General Practice and Digital Methods to Recruit Stroke Survivors to a Clinical Mobility Study: Comparative Analysis

Abstract

Background Participant recruitment remains a barrier to conducting clinical research. The disabling nature of a stroke, which often includes functional and cognitive impairments, and the acute stage of illness at which patients are appropriate for many trials make recruiting patients particularly complex and challenging. In addition, people aged 65 years and older, which includes most stroke survivors, have been identified as a group that is difficult to reach and is commonly underrepresented in health research, particularly clinical trials. Digital media may provide effective tools to support enrollment efforts of stroke survivors in clinical trials. Objective The objective of this study was to compare the effectiveness of general practice (traditional) and digital (online) methods of recruiting stroke survivors to a clinical mobility study. Methods Recruitment for a clinical mobility study began in July 2018. Eligible study participants included individuals 18 years and older who had a single stroke and were currently ambulatory in the community. General recruiting practice included calling individuals listed in a stroke registry, contacting local physical therapists, and placing study flyers throughout a university campus. Between May 21, 2019, and June 26, 2019, the study was also promoted digitally using the social network Facebook and the search engine marketing tool Google AdWords. The recruitment advertisements (ads) included a link to the study page to which users who clicked were referred. Primary outcomes of interest for both general practice and digital methods included recruitment speed (enrollment rate) and sample characteristics. The data were analyzed using the Lilliefors test, the Welch two-sample t test, and the Mann-Whitney test. Significance was set at P=.05. All statistical analyses were performed in MATLAB 2019b. Results Our results indicate that digital recruitment methods can address recruitment challenges regarding stroke survivors. Digital recruitment methods allowed us to enroll study participants at a faster rate (1.8 participants/week) compared to using general practice methods (0.57 participants/week). Our findings also demonstrate that digital and general recruitment practices can achieve an equivalent level of sample representativeness. The characteristics of the enrolled stroke survivors did not differ significantly by age (P=.95) or clinical scores (P=.22; P=.82). Comparing the cost-effectiveness of Facebook and Google, we found that the use of Facebook resulted in a lower cost per click and cost per enrollee per ad. Conclusions Digital recruitment can be used to expedite participant recruitment of stroke survivors compared to more traditional recruitment practices, while also achieving equivalent sample representativeness. Both general practice and digital recruitment methods will be important to the successful recruitment of stroke survivors. Future studies could focus on testing the effectiveness of additional general practice and digital media approaches and include robust cost-effectiveness analyses. Examining the effectiveness of different messaging and visual approaches tailored to culturally diverse and underrepresented target subgroups could provide further data to move toward evidence-based recruitment strategies.

Opportunities and Challenges for Decentralized Clinical Trials: European Regulators’ Perspective

“…The risk of excluding digitally illiterate participants was considered a potential challenge for DCTs, with elderly participants considered to be more often digitally illiterate. Whereas digital recruitment strategies have recruited younger participants in some studies, 44,46 another study found no differences between traditional and digital recruitment strategies in terms of age 47 . In addition, DCTs can use recruitment strategies similar to conventional CTs, such as physicians’ networks and registries.…”

Comparison of Web‐Based Advertising and a Social Media Platform as Recruitment Tools for Underserved and Hard‐to‐Reach Populations in Rheumatology Clinical Research

“…However, identifying and recruiting these individuals is time consuming and resource intensive, especially because these individuals may not present to clinical care because they do not yet have inflammatory arthritis. Some investigators have started to use web-based and social media-based advertising for participant recruitment (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Facebook and other social media platforms have a robust advertising architecture that allows targeting of specific user groups (26).…”

“…Facebook and other social media platforms have a robust advertising architecture that allows targeting of specific user groups (26). Studies of social media advertising show promising results, but these studies focused primarily on public health measures or common diseases (16)(17)(18)(19)(20)(21). Very little information is available on the effectiveness of these advertisements in research of rheumatologic diseases (27,28).…”

“…Some investigators have started to use web‐based and social media–based advertising for participant recruitment (16–25). Facebook and other social media platforms have a robust advertising architecture that allows targeting of specific user groups (26).…”

Screening Out False Participants in Research Recruitment from Social Media Groups

“…For nurse researchers interested in developing interventions to help survivors, these online groups present an opportunity to reach potential study participants. One study reported that digital recruitment (using Facebook posts and Google ads) increased enrollment to 1.8 participants per week, compared with 0.57 participants per week using nondigital methods 5. However, challenges can arise with recruitment on social media.…”