Research recruitment using Facebook advertising: big potential, big challenges

Factors associated with intention of HIV testing among Asian American men: a path analysis

Research has pointed to myriad cultural and socio-psychological factors associated with HIV testing, such as acculturation, social norms about HIV testing, masculinity, homonegativity, and constructs from the Theory of Planned Behavior. However, the interrelationships of these factors on the intentions of HIV testing among the population of Asian American men remains unknown. A dataset of 425 Asian American men in the U.S., collected online with convenience sampling method during 2020-2021, was analyzed to test a conceptual framework that aimed to fill this gap. Results from a path model with two endogenous variables (homonegativity and HIV testing intention) indicated that perceived social norms about HIV testing, attitude about HIV testing, and perceived HIV risk had directandindirect relationships with the intentions of HIV testing in the study population. However, social norms about HIV testing and perceived HIV risk showed stronger direct effects (standardized estimates = 0.37 and 0.34, respectively, p-value < 0.001). Additionally, we found that the relationships of these factors with HIV testing intention were also mediated by homonegativity. Findings from this study advance our understanding of pathways of associations between a host of cultural and socio-psychological factors with HIV testing intention among an understudied population - Asian American men. Our results will help inform the development of future intervention programs to increase HIV testing in this population.

ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder

OBJECTIVE

Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP").

METHOD

Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up.

RESULTS

Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (MCEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average.

DISCUSSION

ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04913194.

Recruitment of Young Adults: Lessons Learned From Research on Rural E-Cigarette Use and Cessation

Electronic nicotine delivery system (ENDS) use continues to grow in rural areas of the United States. In particular, young adults (18-24 years) in rural areas are a hard-to-reach population in regard to understanding the growing ENDS use trend. The purpose of this article was to describe recruitment strategies that were used for a series of ENDS-relevant projects for young adults in rural areas, report recruitment yields from these strategies, and provide methodological considerations to aid researchers in improving recruitment. We used descriptive statistical methods to characterize recruitment yields (responses to screening vs initial invites, and number of individuals who fully met eligibility criteria vs responses to screening) from 2 ENDS studies that focused on 3 main recruitment strategies, including student directories, leadership offices (eg, Student Affairs), and regional tobacco control support networks (eg, Area Health Education Centers) for reaching young adults in rural communities. The recruitment yield rates varied and ranged from 2% to 14% depending on strategy with leadership offices resulting in the highest recruitment yield. Methodological considerations by strategy are described in detail. Results of this study can be used to inform tailored recruitment strategies to increase the representation of rural young adults in ENDS or other tobacco research.

"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.

Using social media to recruit individuals for health-related research: Feasibility and lessons learned

Online recruitment via social media for health-related research is increasing. Metrics regarding social media recruitment may increase its use in this field. This study evaluates the feasibility of recruiting individuals with a smoking history through targeted advertising on Facebook for a randomized study focused on lung cancer screening. Individuals completed eligibility questions and were randomized to one of two groups. We analyzed advertisement reach and response patterns, advertisement cost, data integrity and sample representativeness. The advertisement was active for 34 days and resulted in 2111 unique clicks on the survey link. Four hundred thirty-three eligibility entries were collected, and 61 entries were excluded due to failure to correctly answer the data integrity check. Two hundred eighty-two participants met eligibility criteria and were randomized, 191 participants completed questionnaires and 10 entries were subsequently excluded due to a failed attention check. Recruitment utilizing targeted advertising on Facebook is an effective and efficient strategy for health-related research.

Direct-to-Consumer Recruitment Methods via Traditional and Social Media to Aid in Research Accrual for Clinical Trials for Rare Diseases: Comparative Analysis Study

BACKGROUND

Recruitment into clinical trials is a challenging process, with as many as 40% of studies failing to meet their target sample sizes. The principles of direct-to-consumer (DTC) advertising rely upon novel marketing strategies. The ability to reach expansive audiences in the web-based realm presents a unique opportunity for researchers to overcome various barriers to enrollment in clinical trials. Research has investigated the use of individual web-based platforms to aid in recruitment and accrual into trials; however, a gap in the literature exists, whereby multiple mass communication platforms have yet to be investigated across a range of clinical trials.

OBJECTIVE

There is a need to better understand how individual factors combine to collectively influence trial recruitment. We aimed to test whether DTC recruitment of potentially eligible study participants via social media platforms (eg, Facebook [Meta Platforms Inc] and Twitter [Twitter Inc]) was an effective strategy or whether this acted as an enhancement to traditional (eg, email via contact registries) recruitment strategies through established clinical research sites.

METHODS

This study tested multiple DTC web-based recruitment efforts (Facebook, Twitter, email, and patient advocacy group [PAG] involvement) across 6 national and international research studies from 5 rare disease consortia. Targeted social media messaging, social media management software, and individual study websites with prescreening questions were used in the Protocol for Increasing Accrual Using Social Media (PRISM).

RESULTS

In total, 1465 PRISM website referrals occurred across all 6 studies. Organic (unpaid) Facebook posts (676/1465, 46.14%) and Rare Diseases Clinical Research Network patient contact registry emails (461/1465, 31.47%) represented the most successful forms of engagement. PRISM was successful in accumulating a 40.1% (136/339) lead generation (those who screened positive and consented to share their contact information to be contacted by a clinical site coordinator). Despite the large number of leads generated from PRISM recruitment efforts, the number of patients who were subsequently enrolled in studies was low. Across 6 studies, 3 participants were ultimately enrolled, meaning that 97.8% (133/136) of leads dropped off.

CONCLUSIONS

The results indicate that although accrual results were low, this is consistent with previously documented challenges of studying populations with rare diseases. Targeted messaging integrated throughout the recruitment process (eg, referral, lead, and accrual) remains an area for further research. Key elements to consider include structuring the communicative workflow in such a way that PAG involvement is central to the process, with clinical site coordinators actively involved after an individual consents to share their contact information. Customized approaches are needed for each population and research study, with observational studies best suited for social media recruitment. As evidenced by lead generation, results suggest that web-based recruitment efforts, coupled with targeted messaging and PAG partnerships, have the potential to supplement clinical trial accrual.

Help-seeking for mental health services in Asian American college students: an exploratory qualitative study

Objective: To understand how the college environment might influence mental health help-seeking in Asian American undergraduates. Participants: Participants were 19 Asian American undergraduates recruited through Facebook. Methods: Participants were interviewed about attitudes toward mental health and mental health help-seeking, and thematic analysis with both inductive and deductive codes was used to analyze interview transcripts. Results: Several factors specific to the college environment encourage students to seek help: social support provided by peers and by campuses, psychological distance from home, and physical distance from home. However, other Asian American-specific factors discourage students from seeking help, such as cultural factors and stigma surrounding mental health issues. Conclusions: The college environment may encourage help-seeking, while Asian American-specific factors may discourage it. Potential interventions based on these findings may increase help-seeking rates by focusing on these encouraging factors in a culturally-sensitive way.

Social Media Use for Research Participant Recruitment: Integrative Literature Review

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Using Facebook Advertisements for Women's Health Research: Methodology and Outcomes of an Observational Study

BACKGROUND

Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants.

OBJECTIVE

A Qualtrics survey was fielded to ascertain women's knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies.

METHODS

Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined.

RESULTS

In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%).

CONCLUSIONS

Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations.

#GeneticTesting: Using Social Media to Facilitate Communication about testing to Women (Preprint)

Background

Strong participant recruitment practices are critical to public health research but are difficult to achieve. Traditional recruitment practices are often time consuming, costly, and fail to adequately target difficult-to-reach populations. Social media platforms such as Facebook are well-positioned to address this area of need, enabling researchers to leverage existing social networks and deliver targeted information. The MAGENTA (Making Genetic Testing Accessible) study aimed to improve the availability of genetic testing for hereditary cancer susceptibility in at-risk individuals through the use of a web-based communication system along with social media advertisements to improve reach.

Objective

This paper is aimed to evaluate the effectiveness of Facebook as an outreach tool for targeting women aged ≥30 years for recruitment in the MAGENTA study.

Methods

We designed and implemented paid and unpaid social media posts with ongoing assessment as a primary means of research participant recruitment in collaboration with patient advocates. Facebook analytics were used to assess the effectiveness of paid and unpaid outreach efforts.

Results

Over the course of the reported recruitment period, Facebook materials had a reach of 407,769 people and 57,248 (14.04%) instances of engagement, indicating that approximately 14.04% of people who saw information about the study on Facebook engaged with the content. Paid advertisements had a total reach of 373,682. Among those reached, just <15% (54,117/373,682, 14.48%) engaged with the page content. Unpaid posts published on the MAGENTA Facebook page resulted in a total of 34,087 reach and 3131 instances of engagement, indicating that around 9.19% (3131/34,087) of people who saw unpaid posts engaged. Women aged ≥65 years reported the best response rate, with approximately 43.95% (15,124/34,410) of reaches translating to engagement. Among the participants who completed the eligibility questionnaire, 27.44% (3837/13,983) had heard about the study through social media or another webpage.

Conclusions

Facebook is a useful way of enhancing clinical trial recruitment of women aged ≥30 years who have a potentially increased risk for ovarian cancer by promoting news stories over social media, collaborating with patient advocacy groups, and running paid and unpaid campaigns.

Trial Registration

ClinicalTrials.gov NCT02993068; https://clinicaltrials.gov/ct2/show/NCT02993068

Characterizing low effort responding among young African adults recruited via Facebook advertising

Multiple studies have successfully used Facebook's advertising platform to recruit study participants. However, very limited methodological discussion exists regarding the magnitude of low effort responses from participants recruited via Facebook and African samples. This study describes a quasi-random study that identified and enrolled young adults in Kenya, Nigeria, and South Africa between 22 May and 6 June 2020, based on an advertisement budget of 9,000.00 ZAR (US $521.44). The advertisements attracted over 900,000 views, 11,711‬ unique clicks, 1190 survey responses, and a total of 978 completed responses from young adults in the three countries during the period. Competition rates on key demographic characteristics ranged from 82% among those who attempted the survey to about 94% among eligible participants. The average cost of the advertisements was 7.56 ZAR (US $0.43) per survey participant, 8.68 ZAR (US $0.50) per eligible response, and 9.20 ZAR (US $0.53) per complete response. The passage rate on the attention checks varied from about 50% on the first question to as high as 76% on the third attention check question. About 59% of the sample passed all the attention checks, while 30% passed none of the attention checks. Results from a truncated Poisson regression model suggest that passage of attention checks was significantly associated with demographically relevant characteristics such as age and sex. Overall, the findings contribute to the growing body of literature describing the strengths and limitations of online sample frames, especially in developing countries.

Comparison of Facebook, Google Ads, and Reddit for the Recruitment of People Who Considered but Did Not Obtain Abortion Care in the United States: Cross-sectional Survey

Background

In the United States, abortion access is restricted by numerous logistical, financial, social, and policy barriers. Most studies on abortion-seeking experiences in the United States have recruited participants from abortion clinics. However, clinic-based recruitment strategies fail to capture the experiences of people who consider an abortion but do not make it to an abortion clinic. Research indicates that many people search for abortion information on the web; however, web-based recruitment remains underutilized in abortion research.

Objective

This study aims to establish the feasibility of using Facebook, Google Ads, and Reddit as recruitment platforms for a study on abortion-seeking experiences in the United States.

Methods

From August to September 2018, we posted recruitment advertisements for a survey about abortion-seeking experiences through Facebook, Google Ads, and Reddit. Eligible participants were US residents aged 15-49 years who had been pregnant in the past 5 years and had considered abortion for a pregnancy in this period but did not abort. For each platform, we recorded staff time to develop advertisements and manage recruitment, as well as costs related to advertisement buys and social marketing firm support. We summarized the number of views and clicks for each advertisement where possible, and we calculated metrics related to cost per recruited participant and recruitment rate by week for each platform. We assessed differences across platforms using the chi-square and Kruskal-Wallis tests.

Results

Overall, study advertisements received 77,464 views in the 1-month period (from Facebook and Google; information not available for Reddit) and 2808 study page views. After clicking on the advertisements, there were 1254 initiations of the eligibility screening survey, which resulted in 98 eligible survey participants (75 recruited from Facebook, 14 from Google Ads, and 9 from Reddit). The cost for each eligible participant in each platform was US $49.48 for Facebook, US $265.93 for Google Ads, and US $182.78 for Reddit. A total of 84% (66/79) of those who screened eligible from Facebook completed the short survey compared with 73% (8/11) of those who screened eligible from Reddit and 13% (7/53) of those who screened eligible from Google Ads.

Conclusions

These results suggest that Facebook advertisements may be the most time- and cost-effective strategy to recruit people who considered but did not obtain an abortion in the United States. Adapting and implementing Facebook-based recruitment strategies for research on abortion access could facilitate a more complete understanding of the barriers to abortion care in the United States.

Successful and Cost-Effective Facebook Recruitment: Is It Possible? Results From a Longitudinal Randomized Clinical Trial in Grandmother Caregivers

Facebook is often cited in health-related research as a practical option to recruit participants into research studies, but issues with recruiting verifiable and qualified participants and unpredictable costs exist. The purpose of this paper is to describe a social network theory-guided, no-cost, Facebook recruitment strategy in comparison to a traditional recruitment campaign for a national online intervention study for grandmother caregivers (n = 348); 211 participants were recruited via Facebook, and 137 through traditional techniques. Participation rates did not vary by recruitment method. Facebook participants were slightly older, higher income, and more likely to be white and married, but did not differ in education levels. Our strategy quickly obtained an engaged and committed participant base. The application of social network theory to traditional recruitment strategies represents a novel way for researchers to recruit through Facebook and yield viable and engaged participants without investing in Facebook ads.

Delivering information about retirement saving among Hispanic women: two Facebook experiments

We conducted two Facebook experiments (the first one during July 21-25, 2016, and the second during April 22-25, 2018) to determine what type of message related to injunctive norms is more effective in getting Hispanic women interested in learning about financial planning for retirement. We also explore how social media tools could be used in future interventions to promote retirement saving among Hispanic women. In both experiments, we found that a message centered on peer influence may be more successful than a message centered on familism in getting Hispanic women interested in learning more about financial planning for retirement. When we disaggregate our data by age and state, we find that click-through rates were higher among Hispanic women between 45 and 55 years old, and the largest numbers of impressions were among Hispanic women in California and Texas. When we disaggregate our data by device, we find that most study participants were reached through an Android smartphone.

Knowledge and Attitude Toward Human Papillomavirus Infection and Vaccination among Thai Women: A Nationwide Social Media Survey

Objectives:

This study was performed first to assess Thai women’s knowledge and attitude toward Human papillomavirus (HPV) infection and vaccination and second to find out factors associated with knowledge in this regard.

Methods:

The survey announcement was advertised via Facebook from 17 May 2019 to 14 June 2019 to recruit women aged 18-26 years living in Thailand. A score below 5 out of total score of 10 on the survey was considered as a poor level of knowledge. Multivariate analysis was applied to identify factors associated with HPV infection and vaccination knowledge.

Results:

A total of 1,175 participants were recruited. The participants’ median age was 22 years. Approximately, 46% of the participants had poor level of knowledge regarding HPV infection and vaccination. Factors associated with poor knowledge included low educational level (adjusted OR, 1.35; 95% CI 1.04-1.77), low family income (adjusted OR, 2.14; 95% CI 1.65-2.78), being Christian (adjusted OR, 4.04; 95% CI 1.22-13.40), being engaged in sexual intercourse (adjusted OR, 0.75; 95%CI 0.58-0.97), and being unvaccinated against HPV infection (adjusted OR, 5.74; 95% CI 3.07-10.74).

Conclusion:

Nearly half of the Thai women who participated in the survey had poor level of knowledge regarding HPV infection and vaccination, indicating a need for more effective health education intervention. Factors associated with knowledge included socioeconomic status and sexual behavior.

The influence of social media on recruitment to surgical trials

BACKGROUND

Social media has changed the way surgeons communicate worldwide, particularly in dissemination of trial results. However, it is unclear if social media could be used in recruitment to surgical trials. This study aimed to investigate the influence of Twitter in promoting surgical recruitment in The Emergency Laparotomy and Frailty (ELF) Study.

METHODS

The ELF Study was a UK-based, prospective, observational cohort that aimed to assess the influence of frailty on 90-day mortality in older adults undergoing emergency surgery. A power calculation required 500 patients to be recruited to detect a 10% change in mortality associated with frailty. A 12-week recruitment period was selected, calculated from information submitted by participating hospitals and the numbers of emergency surgeries performed in adults aged > 65 years. A Twitter handle was designed (@ELFStudy) with eye-catching logos to encourage enrolment and inform the public and clinicians involved in the study. Twitter Analytics and Twitonomy (Digonomy Pty Ltd) were used to analyse user engagement in relation to patient recruitment.

RESULTS

After 90 days of data collection, 49 sites from Scotland, England and Wales recruited 952 consecutive patients undergoing emergency laparotomy, with data logged into a database created on REDCap. Target recruitment (n = 500) was achieved by week 11. A total of 591 tweets were published by @ELFStudy since its conception, making 218,136 impressions at time of writing. The number of impressions (number of times users see a particular tweet) prior to March 20th 2017 (study commencement date) was 23,335 (343.2 per tweet), compared to the recruitment period with 114,314 impressions (256.3 per tweet), ending June 20th 2017. Each additional tweet was associated with an increase in recruitment of 1.66 (95%CI 1.36 to 1.97; p < 0.001).

CONCLUSION

The ELF Study over-recruited by nearly 100%, reaching over 200,000 people across the U.K. Branding enhanced tweet aesthetics and helped increase tweet engagement to stimulate discussion and healthy competition amongst clinicians to aid trial recruitment. Other studies may draw from the social media experiences of the ELF Study to optimise collaboration amongst researchers.

TRIAL REGISTRATION

This study is registered online at www.clinicaltrials.gov (registration number NCT02952430 ) and has been approved by the National Health Service Research Ethics Committee.

Utilizing Facebook and Automated Telephone Calls to Increase Adoption of a Local Smoke Alarm Installation Program

CONTEXT

Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior.

OBJECTIVE

We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program.

PARTICIPANTS

We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system.

DESIGN

The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system.

RESULTS

By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call.

CONCLUSION

Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.

"We have to keep it a secret" - The dynamics of front and backstage behaviours surrounding meat consumption in India

Meat consumption is on the rise in India. However, most studies on meat consumption have been conducted among Western audiences and there are relatively few insights into meat consumption in emerging markets, especially India, which tends to be stereotyped as a vegetarian nation. The aim of this qualitative study was to explore meat consumption practices among urban Indians aged 23-45 years. The sample comprised mainly Mumbai residents. The research methodology used constructivist grounded theory. Semi-structured face-to-face in-depth interviews was the main mode of data collection and the research used an iterative study design along with an inductive analysis approach. A key finding was that while meat consumption is on the rise, there are social stigmas still associated with it. This has led to discrepancies between consumption behaviours occurring in public (frontstage behaviours) and those carried out in private (backstage behaviours). Using Goffman's theory of self-presentation, the study provides insights into various ways in which backstage meat consumption occurs in collectivist Indian society today. The backstage setting can comprise places outside the home, such as restaurants, and in some instances, segregated 'safe' spaces within the home itself. Within these spaces, the study explores how certain consumption taboos are quietly broken while actions are taken to present appropriate frontstage appearances before various audiences. This study contributes to the relatively sparse literature on meat consumption in India while also using Goffman's theory to highlight the discrepancies between public and private consumption behaviours within the collectivist Indian context.

The rise of #SocialMedia in the Nephrology world

Social media (SoMe) use has increased exponentially in the last decade and is having a profound impact on the Nephrology world. The use of these platforms is contributing to continuous educational and professional development by exposing nephrologists to new research, allowing them to connect with experts, to exchange experiences, or to engage in scientific debates. Here, we introduce the basics of SoMe, focusing on Twitter because it is the most popular SoMe platform used by the medical community for professional purposes. We will review the main education platforms and tools available, such as visual abstracts, blogs, tweetorials, videos, and podcasts. We will also focus on their different applications for educational purposes such as online journal clubs, webinars, or online games. The role of SoMe in academic promotion, dissemination of research, expansion of nephrology societies and coverage of scientific events will also be discussed. In the end, we will reflect on SoMe risks and limitations, much-needed developments in SoMe platforms and the challenges ahead of us.

Inflammatory Bowel Disease Patient Experiences with Psychotherapy in the Community

This study aimed to characterize patient expectations for integrating mental health into IBD treatment, describe experiences with psychotherapy, and evaluate therapy access and quality. Adults with IBD were recruited online and via a gastroenterology practice. Participants, 162 adults with IBD, completed online questionnaires. The sample was primarily middle-aged, White, and female. Sixty percent had Crohn's Disease. Disease severity was mild to moderate; 38% reported utilizing therapy for IBD-specific issues. The greatest endorsed barrier to psychotherapy was its cost. Psychotherapy was perceived as leading to modest gains in quality of life, emotional well-being, and stress reduction. Participants reported a disparity between their desire for mental health discussions and their actual interactions with providers. The majority of participants (81%) stated there are insufficient knowledgeable therapists. A significant number of patients with IBD endorsed the desire for mental health integration into care. Disparities exist in reported provider-patient communication on these topics. There appears to be a dearth of IBD-knowledgeable therapists in the community.

A novel approach to conducting clinical trials in the community setting: utilizing patient-driven platforms and social media to drive web-based patient recruitment

Background

Participant recruitment for clinical research studies remains a significant challenge for researchers. Novel approaches to recruitment are necessary to ensure that populations are easier to reach. In the context of rare diseases, social media provides a unique opportunity for connecting with patient groups that have representatively lower diagnosis rates when compared with more common diseases or illness. We describe the implementation of designing a patient-centered approach to message design for the purposes of recruiting patients for clinical research studies for rare disease populations.

Methods

Using an iterative research approach, we analyzed our previous experience of using web-based direct-to-patient recruitment methods to compare these online strategies with traditional center of excellence recruitment strategies. After choosing six research studies for inclusion in the previous study, in-depth, online interviews (n = 37) were conducted with patients represented in each disease category to develop and test recruitment message strategies for social media and a Web-based platform for patients to access study information and pre-screen. Finally, relationships were established with Patient Advocacy Groups representing each rare disease category to ensure further dissemination of recruitment materials via their own social media networks.

Results

Guided by social marketing theory, we created and tested various recruitment message designs. Three key message concepts preferred by patients emerged: (1) infographic; (2) positive emotional messages; and (3) educational information for sharing. A base study website was designed and created based on data from patient interviews. This website includes the option for potential participants to pre-screen and determine their eligibility for the study.

Conclusions

Study participants report wanting to be involved in the design and implementation of recruitment approaches for clinical research studies. The application of the aforementioned methods could aide in the evolution of clinical research practices for the recruitment of both rare and common diseases, where patient-centric approaches can help to create targeted messages designs that participants pre-test and support.

Communication strategies for designing Facebook advertising campaigns to recruit rural participants to develop healthcare delivery interventions

Background:

Little is known about designing research recruitment campaigns that connect with underserved, geographically isolated rural populations. A theoretically informed process is needed to assist research teams and practitioners in their evaluation of Facebook’s feasibility as a recruitment tool and development of online materials for recruiting rural adults into healthcare delivery intervention development studies.

Methods:

We drew from research and theory in communication and incorporated process analysis techniques to develop replicable procedures for designing and evaluating Facebook campaigns for rural recruitment. We describe our process and illustrate using two case studies.

Results:

Campaigns received approximately 1000 link clicks from the target rural demographic and successfully enrolled participants using Facebook as a primary method of recruitment. The rural tobacco intervention development study received a total of 477 link clicks, cost only $155.80, and enrolled three (23%) of its 13 participants from Facebook. The rural mental health intervention development study received a total of 518 link clicks, cost only $233.28, and enrolled 178 participants.

Conclusions:

Our process yielded two successful recruitment campaigns. Facebook was an affordable and efficacious strategy for enrolling adults in behavioral research studies on tobacco and mental health. Future work should apply these theoretical techniques to additional study topics and evaluate specific message features associated with recruitment.

Recruiting cancer survivors into research studies using online methods: a secondary analysis from an international cancer survivorship cohort study

Recruiting participants into cancer survivorship research remains a significant challenge. Few studies have tested and compared the relative use of non-clinical online recruitment methods, especially in samples of adult cancer survivors. This paper reports on the feasibility of recruiting a representative cohort of cancer survivors using online social media. Two hundred participants with cancer diagnosis within the past 12 months were recruited via social media (Facebook, Twitter and Reddit) into a longitudinal questionnaire study. Different methods of online recruitment proved to be more effective than others over time. Paid Facebook boosting, Reddit posts and Twitter advertisements placed by existing cancer charities proved most helpful in reaching our recruitment target (contributing 27%, 22% and 32%, respectively). Recruiting online achieved a more demographically and clinically representative sample for our study: our subject was younger, less heteronormative, including those with a range of clinical diagnoses, primary and recurrence illness, and patients who had both completed and were still receiving treatment. This was certainly not a quick method of sample recruitment but that could have been optimised by focussing only on the three most effective methods described earlier. While we found that online recruitment is significantly lower in cost than traditional recruitment methods, and can reduce some biases, there still remains the potential for some biases (e.g. excluding much older participants) and ethical/methodological issues (e.g. excluding those without access to Internet). We outline our recruitment strategy, retention rates and a cost breakdown in order to guide other researchers considering such methods for future research in cancer survivorship.

Approaches to Recruitment of Postmenopausal Women for a Community-Based Study

BACKGROUND

Few researchers have focused on the challenges of recruiting postmenopausal women for community-based research. Researchers have reported that multiple methods may be needed to recruit the required number of subjects. One contemporary approach to recruitment is use of Facebook. More studies are needed examining Facebook as a recruitment strategy.

OBJECTIVE

The aim of the study was to examine which recruitment methods were most successful and cost-effective in recruiting postmenopausal women for a randomized controlled trial on bone loss.

METHODS

Subjects were 276 postmenopausal women who had osteopenia and were within 5 years of menopause. Multiple methods were used to recruit women. To determine which methods were successful, women were asked how they learned about the study. Descriptive data were used to examine recruitment numbers as well as to determine the cost-effectiveness and enrollment efficiency of recruitment methods.

RESULTS

Healthcare provider letters yielded the highest number of enrolled subjects (n = 58), followed by postcard mailings (n = 47), and Facebook posts (n = 44). Eleven subjects were referred by family and friends, five subjects were from newspaper or television, and two were from digital ads. Cost of recruitment per subject enrolled was highest with digital ads and postcard mailings.

DISCUSSION

Recruitment could be more costly and time-consuming than anticipated. Recruitment using direct-targeted mailings, such as provider letters and postcards, was successful in our study and has been effective in previous studies reviewed. Facebook was successful for recruitment in our study and may continue to be useful for recruitment in the future, as the number of women accessing Facebook continues to increase.

Social media partnerships with patient organizations for neuro-oncology patient recruitment

Background

In neuro-oncology, traditional methods of enrolling the large numbers of participants required for studies of disease etiology and treatment response are costly, labor intensive, and may not include patients in regions without tumor registries.

Methods

In the Yale Acoustic Neuroma (AN) Study and International Low-Grade Glioma (LGG) Registry, we partnered with several brain tumor patient organizations to develop social media enrollment campaigns and use web-based data collection resources at the Yale University School of Public Health to test alternative methods to enroll neuro-oncology patients for epidemiologic study.

Results

In the AN study, we enrolled 1024 patients over 2 years. Of these, 865 patients completed the online questionnaire, 697 returned written consent, 583 sent a pathology report, and 569 returned a saliva specimen. The completed 569 participants did not differ by age or treatment from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data but were more likely to be female (67% vs 52%) and white (94.8% vs 84%). Patients learned of the study through the Acoustic Neuroma Association (ANA) website (61.3%), ANA support group members (18%), and social media (primarily Facebook). Costs per patient enrolled were approximately 10% to 20% that of traditional registry-based enrollment methods. Results for the LGG study were similar.

Conclusions

Although additional effort will be required to ensure a diverse participant population, partnership with established patient organizations along with use of web-based technology and social media allowed for the successful enrollment of neuro-oncology patients at a fraction of the cost relative to traditional methods.

Genes for Good: Engaging the Public in Genetics Research via Social Media

The Genes for Good study uses social media to engage a large, diverse participant pool in genetics research and education. Health history and daily tracking surveys are administered through a Facebook application, and participants who complete a minimum number of surveys are mailed a saliva sample kit ("spit kit") to collect DNA for genotyping. As of March 2019, we engaged >80,000 individuals, sent spit kits to >32,000 individuals who met minimum participation requirements, and collected >27,000 spit kits. Participants come from all 50 states and include a diversity of ancestral backgrounds. Rates of important chronic health indicators are consistent with those estimated for the general U.S. population using more traditional study designs. However, our sample is younger and contains a greater percentage of females than the general population. As one means of verifying data quality, we have replicated genome-wide association studies (GWASs) for exemplar traits, such as asthma, diabetes, body mass index (BMI), and pigmentation. The flexible framework of the web application makes it relatively simple to add new questionnaires and for other researchers to collaborate. We anticipate that the study sample will continue to grow and that future analyses may further capitalize on the strengths of the longitudinal data in combination with genetic information.

An online experiment to assess bias in professional medical coding

Background

Multiple studies have documented bias in medical decision making, but no studies have examined whether this bias extends to medical coding practices. Medical coding is foundational to the US health care enterprise. We evaluate whether bias based on patient characteristics influences specific coding practices of professional medical coders.

Methods

This is an online experimental study of members of a national professional medical coding organization. Participants were randomly assigned a set of six clinical scenarios reflecting common medical conditions and asked to report encounter level of service codes for these clinical scenarios. Clinical scenarios differed by patient demographics (race, age, gender, ability) or social context (food insecurity, housing security) but were otherwise identical. We estimated Ordinary Least Squares regression models to evaluate differences in outcome average visit level of service by patient demographic characteristics described in the clinical scenarios; we adjusted for coders’ age, gender, race, and years of coding experience.

Results

The final analytic sample included 586 respondents who coded at least one clinical scenario. Higher mean level of service was assigned to clinical scenarios describing seniors compared to middle-aged patients in two otherwise identical scenarios, one a patient with type II diabetes mellitus (Coef: 0.28, SE: 0.15) and the other with rheumatoid arthritis (Coef: 0.30, SE: 0.13). Charts describing women were assigned lower level of service than men in patients with asthma exacerbation (Coef: -0.25, SE: 0.13) and rheumatoid arthritis (Coef: -0.20, SE: 0.12). There were no other significant differences in mean complexity score by patient demographics or social needs.

Conclusion

We found limited evidence of bias in professional medical coding practice by patient age and gender, though findings were inconsistent across medical conditions. Low levels of observed bias may reflect medical coding workflow and training practices. Future research is needed to better understand bias in coding and to identify effective and generalizable bias prevention practices.

Electronic supplementary material

The online version of this article (10.1186/s12911-019-0832-x) contains supplementary material, which is available to authorized users.

Using Paid and Free Facebook Methods to Recruit Australian Parents to an Online Survey: An Evaluation

Background

The prevalence of social media makes it a potential alternative to traditional offline methods of recruiting and engaging participants in health research. Despite burgeoning use and interest, few studies have rigorously evaluated its effectiveness and feasibility in terms of recruitment rates and costs, sample representativeness, and retention.

Objective

This study aimed to determine the feasibility of using Facebook to recruit employed Australian parents to an online survey about managing work and family demands, specifically to examine (1) recruitment rates and costs; (2) sample representativeness, compared with a population-based cohort of parents; and (3) retention, including demographic and health characteristics of parents who returned to complete a follow-up survey 6 weeks later.

Methods

Recruitment was conducted using 20 paid Facebook advertising campaigns, supplemented with free advertising approaches such as posts on relevant Facebook pages and requests for professional networks to circulate the survey link via Facebook. Recruitment rates and costs were evaluated using the Checklist for Reporting Results of Internet E-Surveys, including view rate, participation rate, completion rate, cost per consent, and cost per completer. Sample representativeness was evaluated by comparing demographic and outcome variables with a comparable sample from the Longitudinal Study of Australian Children including educational attainment, marital status, country of birth, neighborhood disadvantage, work-family conflict, and psychological distress. Retention was evaluated by comparing the number and demographic characteristics of participants at recruitment and at 6-week follow-up.

Results

Recruitment strategies together resulted in 6653 clicks on the survey link, from which 5378 parents consented to participate and 4665 (86.74%) completed the survey. Of those who completed the survey, 85.94% (4009/4665) agreed to be recontacted, with 57.79% (2317/4009) completing the follow-up survey (ie, 43.08% [2317/5378] of parents who consented to the initial survey). Paid Facebook advertising recruited nearly 75% of the sample at Aus $2.32 per completed survey (Aus $7969 spent, 3440 surveys completed). Compared with a population-based sample, participants at baseline were more likely to be university educated (P<.001), experience greater work-family conflict (P<.001) and psychological distress (P<.001), and were less likely to be born outside Australia (P<.001) or live in a disadvantaged neighborhood (P<.001).

Conclusions

Facebook provided a feasible, rapid method to recruit a large national sample of parents for health research. However, some sample biases were observed and should be considered when recruiting participants via Facebook. Retention of participants at 6- to 8-week follow-up was less than half the initial sample; this may reflect limited ongoing participant engagement for those recruited through social media, compared with face-to-face.

Facebook recruitment of smokers: comparing gain- and loss-framed ads for the purposes of an Internet-based smoking cessation intervention

Abstract: Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the “Live Without Tobacco” intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.

Using Facebook for Large-Scale Online Randomized Clinical Trial Recruitment: Effective Advertising Strategies

Targeted Facebook advertising can be an effective strategy to recruit participants for a large-scale online study. Facebook advertising is useful for reaching people in a wide geographic area, matching a specific demographic profile. It can also target people who would be unlikely to search for the information and would thus not be accessible via Google AdWords. It is especially useful when it is desirable not to raise awareness of the study in a demographic group that would be ineligible for the study. This paper describes the use of Facebook advertising to recruit and enroll 1145 women over a 15-month period for a randomized clinical trial to teach support skills to female partners of male smokeless tobacco users. This tutorial shares our study team's experiences, lessons learned, and recommendations to help researchers design Facebook advertising campaigns. Topics covered include designing the study infrastructure to optimize recruitment and enrollment tracking, creating a Facebook presence via a fan page, designing ads that attract potential participants while meeting Facebook's strict requirements, and planning and managing an advertising campaign that accommodates the rapid rate of diminishing returns for each ad.

The Use of Web-Based Technologies in Health Research Participation: Qualitative Study of Consumer and Researcher Experiences

BACKGROUND

Health consumers are often targeted for their involvement in health research including randomized controlled trials, focus groups, interviews, and surveys. However, as reported by many studies, recruitment and engagement of consumers in academic research remains challenging. In addition, there is scarce literature describing what consumers look for and want to achieve by participating in research.

OBJECTIVE

Understanding and responding to the needs of consumers is crucial to the success of health research projects. In this study, we aim to understand consumers' needs and investigate the opportunities for addressing these needs with Web-based technologies, particularly in the use of Web-based research registers and social networking sites (SNSs).

METHODS

We undertook a qualitative approach, interviewing both consumer and medical researchers in this study. With the help from an Australian-based organization supporting people with musculoskeletal conditions, we successfully interviewed 23 consumers and 10 researchers. All interviews were transcribed and analyzed with thematic analysis methodology. Data collection was stopped after the data themes reached saturation.

RESULTS

We found that consumers perceive research as a learning opportunity and, therefore, expect high research transparency and regular updates. They also consider the sources of the information about research projects, the trust between consumers and researchers, and the mobility of consumers before participating in any research. Researchers need to be aware of such needs when designing a campaign for recruitment for their studies. On the other hand, researchers have attempted to establish a rapport with consumer participants, design research for consumers' needs, and use technologies to reach out to consumers. A systematic approach to integrating a variety of technologies is needed.

CONCLUSIONS

On the basis of the feedback from both consumers and researchers, we propose 3 future directions to use Web-based technologies for addressing consumers' needs and engaging with consumers in health research: (1) researchers can make use of consumer registers and Web-based research portals, (2) SNSs and new media should be frequently used as an aid, and (3) new technologies should be adopted to remotely collect data and reduce administrative work for obtaining consumers' consent.

A multi-modal recruitment strategy using social media and internet-mediated methods to recruit a multidisciplinary, international sample of clinicians to an online research study

Background

Challenges exist in recruiting an international sample of clinicians and researchers to an online survey. Traditional recruitment methods remain relevant but issues such as narrow geographical reach, high cost and time intensity limit what can be achieved when aiming to recruit an international, multi-disciplinary sample. Internet-mediated and social media approaches to recruitment and engagement offer new, untested ways of capitalizing upon existing professional networks.

Objective

To develop, use and appraise a multi-modal recruitment strategy for an online, international survey regarding the management of shoulder pain.

Methods

Traditional recruitment methods were combined with internet-mediated recruitment methods to form a multi-modal recruitment strategy. An overview of the development of this three-month recruitment strategy is provided and the value and role of each strand of the recruitment strategy discussed.

Results

In response to the multi-modal recruitment strategy, data was received from 565 clinicians and researchers from 31 countries (64% UK). Complete data was received from 387 respondents with no demographic differences between respondents who completed, and those who started but did not complete the survey. Over 30% of responses were received within 1 week, 50% within 4 weeks and 81% within 8 weeks.

Conclusions

This study shows the acceptability and international, multidisciplinary reach of a low cost multi-modal recruitment strategy for an online survey of international clinicians and researchers. Incorporating the use of social media proved to be an effective, time and resource-efficient recruitment strategy for this online survey and appeared to enhance clinician engagement. A multimodal recruitment strategy is worthy of consideration for future online surveys of clinicians and researchers.

Use of Social Media in the Assessment of Relative Effectiveness: Explorative Review With Examples From Oncology

Background

An element of health technology assessment constitutes assessing the clinical effectiveness of drugs, generally called relative effectiveness assessment. Little real-world evidence is available directly after market access, therefore randomized controlled trials are used to obtain information for relative effectiveness assessment. However, there is growing interest in using real-world data for relative effectiveness assessment. Social media may provide a source of real-world data.

Objective

We assessed the extent to which social media-generated health data has provided insights for relative effectiveness assessment.

Methods

An explorative literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify examples in oncology where health data were collected using social media. Scientific and grey literature published between January 2010 and June 2016 was identified by four reviewers, who independently screened studies for eligibility and extracted data. A descriptive qualitative analysis was performed.

Results

Of 1032 articles identified, eight were included: four articles identified adverse events in response to cancer treatment, three articles disseminated quality of life surveys, and one study assessed the occurrence of disease-specific symptoms. Several strengths of social media-generated health data were highlighted in the articles, such as efficient collection of patient experiences and recruiting patients with rare diseases. Conversely, limitations included validation of authenticity and presence of information and selection bias.

Conclusions

Social media may provide a potential source of real-world data for relative effectiveness assessment, particularly on aspects such as adverse events, symptom occurrence, quality of life, and adherence behavior. This potential has not yet been fully realized and the degree of usefulness for relative effectiveness assessment should be further explored.

Using Twitter to recruit participants for health research: An example from a caregiving study

Twitter has the potential to optimize research conduct, but more research is needed around the nature of study-related tweets and strategies for optimizing reach. In the context of our caregiving study, we aimed to describe the nature and extent of study-related tweets, the extent to which they were shared by others, and their potential reach. To do so, we conducted a secondary analysis of our Twitter recruitment. We aggregated and categorized study-related tweets and analyzed the reach of the 10 most retweeted tweets. Results indicated that of 71 caregivers, 27 were recruited via Twitter. General recruitment tweets were most-shared by users. Tweet reach ranged from 5273 to 62,144 users. Twitter caregivers were demographically comparable to non-Twitter caregivers but had higher Internet proficiency and fewer children. Overall, using a personal Twitter account can expand the reach of study recruitment. Future research should compare different recruitment strategies and explore characteristics that may challenge the heterogeneity of Twitter samples.

Studying Cannabis Use Behaviors With Facebook and Web Surveys: Methods and Insights

The rapid and wide-reaching expansion of internet access and digital technologies offers epidemiologists numerous opportunities to study health behaviors. One particularly promising new data collection strategy is the use of Facebook’s advertising platform in conjunction with Web-based surveys. Our research team at the Center for Technology and Behavioral Health has used this quick and cost-efficient method to recruit large samples and address unique scientific questions related to cannabis use. In conducting this research, we have gleaned several insights for using this sampling method effectively and have begun to document the characteristics of the resulting data. We believe this information could be useful to other researchers attempting to study cannabis use or, potentially, other health behaviors. The first aim of this paper is to describe case examples of procedures for using Facebook as a survey sampling method for studying cannabis use. We then present several distinctive features of the data produced using this method. Finally, we discuss the utility of this sampling method for addressing specific types of epidemiological research questions. Overall, we believe that sampling with Facebook advertisements and Web surveys is best conceptualized as a targeted, nonprobability-based method for oversampling cannabis users across the United States.

The Feasibility of Using Facebook, Craigslist, and Other Online Strategies to Recruit Young African American Women for a Web-Based Healthy Lifestyle Behavior Change Intervention

BACKGROUND

Reports describing successful recruiting of minority participants are available; however, they focus largely on traditional strategies. Internet and mobile devices are widely used, providing alternative approaches, yet less information is available describing the success of these approaches.

OBJECTIVE

This article (1) evaluates the feasibility of using online advertising as a recruiting modality for a healthy lifestyle behavior change intervention targeting young African American women and (2) describes lessons learned to better inform researchers for future directions.

METHODS

African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week randomized study providing physical activity or nutrition behavior change education delivered via online modules. Traditional strategies included flyers, tabletop cards, blood pressure screenings, health fairs, and clinics. Online-related strategies included posting ads on Facebook, Craigslist, and on the university Web site, intranet, and "on-hold" telephone line. Descriptive statistics were used to identify frequency of recruitment strategies. χ Analysis was used to assess differences between enrolled and nonenrolled inquiries.

RESULTS

Among all 176 inquiries, the most frequented strategies were the university Web site (44%), blood pressure screenings (15%), Facebook/Craigslist (13%), and clinics (12%). Enrollment rates differed across recruitment strategies (χ P = .046). The 3 highest enrollment rates were (1) employee in-services (100%), (2) flyers/tabletop cards (31.6%), and (3) word of mouth/physician referral (25%).

CONCLUSION

Online-related strategies are convenient and have great potential for reaching large numbers of people. However, the actual rate of participants successfully enrolled online was proportionally smaller when compared with traditional recruiting strategies.

Assessing Physician and Patient Perceptions of Generic Drugs via Facebook: A Feasibility Study

Background: Social media offer a novel avenue to engage with and recruit research participants. Facebook in particular is a promising option given its popularity and widespread use. Objective: To explore the feasibility of using Facebook to recruit physicians and patients to participate in a survey to assess their perceptions about generic venlafaxine extended release (ER) tablet indicated for depression. Methods: Web-based surveys were developed to gauge physicians’ prescribing experiences with and patients’ perceptions of generic venlafaxine ER tablet. The surveys included questions specific to venlafaxine ER tablets, such as perceived safety and efficacy of the drug and overall comfort level with either prescribing or taking the drug. Survey links were then posted and advertised on Facebook to recruit physicians and patients. Results: Advertisement for physicians reached 1898 Facebook users and advertisement for patients reached 1144 users during a 10-day advertising period. However, only 14 and 35 users clicked on the survey for physicians and patients, respectively. No physician completed the physician survey while 3 patients completed the patient survey. Conclusions: The findings of this study suggest that Facebook may not be an effective method to recruit physicians. Facebook holds promise to recruit patients, but additional recruitment efforts, such as incentives, are needed.

Participants' accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review

Background

Across sub-Saharan Africa (SSA), HIV disproportionately affects men-who-have-sex-with-men (MSM) compared with other men of the same age group in the general population. Access to HIV services remains low among this group although several effective interventions have been documented. It is therefore important to identify what has worked well to increase the reach of HIV services among MSM.

Methods

We searched MEDLINE, POPLINE and the Web of Science databases to collect published articles reporting HIV interventions among MSM across sub-Saharan Africa. Covidence was used to review the articles. The review protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) - CRD42017060808.

Results

The search identified 2627 citations, and following removal of duplicates and inclusion and exclusion criteria, only 15 papers were eligible for inclusion in the review. The articles reported various accrual strategies, namely: respondent driven sampling, known peers identified through hotspot or baseline surveys, engagement with existing community-based organizations, and through peer educators contacting MSM in virtual sites. Some programs, however, combined some of these accrual strategies. Peer-led outreach services were indicated to reach and deliver services to more MSM. A combination of peer outreach and mobile clinics increased uptake of health information and services. Health facilities, especially MSM-friendly facilities attract access and use of services by MSM and retention into care.

Conclusions

There are various strategies for accrual and delivering services to MSM across SSA. However, each of these strategies have specific strengths and weaknesses necessitating combinations of interventions and integration of the specific context to inform implementation. If the best of intervention content and implementation are used to inform these services, sufficient coverage and impact of HIV prevention and treatment programs for MSM across SSA can be optimized.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5303-2) contains supplementary material, which is available to authorized users.

Interest in web-based treatments for postpartum anxiety: an exploratory survey

OBJECTIVE

This study aimed to explore women's interest in web-based treatments for postpartum anxiety and determine the feasibility of reaching women with postpartum anxiety online.

BACKGROUND

Anxiety in the postpartum period is common and often untreated. One innovative approach of offering treatment during this period is through web-based self-help. Assessing women's interest in new treatments, such as a web-based self-help, is an important step prior to development efforts.

METHODS

A cross-sectional online survey was created and promoted for 4 months via unpaid social media posts (Facebook and Twitter). To be eligible, women had to be over the age of 18, live in England, fluent in English, be within 12 months postpartum and self-report at least mild levels of anxiety.

RESULTS

A sample of 114 eligible women were recruited. The majority were Caucasian, well-educated, middle-class women. Seventy percent reported moderate or severe anxiety. Sixty-one percent of women expressed interest in web-based postpartum anxiety treatments. Women preferred treatment in a smartphone/tablet application format, presented in brief modules and supported by a therapist via email or chat/instant messaging.

CONCLUSIONS

Based on the stated preferences of participating women it is recommended that postpartum anxiety web-based treatments include different forms of therapist support and use a flexibly accessible smartphone/tablet application format with content split into short sections. The findings also suggest that unpaid social media can be feasible in reaching women with postpartum anxiety, but additional efforts are needed to reach a more diverse population.

Evaluation of second step child protection videos: A randomized controlled trial

This randomized controlled trial (RCT) examined the effects of the Second Step Child Protection Unit videos on parents' knowledge, motivation, and self-reported communication with their child about personal safety and childhood sexual abuse prevention. Parents of children between the ages of 3-11 years were randomly assigned to the intervention (watching the Second Step videos) or the control (watching videos on child obesity) groups. They completed measures assessing their knowledge of child sexual abuse (CSA), motivation to discuss CSA, self-reported discussions of CSA, child history of victimization, parent exposure to CSA, and comparable measures on topics of health and nutrition at pre-test. Participants viewed the videos one week later and immediately completed post-test 1, and then two months later completed the measures again. Multivariate Analyses of Covariance (MANCOVAs) and serial mediation analyses were conducted with the final sample of 438. The intervention group, compared to the control group, had significant increases in knowledge (specifically, less restrictive stereotype beliefs about CSA) and motivation to talk with their children about CSA both immediately after the intervention and at the two-month follow-up. Although the intervention did not have a direct effect on parent self-reported conversations with their children about CSA, it had a mediated effect. The intervention increased knowledge regarding CSA, which then predicted motivation, which in turn predicted conversations. The most pronounced effect was the intervention's direct effect of increasing motivation immediately after the intervention, which then increased self-reported conversations with children about personal safety and CSA two months later.

Using Facebook to Recruit Young Australian Men Into a Cross-Sectional Human Papillomavirus Study

Background

Young men can be difficult to engage in health research using traditional methods of recruitment. Social networking sites are increasingly being used to recruit participants into health research, due to their cost effectiveness, overall generalizability, and wide reach.

Objective

The aim of this study was to determine the feasibility of using Facebook to recruit young Australian men into a human papillomavirus (HPV) prevalence study.

Methods

We recruited male permanent residents of Australia, aged 18 to 35 years, into the HPV in Young Males (HYM) study through targeted advertising placed on Facebook. Consenting participants completed an online questionnaire and provided a self-collected penile swab for HPV DNA detection and genotyping. We compared sociodemographic characteristics of the study population with those of the general Australian male population, based on Australian 2011 census data.

Results

Between February 2015 and February 2017, targeted Facebook advertisements reached 1,523,239 men, resulting in 41,811 clicks through to the study website, with 1072 (2.56%) converting to lodgment of an expression of interest. Of these, 681 (63.53%) provided written informed consent and 535 (78.6% of recruited participants) completed all the study requirements. Reasons for participating in the study included altruism, past history of HPV, gaining more knowledge about HPV or the vaccine, working in the health industry, and the monetary compensation. The average advertising cost per completed study participant was Aus $48. Compared with the census population, HYM study participants were more likely to be Australian born (P<.001), be from Victoria (P=.003) or the Australian Capital Territory (P=.004), reside in a major city (P<.001), and have completed undergraduate (P<.001) or postgraduate education (P<.001). HYM study participants were less likely to report being a current smoker (P=.03), but were more likely to identify as bisexual or homosexual (294/529, 55.6%, P<.001), than the general population.

Conclusions

Using Facebook is a feasible and efficient strategy for the recruitment of men from across Australia for HPV testing. This method could be used for monitoring the impact of HPV vaccination. Additional targeting may achieve a sample that is broadly demographically representative of the Australian population. Future research should explore how the sexual risk behavior characteristics of populations recruited through Facebook compare with those of traditional recruitment methods.

The Use of Facebook in Recruiting Participants for Health Research Purposes: A Systematic Review

BACKGROUND

Social media is a popular online tool that allows users to communicate and exchange information. It allows digital content such as pictures, videos and websites to be shared, discussed, republished and endorsed by its users, their friends and businesses. Adverts can be posted and promoted to specific target audiences by demographics such as region, age or gender. Recruiting for health research is complex with strict requirement criteria imposed on the participants. Traditional research recruitment relies on flyers, newspaper adverts, radio and television broadcasts, letters, emails, website listings, and word of mouth. These methods are potentially poor at recruiting hard to reach demographics, can be slow and expensive. Recruitment via social media, in particular Facebook, may be faster and cheaper.

OBJECTIVE

The aim of this study was to systematically review the literature regarding the current use and success of Facebook to recruit participants for health research purposes.

METHODS

A literature review was completed in March 2017 in the English language using MEDLINE, EMBASE, Web of Science, PubMed, PsycInfo, Google Scholar, and a hand search of article references. Papers from the past 12 years were included and number of participants, recruitment period, number of impressions, cost per click or participant, and conversion rate extracted.

RESULTS

A total of 35 studies were identified from the United States (n=22), Australia (n=9), Canada (n=2), Japan (n=1), and Germany (n=1) and appraised using the Critical Appraisal Skills Programme (CASP) checklist. All focused on the feasibility of recruitment via Facebook, with some (n=10) also testing interventions, such as smoking cessation and depression reduction. Most recruited young age groups (16-24 years), with the remaining targeting specific demographics, for example, military veterans. Information from the 35 studies was analyzed with median values being 264 recruited participants, a 3-month recruitment period, 3.3 million impressions, cost per click of US $0.51, conversion rate of 4% (range 0.06-29.50), eligibility of 61% (range 17-100), and cost per participant of US $14.41. The studies showed success in penetrating hard to reach populations, finding the results representative of their control or comparison demographic, except for an over representation of young white women.

CONCLUSIONS

There is growing evidence to suggest that Facebook is a useful recruitment tool and its use, therefore, should be considered when implementing future health research. When compared with traditional recruitment methods (print, radio, television, and email), benefits include reduced costs, shorter recruitment periods, better representation, and improved participant selection in young and hard to reach demographics. It however, remains limited by Internet access and the over representation of young white women. Future studies should recruit across all ages and explore recruitment via other forms of social media.

"Just not all ice users do that": investigating perceptions and potential harms of Australia's Ice Destroys Lives campaign in two studies

Background

In 2015, the Australian government launched the media campaign Ice Destroys Lives targeting crystal methamphetamine use. Previous research indicates mass media campaigns may have harmful effects for people engaged in drug use. This study investigated perceptions and harms of Ice Destroys Lives among adults with a history of injecting drugs and young people.

Methods

This analysis includes data from two studies: an online questionnaire with young people and in-depth interviews with adults who use crystal methamphetamine. Young people from Victoria, Australia, were recruited through Facebook. We collected data on drug use, campaign recognition and behaviours. Participants who recognised the campaign indicated whether they agreed with five statements related to Ice Destroys Lives. We compared campaign perceptions between young people who reported ever using crystal methamphetamine and those who did not. Adults who use crystal methamphetamine were sampled from the Melbourne injecting drug user cohort study. We asked participants if they recognised the campaign and whether it represented their experiences.

Results

One thousand twenty-nine young people completed the questionnaire; 71% were female, 4% had used crystal methamphetamine and 69% recognised Ice Destroys Lives. Three quarters agreed the campaign made them not want to use ice. Ever using crystal methamphetamine was associated with disagreeing with three statements including this campaign makes you not want to use ice (adjusted odds ratio (AOR) = 4.3, confidence interval (CI) = 1.8–10.0), this campaign accurately portrays the risks of ice use (AOR = 3.2, CI = 1.4–7.6) and this campaign makes you think that people who use ice are dangerous (AOR = 6.6, CI = 2.2–19.8). We interviewed 14 people who used crystal methamphetamine; most were male, aged 29–39 years, and most recognised the campaign. Participants believed Ice Destroys Lives misrepresented their experiences and exaggerated “the nasty side” of drug use. Participants felt the campaign exacerbated negative labels and portrayed people who use crystal methamphetamine as “violent” and “crazy”.

Conclusion

In our study, Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign also reinforced negative stereotypes and did not encourage help seeking. Alternative evidence-based strategies are required to reduce crystal methamphetamine-related harms.

Recruitment and retention of young adult veteran drinkers using Facebook

The objective of this study was to describe the feasibility of using Facebook as a platform to recruit and retain young adult veteran drinkers into an online-alcohol use intervention study. Facebook's wide accessibility and popularity among the age group that comprises the majority of veterans from the conflicts in Iraq and Afghanistan make it a compelling resource through which research can extend its reach to this otherwise hard-to-reach group. We developed a series of Facebook advertisement campaigns to reach veteran drinkers not specifically searching for alcohol treatment. In doing so, we recruited 793 valid veteran participants in approximately two weeks for an advertising cost of $4.53 per obtained participant. The study sample consisted primarily of male veterans, between 19 and 34 years of age, who were drinking at moderate to heavy levels. Although about half of the sample reported mental health comorbidity, few had received any mental health or substance use treatment in the past year. Facebook appears to be a valuable mechanism through which to recruit young veterans with unmet behavioral health needs, although more specific efforts may be needed to engage certain types of veterans after initial study enrollment.

Costs and Efficiency of Online and Offline Recruitment Methods: A Web-Based Cohort Study

BACKGROUND

The Internet is widely used to conduct research studies on health issues. Many different methods are used to recruit participants for such studies, but little is known about how various recruitment methods compare in terms of efficiency and costs.

OBJECTIVE

The aim of our study was to compare online and offline recruitment methods for Internet-based studies in terms of efficiency (number of recruited participants) and costs per participant.

METHODS

We employed several online and offline recruitment methods to enroll 18- to 45-year-old women in an Internet-based Danish prospective cohort study on fertility. Offline methods included press releases, posters, and flyers. Online methods comprised advertisements placed on five different websites, including Facebook and Netdoktor.dk. We defined seven categories of mutually exclusive recruitment methods and used electronic tracking via unique Uniform Resource Locator (URL) and self-reported data to identify the recruitment method for each participant. For each method, we calculated the average cost per participant and efficiency, that is, the total number of recruited participants.

RESULTS

We recruited 8252 study participants. Of these, 534 were excluded as they could not be assigned to a specific recruitment method. The final study population included 7724 participants, of whom 803 (10.4%) were recruited by offline methods, 3985 (51.6%) by online methods, 2382 (30.8%) by online methods not initiated by us, and 554 (7.2%) by other methods. Overall, the average cost per participant was €6.22 for online methods initiated by us versus €9.06 for offline methods. Costs per participant ranged from €2.74 to €105.53 for online methods and from €0 to €67.50 for offline methods. Lowest average costs per participant were for those recruited from Netdoktor.dk (€2.99) and from Facebook (€3.44).

CONCLUSIONS

In our Internet-based cohort study, online recruitment methods were superior to offline methods in terms of efficiency (total number of participants enrolled). The average cost per recruited participant was also lower for online than for offline methods, although costs varied greatly among both online and offline recruitment methods. We observed a decrease in the efficiency of some online recruitment methods over time, suggesting that it may be optimal to adopt multiple online methods.

Challenges to translating new media interventions in community practice: a sexual health SMS program case study

Issue addressed Herein we discuss translational challenges for new media interventions, using the Sexual Health & Youth (SHY) short message service (SMS) project to illustrate particular challenges relating to recruitment and evaluation. Methods Following the delivery of an SMS sexual health program, available documents (progress reports, communications with project staff, ethics submissions and reporting) were analysed thematically to elucidate the barriers to recruitment, implementation and evaluation. Results Despite being framed by evidence-based research, the project had little impact on the intended population. Only 119 of an expected 5100 young people (2%) enrolled to receive SMS messages. Program documents highlighted the difficulty of recruiting participants for new media interventions. Key issues identified in recruitment included under-resourcing, delays waiting to receive ethics approval and challenges of school-based recruitment. Conclusion The minimal impact of the SHY program illustrates the need for improved research translation in the field of new media interventions. It is important that recruitment procedures align with the convenience and appeal of mobile phone-based interventions. So what? New media research is not always easily translated into community settings. Large-scale recruitment requires adequate resourcing and careful planning, even for low-cost mobile interventions. Stronger formative research, documentation and use of partnerships are essential for successful implementation. Researchers must also consider translation in planning and disseminating their work.

Self-care management strategies used by Black women who self-report consistent adherence to antihypertensive medication

BACKGROUND

Black women in the USA have the highest prevalence rate of hypertension (HTN) contributing to a higher risk of organ damage and death. Research has focused primarily on poorly controlled HTN, negative belief systems, and nonadherence factors that hinder blood pressure control. No known research studies underscore predominantly Black women who report consistent adherence to their antihypertensive medication-taking. The purpose of this study was to describe self-care management strategies used by Black women who self-report consistent adherence to their antihypertensive medication and to determine the existence of further participation in lifestyle modifications, such as eating a healthy diet and increasing physical activity.

METHODS

Using a qualitative descriptive design, four focus groups with a total of 20 Black women aged 25-71 years were audio-taped. Transcripts were analyzed using qualitative content analysis. Participants were included in the study if they scored perfect adherence on the medication subscale of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.

RESULTS

Medication adherence was predicated on three themes: HTN experience, involvement with treatment regimen, and a strong motivated mentality. Black women would benefit from treatment approaches that are sensitive to 1) diverse emotional responses, knowledge levels, and life experiences; 2) two-way communication and trusting, collaborative relationships with active involvement in the treatment regimen; 3) lifestyle modifications that focus on health benefits and individual preferences; and 4) spiritual/religious influences on adherence.

CONCLUSION

The use of self-care management strategies to enhance antihypertensive medication adherence is key to adequate blood pressure control and the reduction of cardiovascular events. This study provides preliminary insight for future research to develop interventions to aid those Black women who struggle with medication adherence and are disproportionately impacted by HTN.

Using Internet to recruit immigrants with language and culture barriers for tobacco and alcohol use screening: a study among Brazilians

Limited English proficient (LEP) individuals face disparities in accessing substance abuse treatment, but little is known on how to reach this population. This study aimed to test online recruitment methods for tobacco and alcohol screening among LEP Portuguese speakers. The study was advertised in Portuguese using Facebook, Google, online newsletters and E-mail. Participants clicked ads to consent and access a screening for tobacco and alcohol dependence. Ads yielded 690 screening responses in 90 days. Respondents had a mean age of 42.7 (SD 12), with a higher proportion of women than men, 95% born in Brazil with high levels of LEP and low levels of acculturation. Facebook ads yielded 41.4% of responses, and were the lowest cost recruitment channel ($8.9, $31.10 and $20.40 per respondent, hazardous drinker and smoker, respectively). Online recruitment of LEP populations is feasible. Future studies should test similar strategies in other LEP groups.