations, an exit survey, media analytics, and program activity logs. In 2021, 493 participants enrolled in AFF40, with 347 completing laboratory metrics and 298 completing physical metrics. Majority of exit survey respondents (74.5%) reported no alcohol consumption during the 40-day challenge and that they planned to participate in AFF40 2022 (90.9%). The Eat Fit team documented moderate engagement (48.7% of enrolled participants) in program events. Social and digital impressions and page views recorded 23,591 hits while print media resulted in over 750,000 impressions. AFF40 has shown to be highly engaging for participants and effective in supporting temporary abstinence from alcohol. Incorporating stronger methods and evaluation will enhance future program implementation and community impact. Lessons learned and implications for practice are transferable to other community-based efforts to reduce alcohol consumption.

Roadside experiences of parents of children with developmental coordination disorder and/or attention deficit hyperactivity disorder

Introduction

Pedestrians are a vulnerable group at the roadside and previous research has identified that children with DCD and ADHD are at a heightened risk of pedestrian injuries. Despite this, limited research has explored parental perspectives of the pedestrian risks faced by children with DCD and/or ADHD. Understanding parents' perspectives provides a unique insight into the challenges children face every day and the concerns that parents perceive regarding their children's safety as pedestrians. Therefore, the aim of this study was to explore parents' perspectives of the pedestrian risks faced by their children with DCD and/or ADHD.

Methods

Semi-structured interviews were conducted with 14 parents of primary school and early secondary school aged children with age range 7-17. The participants were divided into three groups based on their children's conditions: DCD group (10-17 years, n = 3), ADHD group (7-13 years, n = 5), and co-occurring group (7-16 years, n = 6). All parents confirmed an existing diagnosis and completed the SNAP-IV and DCDQ as screening tools. The interviews explored parents' perspectives regarding their children's pedestrian behaviors, parents' concerns and preventative measures taken to improve the pedestrian safety of their children with DCD and/or ADHD. Reflexive thematic analysis was undertaken to analyze the interviews, from which three themes were developed.

Results

The first theme related to the challenges experienced by children at the roadside; parents emphasized the significance of structured and controlled pedestrian crossing sites, underlining their preference for designated crossings as safer options due to their heightened perceptions of risk associated with other road-crossing locations. The second theme: parental concerns and influences on children's road safety referred to their children's performance and safety at the roadside, leading to increased monitoring and a more protective approach to road crossing. The third theme: road safety education related to various strategies parents implemented to mitigate risks, while balancing independence and prioritizing their safety.

Discussion

While there were commonalities in the challenges faced by children with DCD and/or ADHD at the roadside, there were also notable differences. Parents of children with DCD discussed challenges with spatial awareness and motor skills, whereas parents of children with ADHD discussed challenges with impulsivity and inattention. Parents of children with co-occurring DCD and ADHD described a complex interplay of these challenges. It is evident from the interviews that children with DCD and/or ADHD require a distinct approach to develop their pedestrian skills effectively and parents reported specific strategies they used to address the risks associated with their children's roadside behavior. Promoting pedestrian safety for children with DCD and/or ADHD necessitates collaboration among parents, schools and local authorities to implement comprehensive measures ensuring their safety. These findings contribute to understanding parental experiences and needs, providing valuable guidance for targeted interventions and policies to enhance the road safety of children with DCD and/or ADHD.