Social media and internet driven study recruitment: evaluating a new model for promoting collaborator engagement and participation

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Methods

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

Results

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

Conclusion

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

Risk Classification for Interstitial Cystitis/Bladder Pain Syndrome Using Machine Learning Based Predictions

OBJECTIVE

To improve diagnosis of interstitial cystitis (IC)/bladder pain syndrome(IC) we hereby developed an improved IC risk classification using machine learning algorithms.

METHODS

A national crowdsourcing resulted in 1264 urine samples consisting of 536 IC (513 female, 21 male, 2 unspecified), and 728 age-matched controls (318 female, 402 male, 8 unspecified) with corresponding patient-reported outcome (PRO) pain and symptom scores. In addition, 296 urine samples were collected at three academic centers: 78 IC (71 female, 7 male) and 218 controls (148 female, 68 male, 2 unspecified). Urinary cytokine biomarker levels were determined using Luminex assay. A machine learning predictive classification model, termed the Interstitial Cystitis Personalized Inflammation Symptom (IC-PIS) Score, that utilizes PRO and cytokine levels, was generated and compared to a challenger model.

RESULTS

The top-performing model using biomarker measurements and PROs (area under the curve [AUC]=0.87) was a support vector classifier, which scored better at predicting IC than PROs alone (AUC=0.83). While biomarkers alone (AUC=0.58) did not exhibit strong predictive performance, their combination with PROs produced an improved predictive effect.

CONCLUSION

IC-PIS represents a novel classification model designed to enhance the diagnostic accuracy of IC/bladder pain syndrome by integrating PROs and urine biomarkers. The innovative approach to sample collection logistics, coupled with one of the largest crowdsourced biomarker development studies utilizing ambient shipping methods across the US, underscores the robustness and scalability of our findings.

A qualitative study on tobacco use during the COVID-19 pandemic in Lebanon: Waterpipe and cigarette smokers' views, risk perceptions, and behaviors

INTRODUCTION

Since the beginning of the COVID-19 pandemic, a growing number of studies have documented more severe COVID-19 symptoms and worse outcomes among smokers compared to non-smokers. The aim of this research is to understand the views, risk perceptions, and behaviors of Lebanese adult smokers during the pandemic.

METHODS

We conducted 18 qualitative online structured interviews with adults who smoke cigarettes and waterpipe tobacco residing in Lebanon from November 2020 through April 2021. Participants were recruited predominantly via paid social media ads. Interviews were audio-recorded using Zoom software then transcribed verbatim. Data were analyzed thematically.

RESULTS

The findings showed three main themes: changes to smoking behaviors, concerns over the susceptibility and severity of COVID-19, and using coping methods to protect smokers from COVID-19. Although there was an increased risk perception of COVID-19 in relation to smoking, most participants reported an increase in smoking. Instead of being encouraged to quit, participants developed coping strategies against COVID-19 while smoking.

CONCLUSIONS

Smoking behavior did not seem to decrease during the COVID-19 pandemic. To support cessation initiatives and raise awareness, effective health messaging aimed at smokers is pivotal. Smoking cessation programs need to be better equipped at supporting people who smoke in finding healthier coping mechanisms during a pandemic. Moreover, policies to regulate the propagation of misinformation are required to prevent the development of a false sense of safety and protection from COVID-19.

A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project

Background

This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions.

Methods

A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework.

Results

Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme.

Conclusion

Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

Where Do Oncology Patients Seek and Share Health Information? Survey Study

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"It's a lot more complicated than it seems": physiotherapists' experiences of using compensation strategies in people with Parkinson's

Background

Gait disturbances often result in functional limitations in daily activities and negatively impact the quality of life in people with Parkinson's disease. Physiotherapists often employ compensation strategies in an attempt to improve patients' walking. However, little is known about physiotherapists' experiences in this regard. We evaluated how physiotherapists adopt compensation strategies and what they draw on to inform their clinical decision-making.

Methods

We carried out semi-structured online interviews with 13 physiotherapists with current or recent experience working with people with Parkinson's disease in the United Kingdom. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was utilized.

Results

Two main themes were developed from the data. The first theme, optimizing compensation strategies through personalized care, shows how physiotherapists accounted for the individual needs and characteristics of people with Parkinson's, which resulted in them individually tailoring compensation strategies. The second theme, delivering compensation strategies effectively, considers the available support and perceived challenges with work settings and experience that impact physiotherapists' ability to deliver compensation strategies.

Discussion

Although physiotherapists strived to optimize compensation strategies, there was a lack of formal training in this area, and their knowledge was primarily acquired from peers. Furthermore, a lack of specific knowledge on Parkinson's can impact physiotherapists' confidence in maintaining person-centered rehabilitation. However, the question that remains to be answered is what accessible training could address the knowledge-practice gap to contribute to the delivery of better-personalized care for people with Parkinson's.

Understanding Determinants of Electronic Cigarette and Heated Tobacco Product Use among Young Adults in Lebanon: Prevention and Policy Implications

In line with the global trends, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) have found their way to the Lebanese market. The present study aims to explore the determinants of e-cigarette and HTP use among young adults in Lebanon. Convenience and snowball sampling were used to recruit participants aged 18-30 residing in Lebanon, who were familiar with e-cigarettes products. Twenty-one consenting participants were interviewed via Zoom and the verbatim transcriptions were analyzed thematically. The outcome expectancy theory was used to categorize the results into determinants and deterrents of use. HTPs were viewed by participants as another mode of smoking. The results showed that most participants perceived e-cigarettes and HTPs to be healthier alternatives to cigarettes/waterpipes and to be used as smoking cessation tools. Both e-cigarettes and HTPs were found to be easily accessible in Lebanon; although, in the recent economic crisis, e-cigarettes have become unaffordable. More research is needed to investigate the motivations and behaviors of e-cigarette and HTP users if effective policies and regulations are to be developed and enforced. Furthermore, greater public health efforts need to be made to increase awareness of the harmful impacts of e-cigarettes and HTPs and to implement evidence-based cessation programs tailored to those modes of smoking.

Promoting the Participation of "Hard-to-Reach" Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile

The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit "hard-to-reach" international migrants for qualitative public health research during the pandemic in Chile, based on the authors' experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.

Comparing online crowdsourcing with clinic patient enrollment: Findings from the IP4IC Study on interstitial cystitis/bladder pain syndrome

Introduction

Interstitial cystitis/bladder pain syndrome (IC/BPS) manifests as urinary symptoms including urgency, frequency, and pain. The IP4IC Study aimed to establish a urine-based biomarker score for diagnosing IC/BPS. To accomplish this objective, we investigated the parallels and variances between patients enrolled via physician/hospital clinics and those recruited through online crowdsourcing.

Methods

Through a nationwide crowdsource effort, we collected surveys from patients with history of IC/BPS. Study participants were asked to complete the validated instruments of Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), as well as provide demographic information. We then compared the survey responses of patients recruited through crowdsourcing with those recruited from three specialized tertiary care urology clinics engaged in clinical research.

Results

Survey responses of 1300 participants were collected from all 50 states of the USA via crowdsourcing and 319 from a clinical setting. ICSI and ICPI were similar for IC/BPS patients diagnosed by the physicians in clinic and self-reported by subjects via crowdsourcing stating they have a history of previous physician diagnosis of IC/BPS. Surprisingly, ICSI and ICPI were significantly lower in crowdsourced control than in-clinic control subjects.

Conclusion

The IP4IC Study provides valuable insights into the similarities and differences between patients recruited through clinics and those recruited through online crowdsourcing. There were no significant differences in disease symptoms among these groups. Individuals who express an interest in digital health research and self-identify as having been previously diagnosed by physicians with IC/BPS can be regarded as reliable candidates for crowdsourcing research.

Knowledge and Attitudes of Saudi Medical Students about Emergency Management of Traumatic Dental Injuries

Several studies indicate that physicians lack emergency management knowledge concerning traumatic dental injuries (TDIs), emphasizing the fact that medical students are not taught about this topic. This study aimed to assess the basic knowledge and attitudes of medical students in Saudi Arabia about emergency TDI management. This cross-sectional study recruited a convenience sample of medical students in their clinical years through social networking sites and asked them to answer a pretested internationally accepted questionnaire that included demographic questions, two case scenarios about crown fractures and avulsion of permanent teeth, and self-assessment questions. The data were analyzed statistically using descriptive statistics and the chi-squared test (p < 0.05). A total of 761 medical students responded. Only 5.8% of the students reported receiving information about TDIs in their curriculum. Medical students, mainly those ready to graduate, were more knowledgeable of the emergency management of a crown fractured permanent tooth than an avulsed permanent tooth (p < 0.0001). However, more than half of the students were unable to differentiate between a primary versus permanent fractured tooth and would manage an avulsed primary or permanent tooth similarly. Regarding students' attitudes, less than one-quarter of the students (13.5%) were confident about diagnosing TDIs and/or providing emergency management when required (18.1%). Furthermore, only about one-tenth of the students (9.3%) were satisfied with their self-perceived knowledge, and most (71%) reported needing further education about the topic. Medical students in Saudi Arabia have insufficient knowledge about the emergency management of TDIs. Gaps in students' knowledge of emergency management of avulsion injury were identified in addition to their low confidence level to either diagnose or immediately treat TDIs if required. Students felt dissatisfied with their current knowledge level, this being most prominent among graduating students. There is a need to elaborate the undergraduate medical curriculum in Saudi Arabia to include emergency management of TDIs.

Using Social Media for Clinical Research: Recommendations and Examples From the Brown-Lifespan Center for Digital Health

Social media integration into research has increased, and 92% of American social media participants state they would share their data with researchers. Yet, the potential of these data to transform health outcomes has not been fully realized, and the way clinical research is performed has been held back. The use of these technologies in research is dependent on the investigators' awareness of their potential and their ability to innovate within regulatory and institutional guidelines. The Brown-Lifespan Center for Digital Health has launched an initiative to address these challenges and provide a helpful framework to expand social media use in clinical research.

Recruitment and retention in mobile application-based intervention studies: a critical synopsis of challenges and opportunities

Use of mobile health applications (mHealth apps) is becoming increasingly popular for the management of chronic illnesses, but mHealth-based intervention studies often have limitations associated with subject recruitment and retention. In this synopsis, we focus on targeted aspects of mHealth-based intervention studies, specifically: (i) subject recruitment, (ii) cohort sizes, and (iii) retention rates. We used the Google Scholar (meta-search) and Galileo search engines to identify sample articles focusing on mHealth apps and interventions published between 2010 and 2020 and selected 21 papers for detailed review. Most studies recruited relatively small cohorts (minimum: 20, maximum: 510). Retention rates had high variance with only five studies managing >80% subject retention throughout the study duration, 10.4% being the lowest. Eighty-five percent of the studies expressed concerns regarding study duration, app usage, and lack of proper implementation. The use of mHealth interventions generally yielded positive outcomes, but most studies discussed facing challenges associated with recruitment and retention. There is a clear need to identify strategies for recruiting larger cohorts and improving retention rates, and ultimately increasing the reliability of mHealth app-based intervention studies. We advise that potential underutilized opportunities lie at the intersection of mHealth and social media to address the limitations identified in the synopsis.

Facebook recruitment for research of children and parents during the COVID-19 pandemic

The COVID-19 pandemic has created unique challenges for recruitment of adults and children into clinical research. The sudden onset of stay-at-home orders and social distancing enacted in much of the United States created sudden barriers for researchers to recruit participants in-person. Recognizing the critical need to understand the impact of COVID-19 on children and families in real time, studies required an alternative approach. The present study sought to develop methods and establish the feasibility of utilizing Facebook's targeted advertising to enroll schoolaged children and their parents for a study examining the impact of the COVID-19 pandemic on families.

This study used an 8 week pay-per-click advertisement approach via Facebook for research recruitment. Parents of children age 8 to 17 were invited and asked to include their child. Standardized measures were included for parents and children. Zip code targeting was used to increase diversity in participants.

The ad campaign reached 213,120, yielding 3563 clicks, 684 parent participants, 494 child participants and a 26% conversion rate over eight weeks. The cost-per-click was $0.64, and cost-per-participant was $3.30 and $4.60 for parents and children, respectively.

This nationwide study successfully used social media to recruit a robust nationwide sample of parent-child dyads during the COVID-19 pandemic. Social media recruitment mitigated typical time and engagement barriers for participants while also circumventing social and physical distancing orders due to the pandemic which allowed for real time assessment of the pandemic's effects on families. Future consideration should be given.to social media as a research recruitment methodology.

Using social media to crowdsource collection of urine samples during a national pandemic

The COVID-19 pandemic and subsequent lockdown had a substantial impact on normal research operations. Researchers needed to adapt their methods to engage at-home participants. One method is crowdsourcing, in which researchers use social media to recruit participants, gather data, and collect samples. We utilized this method to develop a diagnostic test for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Participants were recruited via posts on popular social-media platforms, and enrolled via a website. Participants received and returned a mail kit containing bladder symptom surveys and a urine sample cup containing room-temperature preservative. Using this method, we collected 1254 IC/BPS and control samples in 3 months from all 50 United States. Our data demonstrate that crowdsourcing is a viable alternative to traditional research, with the ability to reach a broad patient population rapidly. Crowdsourcing is a powerful tool for at-home participation in research, particularly during the lockdown caused by the COVID-19 pandemic.

Rapid deployment of a community engagement study and educational trial via social media: implementation of the UC-COVID study

Background

In response to the COVID-19 pandemic and associated adoption of scarce resource allocation (SRA) policies, we sought to rapidly deploy a novel survey to ascertain community values and preferences for SRA and to test the utility of a brief intervention to improve knowledge of and values alignment with a new SRA policy. Given social distancing and precipitous evolution of the pandemic, Internet-enabled recruitment was deemed the best method to engage a community-based sample. We quantify the efficiency and acceptability of this Internet-based recruitment for engaging a trial cohort and describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools.

Methods

We recruited 1971 adult participants (≥ 18 years) via engagement with community partners and organizations and outreach through direct and social media messaging. We quantified response rate and participant characteristics of our sample, examine sample representativeness, and evaluate potential non-response bias.

Results

Recruitment was similarly derived from direct referral from partner organizations and broader social media based outreach, with extremely low study entry from organic (non-invited) search activity. Of social media platforms, Facebook was the highest yield recruitment source. Bot activity was present but minimal and identifiable through meta-data and engagement behavior. Recruited participants differed from broader populations in terms of sex, ethnicity, and education, but had similar prevalence of chronic conditions. Retention was satisfactory, with entrance into the first follow-up survey for 61% of those invited.

Conclusions

We demonstrate that rapid recruitment into a longitudinal intervention trial via social media is feasible, efficient, and acceptable. Recruitment in conjunction with community partners representing target populations, and with outreach across multiple platforms, is recommended to optimize sample size and diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.

Trial registration

ClinicalTrials.gov NCT04373135. Registered on May 4, 2020

Peer Mentors for People with Advanced Cancer: Lessons Learnt from Recruiting and Training Peer Mentors for a Feasibility Randomized Controlled Trial

Peer mentors may offer distinctive forms of support to people with advanced cancer. Whilst peer mentor programmes are known, little is understood about recruiting and training peer mentors to support those with advanced cancer. The purpose of this study is to determine the feasibility of recruiting and training peer mentors for a novel peer mentor intervention to promote well-being in people with advanced cancer. Feasibility study testing proactive introduction to a trained peer mentor for 12 weeks in the context of a randomized controlled two-arm trial and nested qualitative process evaluation was used. Peer mentors have/had cancer, recruited via an open call. Two-day training included a new bespoke module on coping with cancer. Descriptive recruitment and training data were captured, supplemented by qualitative interviews, analysed thematically. Forty-eight people expressed interest, mostly female (69%), with breast cancer (32%), and recruited via social media (49%). Twelve people completed training, with attrition often due to availability or mentors' own health; many had advanced cancer themselves. They wanted to 'give something back', but also formed supportive bonds with fellow mentors. It is feasible to recruit and train people with lived experience of cancer to be peer mentors, but those with particular characteristics may predominate. Broad social media based recruitment may have merit in widening the pool of potential peer mentors.

Social Media as a Platform for Recruitment to a National Survey During the COVID-19 Pandemic: Feasibility and Cost Analysis

Background

With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample.

Objective

This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic.

Methods

Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data.

Results

In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19).

Conclusions

Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age.

Rapid Deployment of A Community Engagement Study And Educational Trial Via Social Media: Implementation of The UC-COVID Study

Background:

In response to the COVID-19 pandemic and associated adoption of scarce resource allocation (SRA) policies, we sought to rapidly deploy a novel survey to ascertain community values and preferences for SRA, and to test the utility of a brief intervention to improve knowledge of and values alignment with a new SRA policy. Given social distancing and precipitous evolution of the pandemic, Internet enabled recruitment was deemed the best method to engage a community-based sample. We quantify the efficiency and acceptability of this Internet-based recruitment for engaging a trial cohort and describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools.

Methods:

We recruited 1,971 adult participants (≥18 years) via engagement with community partners and organizations and outreach through direct and social media messaging. We quantified response rate and participant characteristics of our sample, examine sample representativeness, and evaluate potential non-response bias.

Results:

Recruitment was similarly derived from direct referral from partner organizations and broader social media based outreach, with extremely low study entry from organic (non-invited) search activity. Of social media platforms, Facebook was the highest yield recruitment source. Bot activity was present but minimal and identifiable through meta-data and engagement behavior. Recruited participants differed from broader populations in terms of sex, ethnicity, and education, but had similar prevalence of chronic conditions. Retention was satisfactory, with entrance into the first follow-up survey for 61% of those invited.

Conclusions:

We demonstrate that rapid recruitment into a longitudinal intervention trial via social media is feasible, efficient, and acceptable. Recruitment in conjunction with community partners representing target populations, and with outreach across multiple platforms, is recommended to optimize sample size and diversity. Trial implementation, engagement tracking, engagement and retention are feasible with off-the-shelf tools using preexisting platforms.

Trial Registration:

ClinicalTrials.gov registration NCT04373135.

Utilisation of outcome measures in the management of non-specific neck pain: A national survey of current physiotherapy practice in the UK

BACKGROUND

Routine utilisation of outcome measures (OMs) is an integral part of physiotherapy rehabilitation when managing non-specific neck pain (NSNP). Numerous relevant OMs exist; however, the extent to which OMs are used by physiotherapists in the UK for NSNP is unknown.

OBJECTIVE

To determine current utilisation patterns of OMs in UK physiotherapy practice when managing NSNP.

METHODS

An online web-based survey instrument was developed and physiotherapists were invited to participate if they were currently practicing in the UK and had some experience of managing patients with neck pain. Logistic regression analyses using the generalised linear models was carried out to identify characteristics associated with OMs utilisation.

RESULTS

A total of 2101 surveys were completed. One-third of the respondents reported not using OMs when managing NSNP. Lack of time and clear guidance about the suitability of available OMs were the most commonly reported reasons. A majority of the two-thirds of those who reported using OMs were consistently using pain and range of motion rating measures. Physical/functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NSNP, were rarely measured. Years of practice (p = 0.000), nation (p = 0.019) and proportion of patients with neck pain (p = 0.034) variables were found to be independently associated with frequent use of OMs.

CONCLUSION

This survey established the poor integration of OMs in the UK when managing NSNP. Further attention is required to identify or develop OMs which are feasible for use in busy clinical practice and to market them more effectively to physiotherapists.

The Impact of COVID-19 on Dual-Physician Couples: A Disproportionate Burden on Women Physicians

Background: Currently, physicians face an unprecedented crisis with the novel coronavirus disease 2019 (COVID-19) pandemic. The impact of the pandemic on dual-physician households remains unknown. In this survey study, we examined the impact of the COVID-19 pandemic on dual-physician families and described gendered differences related to the impact of the pandemic. Methods: This was a cross-sectional survey distributed via e-mail and social media, with results collected from April 30, 2020 until May 26, 2020. Respondents were members of a dual-physician couple. Respondents provided information on demographic characteristics and the impact of the pandemic on their professional lives, personal lives, and well-being. Categorical variables were compared using chi-squared or Fisher's exact test. Ordinal variables were compared between genders using Cochran-Armitage trend test. Feeling emotionally and physically drained compared to pre-pandemic was analyzed as a binary outcome in a multivariable logistic model. Results: Of the 1799 physicians who completed the survey, 52% were between 30 and 39 years old, 81% self-identified as women, and 62% were white. Women were more likely to report increased worry about their job security, finances, personal health, partner's health, and children's health (p = 0.02, p = 0.01, p < 0.001, p < 0.001, and p < 0.001, respectively). Seventy-eight percent of respondents reported feeling more drained during the pandemic. Multivariable analysis revealed that female gender (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7-3.3, p < 0.001), and having children younger than 5 years of age (OR 1.43, 95% CI 1.05-1.95, p = 0.02) were associated with an increased risk of feeling more drained. Conclusions: Women were more likely to report increased worry about job security, finances, and health and had an increased risk of feeling more drained during the pandemic. While the COVID-19 pandemic is a significant stress for all physicians, women in dual-physician families were disproportionately affected, demonstrating the need for increased support from hospital administrations.

Impact of the COVID-19 Pandemic Lockdown on Routine Childhood Immunization: A Saudi Nationwide Cross-Sectional Study

Background: Routine childhood immunization is the most cost-effective method to prevent infection and decrease childhood morbidity and mortality. The COVID-19 pandemic has affected access to health care in Saudi Arabia, including mandatory vaccinations for young children. We aimed to assess the prevalence of intentionally delayed vaccinations in children aged ≤ 2 years during the COVID-19 pandemic curfew in Saudi Arabia, its relation to the caregivers' fear of infection, and identifying factors affecting the caregivers' decision. Methods: We conducted a cross-sectional study using a self-administered survey that targeted primary caregivers of children aged ≤ 2 years residing in Saudi Arabia during the COVID-19 pandemic curfew (March 4-July 6, 2020). Results: We received responses from 577 caregivers, of whom 90.8% were mothers. The prevalence of intentional vaccination delay was 37%. Upon adjusting the potential confounders, the odds of delaying scheduled childhood vaccination because of COVID-19 pandemic fears were greater among caregivers with higher levels of fear (OR 1.10, 95% CI 1.02-1.11). Common reasons for delaying vaccinations were COVID-19 infection and prevention of exposure to COVID-19 cases. Conclusion: Intentional vaccination delay leaves young children vulnerable to preventable infectious diseases. Identifying these children and offering catch-up vaccinations reduces this risk. Campaigns to increase awareness about the dangers of delaying vaccine-preventable diseases must be promoted to caregivers in addition to the promotion of home vaccination services. In preparation for future pandemics, we recommend countries consider interventions to control the level of fear and anxiety provoked by the pandemics and media, and interventions for improved access to vaccinations.

Social media recruitment for mental health research: A systematic review

BACKGROUND

Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored.

OBJECTIVE

A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research.

METHOD

A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant.

RESULTS

A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing).

CONCLUSION

Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.

Microsurgery Fellowship Website and Social Media Presence: Are Programs Optimizing Recruitment Strategy?

BACKGROUND

 Microsurgery fellowship applicants make decisions for future training based on information obtained from colleagues, mentors, and microsurgery fellowship program Websites (MFWs). In this study, we sought to evaluate the accessibility and quality of available information by microsurgery programs by analyzing the most commonly used web resources and social media outlets for applicants.

METHODS

 The San Francisco (SF) Match and American Society of Reconstructive Microsurgery Websites were queried in April 2020 for microsurgery fellowship programs (MFPs) participating in the SF Match. Twenty-two independent variables of information were assessed on MFWs based on previously published data. Social media presence was also assessed by querying Facebook, Instagram, and Twitter for official hospital, plastic surgery residency, and microsurgery fellowship accounts.

RESULTS

 All 24 MFWs participating in the SF Match had a webpage. Program description, faculty listing, operative volume, and eligibility requirements were listed for all programs (100%). The majority of MFWs listed affiliated hospitals (75%), provided a link to the fellowship application (66.7%), listed interview dates (66.7%), and highlighted research interests (50%). A minority of MFWs provided information on conference schedule (37.5%), current fellow listing (25%), previous fellow listing (16.67%), and positions held by previous fellows (8.33%). No MFWs (0%) presented information on selection process, or rotation schedule.All hospitals with an MFP had a Facebook page and nearly all had Instagram (83.3%) and Twitter accounts (95.8%). Plastic surgery residency programs at the same institution of an MFP had social media presence on Facebook (38.9%), Twitter (38.9%), and Instagram (66.7%). Only three MFPs had Facebook accounts (12.5%) and none had Instagram or Twitter accounts.

CONCLUSION

 As the field of microsurgery continues to grow, the need for effective recruitment and training of microsurgeons continues to be essential. Overall, we conclude that both the accessibility and quality of information available to applicants are limited, which is a missed opportunity for recruitment.

Perceived risk of infection and smoking behavior change during COVID-19 in Ohio

Objective

The recent COVID‐19 pandemic may catalyze smoking behavior modification. The purpose of the study was to examine factors associated with reducing smoking exposure during the COVID‐19 outbreak.

Design

Cross‐sectional design using the Health Belief Model to develop an online survey distributed throughout Ohio early during the outbreak.

Sample

810 adults in Ohio (77.9% non‐smokers, 22.1% current smokers).

Measurements

Sociodemographic factors, smoking and behavior changes since the COVID‐19 outbreak, and perceived risk of infection were collected. Logistic regression analyses were conducted to determine factors associated with indoor smoking bans and factors associated with desire to quit smoking since the outbreak.

Results

For the overall sample, the odds of indoor smoking bans were significantly associated with never smoked, college education, single‐family residence, not living with smokers, and perceived importance of avoiding public places. For smokers, the desire to quit smoking since the COVID‐19 outbreak was associated with diabetes and perceived risk of severe infection.

Conclusions

Identified factors inform residential smoking exposure reduction through indoor smoking bans. Having an increased perceived risk of severe infection among smokers may motivate cessation. Public health nurses can provide accurate and accessible resources for smoking cessation during the COVID‐19 pandemic to promote healthy lifestyle modification.

Recruitment and retention of mothers of preschoolers and school-aged children in a social media-delivered healthy eating intervention: lessons learned from a randomized controlled trial

BACKGROUND

Social media represent cost-effective platforms to advance the dissemination and uptake of health research to improve population health. However, there is limited evidence available to support researchers overcome methodological challenges related to recruitment and retention of participants in studies using social media for delivering behavior change interventions. This study aims to describe the recruitment and the retention strategies used in a randomized controlled trial (RCT) that evaluated a blog-delivered healthy eating intervention among mothers of preschoolers and school-aged children.

METHODS

Eighty-four adult mothers of children aged between two and 12 years old living in Quebec City, Quebec, Canada, were recruited between October 2015 and February 2017 using traditional methods (e.g. institutional email lists, flyers, newspapers, and word of mouth) and Facebook advertisements. Retention rates were calculated at the end of the 6-month intervention and at a 12-month follow-up assessment. Sociodemographic characteristics, Internet use behaviors and retention rates of mothers recruited through traditional methods and Facebook were compared using Wilcoxon-Mann-Whitney tests and Fisher exact tests.

RESULTS

Of the 196 mothers who responded to the recruitment call, 87 (44.4%) were eligible and 84 (42.9%) were randomized to the trial, representing a recruitment success of 76.4% (84/110) from the planned sample size target. Among those, a minority (3.6%) were recruited using Facebook. Those mothers presented similar sociodemographic characteristics to those recruited using traditional methods. Retention rates were 73.8% and 66.7% at 6 and 12 months, respectively, with similar rates between mothers recruited using Facebook and traditional methods. Various challenges associated with population retention were highlighted with lack of time being mothers' main reason for withdrawing from the study.

CONCLUSIONS

The methodological challenges experienced during the conduct of the blog-delivered healthy eating intervention allowed to draw upon several lessons regarding the recruitment process and the retention of mothers of preschoolers and school-aged children to inform future social media-delivered research. Recommendations for future research include exploring mothers' perceptions and preferences to tailor social media recruitment, ensure that interventions are delivered to them using social media platforms that are already integrated into their routine, and are providing remote outcome assessments to increase participant retention.

TRIAL REGISTRATION

Clinical Trial Protocol NCT03156803 . Registered on 17 May 2017, retrospectively registered.

Social media and the modern scientist: a research primer for low- and middle-income countries

Social media has changed the way we communicate. Wherever you are in the world, various forms of social media are being used by individuals to share information and connect without borders. Due to its ubiquity, social media holds great promise in linking clinicians, scientists, investigators, and the public to change the way we conduct scientific discourse. In this paper, we present a step-by-step guide on optimizing your social media strategy with regards to: research/scholarly practice (discourse, collaboration, recruitment), knowledge translation, dissemination, and education. This guide also highlights key readings that provide guidance to those interested in incorporating social media into their scholarly practice.

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.

Do the shuffle: Exploring reasons for music listening through shuffled play

Adults listen to music for an average of 18 hours a week (with some people reaching more than double that). With rapidly changing technology, music collections have become overwhelmingly digital ushering in changes in listening habits, especially when it comes to listening on personal devices. By using interactive visualizations, descriptive analysis and thematic analysis, this project aims to explore why people download and listen to music and which aspects of the music listening experience are prioritized when people talk about tracks on their device. Using a newly developed data collection method, Shuffled Play, 397 participants answered open-ended and closed research questions through a short online questionnaire after shuffling their music library and playing two pieces as prompts for reflections. The findings of this study highlight that when talking about tracks on their personal devices, people prioritise characterizing them using sound and musical features and associating them with the informational context around them (artist, album, and genre) over their emotional responses to them. The results also highlight that people listen to and download music because they like it–a straightforward but important observation that is sometimes glossed over in previous research. These findings have implications for future work in understanding music, its uses and its functions in peoples’ everyday lives.

Predictors of psychological distress and sleep quality in former family caregivers of people with dementia

Objectives: The stress-related psychological symptoms experienced by informal family caregivers do not always improve or resolve after the death of the care recipient. The purpose of this study was to explore the independent associations of sociodemographic variables, personality and coping, environmental variables, and caregiver guilt with the sleep quality and psychological distress of former family caregivers of individuals with dementia following care recipient's death.Method: A cross-sectional, correlational study was conducted with a sample of 171 former family caregivers of people with dementia. Participants completed an online survey comprised of six instruments and demographic items. Caregiver personal variables (e.g. personality and coping), environmental variables, guilt, psychological distress (depressive and anxiety symptoms), and sleep quality were evaluated using psychometrically validated measures.Results: In bivariate analysis, post-caregiving guilt was significantly associated with depressive and anxiety symptoms (p < 0.01). After controlling for covariates, dysfunctional coping and neuroticism explained 32% of the variance in depressive symptoms (R2 = .52, ΔR2 = .32, F(5, 165) = 36.24, p < .001) and 24% of the variance in anxiety symptoms (R2 = .41, ΔR2 = .24, F(5, 165) = 22.65, p < .001), while dysfunctional coping, pre-loss depression, and extraversion accounted for 16% of the variance in sleep quality (R2 = .30, ΔR2 = .16, F(6, 164) = 11.44, p < .001).Conclusion: This study demonstrates the critical role of personal variables, including personality traits, coping strategies, and pre-loss depression, in explaining psychological distress and sleep quality in this sample of former dementia caregivers.

Supportive technology in collaborative research: proposing the STiCR framework

INTRODUCTION

Achieving a standard of clinical research at the pinnacle of the evidence pyramid is historically expensive and logistically challenging. Research collaboratives have delivered high-impact prospective multicentre audits and clinical trials by using trainee networks with a range of enabling technology. This review outlines such use of technology in the UK and provides a framework of recommended technologies for future studies.

METHODS

A review of the literature identified technology used in collaborative projects. Additional technologies were identified through web searches. Technologies were grouped into themes including access (networking and engagement), collaboration and event organisation. The technologies available to support each theme were studied further to outline relative benefits and limitations.

FINDINGS

Thirty-three articles from trainee research collaboratives were identified. The most frequently documented technologies were social media applications, website platforms and research databases. The Supportive Technologies in Collaborative Research framework is proposed, providing a structure for using the technologies available to support multicentre collaboration. Such technologies are often overlooked in the literature by established and start-up collaborative project groups. If used correctly, they might help to overcome the physical, logistical and financial barriers of multicentre clinical trials.

Criteria to Measure Social Media Value in Health Care Settings: Narrative Literature Review

BACKGROUND

With the growing use of social media in health care settings, there is a need to measure outcomes resulting from its use to ensure continuous performance improvement. Despite the need for measurement, a unified approach for measuring the value of social media used in health care remains elusive.

OBJECTIVE

This study aimed to elucidate how the value of social media in health care settings can be ascertained and to taxonomically identify steps and techniques in social media measurement from a review of relevant literature.

METHODS

A total of 65 relevant articles drawn from 341 articles on the subject of measuring social media in health care settings were qualitatively analyzed and synthesized. The articles were selected from the literature from diverse disciplines including business, information systems, medical informatics, and medicine.

RESULTS

The review of the literature showed different levels and focus of analysis when measuring the value of social media in health care settings. It equally showed that there are various metrics for measurement, levels of measurement, approaches to measurement, and scales of measurement. Each may be relevant, depending on the use case of social media in health care.

CONCLUSIONS

A comprehensive yardstick is required to simplify the measurement of outcomes resulting from the use of social media in health care. At the moment, there is neither a consensus on what indicators to measure nor on how to measure them. We hope that this review is used as a starting point to create a comprehensive measurement criterion for social media used in health care.

Use of Social Media in Health Communication: Findings From the Health Information National Trends Survey 2013, 2014, and 2017

The number of social media users has increased substantially in the past decade, creating an opportunity for health-care professionals and patients to leverage social media for health communication. This study examines the recent use and predictors of social media for health communication in a nationally representative sample of US adults over time. We used 2013, 2014, and 2017 National Cancer Institute’s Health Information National Trends Survey to identify respondents’ use of social media for sharing health information or exchanging medical information with a health-care professional. We conducted bivariate analysis using the Pearson χ² test to assess the association of respondents’ basic demographic characteristics as well as health status and the use of social media for health communication. We performed multivariable logistic regression models to examine factors associated with the use of social media for health communication. We identified 4242 respondents (weighted sample size: 343 465 241 [2-year pooled sample]) who used social media for sharing health information and 4834 respondents (weighted sample size: 354 419 489 [2-year pooled sample]) who used social media for exchanging medical information. Multivariable analyses indicated the proportion of respondents who used social media for sharing health information has decreased (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.49-0.85, P = .002), while the use of social media for exchanging medical information with a health-care professional has increased (OR, 1.88; 95% CI, 1.09-3.26, P = .025). The younger population had significantly higher odds of using social media for health communication. The study found no racial/ethnic disparities in the use of social media for health communication. Use of social media for sharing health information has declined, while exchanging medical information with health-care professionals has increased. Future research is needed to determine how to engage the population in social media–based health interventions, particularly for older adults.

Recruitment via social media: advantages and potential biases

Background

Adolescent and young adult (AYA) cancer survivors are under-represented in research. Social media is increasingly used for recruitment given its ability to reach large audiences. Differences in participant characteristics and potential biases due to recruitment source are not well understood.

Purpose

This study aimed to: (a) compare recruitment strategies (hospital-based v. social media) in enrollment metrics, and (b) among enrolled participants, evaluate group differences in patient characteristics and patient reported outcomes (PROs).

Methods

Preliminary data from a cancer and fertility study with female AYAs were evaluated. Hospital-based recruitment used electronic medical records (EMR) to identify eligible patients. Social media recruitment involved posting on partner organizations’ social media outlets. PROs included validated measures related to the parent study. Descriptive statistics evaluated recruitment metrics. Independent samples t-tests and chi-square identified differences in participant characteristics and PROs based on recruitment.

Results

Social media yielded a higher enrollment rate (37%; n = 54/146) compared with hospital-based recruitment (7%; n = 21/289) and required fewer study resources. Compared with hospital-based recruitment, participants from social media were more likely to be White (p = 0.01), with a longer time since treatment (p = 0.03); and reported higher levels of reproductive concern (p = 0.004) and negative mood (p = 0.02), and more negative illness perceptions (ps < 0.05).

Conclusion

Recruitment via social media may be a more effective and efficient strategy compared with hospital-based methods. However, group differences were identified that could bias findings and limit generalizability. Advantages of social media should be considered with an understanding of how methodology may impact enrollment and results.

Quality and outcomes in global cancer surgery: protocol for a multicentre, international, prospective cohort study (GlobalSurg 3)

INTRODUCTION

Empirical, observational data relating to the diagnosis, management and outcome of three common worldwide cancers requiring surgery is lacking. However, it has been demonstrated that patients in low/middle-income countries undergoing surgery for cancer are at increased risk of death and major complications postoperatively. This study aims to determine quality and outcomes in breast, gastric and colorectal cancer surgery across worldwide hospital settings.

METHODS AND ANALYSIS

This multicentre, international prospective cohort study will be undertaken by any hospital providing emergency or elective surgical services for breast, gastric or colorectal cancer. Centres will collect observational data on consecutive patients undergoing primary emergency or elective surgery for breast, gastric or colorectal cancer during a 6-month period. The primary outcome is the incidence of mortality and major complication rate at 30 days after cancer surgery. Infrastructure and care processes in the treatment of these cancers worldwide will also be characterised.

ETHICS AND DISSEMINATION

This project will not affect clinical practice and has been classified as clinical audit following research ethics review. The protocol will be disseminated through the international GlobalSurg network.

TRIAL REGISTRATION NUMBER

NCT03471494; Pre-results.

A novice researcher's reflection on recruiting participants for qualitative research

BACKGROUND

This paper is a reflection by a PhD candidate on her qualitative study involving parents, diabetes educators and school teachers who were caring for a child with type 1 diabetes using intensive insulin therapy in primary school.

AIM

To reflect on a novice researcher's experience of recruiting research participants from community, health and education settings in Australia.

DISCUSSION

Participants were successfully recruited for the study using internet communication tools: Facebook support groups; the Australian Diabetes Educators Association (ADEA) e-newsletter; and emails sent to school principals. These methods were successful as Facebook and online support groups are popular, the study topic was of interest, the ADEA has many members, and numerous emails were sent to schools. Potential barriers to recruitment were a lack of access to those who did not use Facebook or the internet, gatekeepers, the high workloads of diabetes educators and teachers, and the time needed to obtain ethics approval and send a large number of emails to schools.

CONCLUSION

Internet communication tools were successful in recruiting participants from community, health and education settings. However, different approaches were required for each type of participant. Lessons learned from this experience were: the importance of taking time to plan recruitment, including an in-depth understanding of potential participants and recruitment tools, the benefit of being an insider, and the need to work closely with gatekeepers.

IMPLICATIONS FOR PRACTICE

An understanding of recruitment is essential for ensuring access to appropriate participants and timely collection of data. The experience of the novice researcher may provide insight to others planning to use internet communication tools for recruitment.

Extrahepatic Autoimmune Diseases are Prevalent in Autoimmune Hepatitis Patients and Their First-Degree Relatives: Survey Study

Background

Concurrent autoimmune illnesses contribute to increased medical burden and reduced quality of life in patients with autoimmune hepatitis (AIH). The frequency of coexisting autoimmune conditions among North American patients with AIH and their families remains incomplete. Challenges associated with disease capture in the electronic medical record, high study costs, and geographic spread of patients are formidable barriers to understanding the extent of concurrent autoimmune conditions in these groups.

Objective

This objective of this study was to examine the frequency of extrahepatic autoimmune diseases (EHAD) among AIH cases and healthy controls as well as their first-degree relatives using social networking sites (SNS).

Methods

We developed a 53-question survey detailing the history of autoimmune diseases. A survey link was posted at routine intervals within specific Web-based cohorts on SNS. Healthy controls, without self-reported autoimmune liver disease, were recruited from Amazon’s Mechanical Turk. Continuous variables were summarized using medians and P values obtained with the Wilcoxon rank-sum test. Categorical variables were compared using the chi-square test.

Results

Compared with controls (n=1162), cases (n=306) were more likely to be older (median age: 49 vs 33 years), female (284/306, 92.81% vs 955/1162, 82.18%), and have an EHAD (128/306, 41.83% vs 218/1162, 18.76%; P=.001). The most frequent EHADs among cases were thyroid disease (49/306, 16.01% ), Sjögren syndrome (27/306, 8.82%), Raynaud phenomenon (23/306, 7.52%), and psoriasis (22/306, 7.19%). Overall, 55.88% (171/306) of cases and 35.71% (1601/4484) of controls reported at least 1 first-degree relative (FDR) with a history of EHAD (P=.001). Cases had a significantly higher risk of EHAD than controls after the adjustment for age, sex, race, and body mass index: odds ratio 2.46 (95% CI 1.8-3.3); P=.001.

Conclusions

Patients with AIH report higher prevalence of coexistent EHAD than healthy controls, and their FDRs are also more likely to have autoimmune disorders.

Optimizing collaborator recruitment and maintaining engagement via social media during large multicentre studies: lessons learned from the National Audit of Small Bowel Obstruction (NASBO)

AIM

The National Audit of Small Bowel Obstruction was a UK-wide study active in early 2017. A Twitter© account was used to interact with collaborators and the public throughout the study to assess whether the use of social media improved study engagement and to establish which Tweet signature styles achieved the highest levels of reach and engagement.

METHOD

Twitter© analytics for @NASBO2017 covering June 2016-May 2017 were reviewed. The number of impressions, Tweet engagements and the engagement rate were analysed according to study stage.

RESULTS

A total of 176 Tweets were made over the study period. The median number of impressions achieved by a Tweet was 533 (75-2709). 3863 engagements were made with National Audit of Small Bowel Obstruction Tweets with a median number of 10 (0-159) per Tweet. The average overall Tweet engagement rate was 3.3% (0%-14.2%). Tweets with most impressions either used images or tagged institutions (e.g. Royal Colleges, professional bodies). The number of impressions and engagement with the Tweets increased over the study period, due to the incremental growth of the National Audit of Small Bowel Obstruction Twitter© account and the identification of successful Tweet styles.

CONCLUSIONS

Social media provided a major contribution to a successful concerted policy of maintaining collaborator engagement during the National Audit of Small Bowel Obstruction. The use of images and videos and tagging of relevant professional bodies aided the reach and engagement of each Tweet. These data can be used to inform engagement strategies for future collaborative projects.

Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study

Background

Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography.

Objective

To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community.

Methods

We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others.

Results

In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page.

Conclusions

This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics.

Utilizing Internet-based recruitment and data collection to access different age groups of former family caregivers

As Internet accessibility grows among adults in the United States, researchers' utilization of Internet-based surveys and recruitment strategies has increased, but there is a paucity of knowledge about their use in different age groups of former dementia caregivers. The purpose of this secondary analysis is to describe 1) the use of Internet-based recruitment in obtaining a sample inclusive of young and middle aged (age 18-64), young-old (age 65-74), and older-old (age 75 and older) former dementia caregivers and 2) the feasibility of collecting data using an online survey in young and middle aged, young-old, and older-old former dementia caregivers. Utilizing convenience sampling, a four-step recruitment strategy encompassing a combination of Internet-based and non-Internet-based recruitment strategies was employed. Participants (N = 171) completed an online survey. Older-old, young-old, and young and middle-aged participants comprised 9%, 30%, and 61% of the sample respectively. All age cohorts provided minimal missing data using an online survey, but older-old participants required 15 additional minutes to complete the survey than young-old participants. Both cohorts of older adults were directed to the survey less frequently through online referral sources than young and middle-aged participants, and no older-old participants were referred via Facebook. All three age cohorts consisted of mostly white women. Internet-based surveys and recruitment were feasible among the age groups but may present challenges for the older-old and minorities. Further research on Internet-based data collection and recruitment is indicated in minority and older-old caregivers, focusing on trust, educational and financial disparities, and technological proficiency as potential barriers.

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.

The academic tweet: Twitter as a tool to advance academic surgery

Social media, Twitter in particular, has emerged as an essential tool for surgeons. In the realm of academic surgery, it enables surgeons to advance the core values of academic surgery, as outlined by the Association for Academic Surgery: inclusion, leadership, innovation, scholarship, and mentorship. This article details the ways in which surgeons are using Twitter to embody these values and how the Twitter account for the Association of Academic Surgeons accomplishes its goal of inspiring and developing young academic surgeons.

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.

Lessons From Recruitment to an Internet-Based Survey for Degenerative Cervical Myelopathy: Comparison of Free and Fee-Based Methods

BACKGROUND

Degenerative Cervical Myelopathy (DCM) is a syndrome of subacute cervical spinal cord compression due to spinal degeneration. Although DCM is thought to be common, many fundamental questions such as the natural history and epidemiology of DCM remain unknown. In order to answer these, access to a large cohort of patients with DCM is required. With its unrivalled and efficient reach, the Internet has become an attractive tool for medical research and may overcome these limitations in DCM. The most effective recruitment strategy, however, is unknown.

OBJECTIVE

To compare the efficacy of fee-based advertisement with alternative free recruitment strategies to a DCM Internet health survey.

METHODS

An Internet health survey (SurveyMonkey) accessed by a new DCM Internet platform (myelopathy.org) was created. Using multiple survey collectors and the website's Google Analytics, the efficacy of fee-based recruitment strategies (Google AdWords) and free alternatives (including Facebook, Twitter, and myelopathy.org) were compared.

RESULTS

Overall, 760 surveys (513 [68%] fully completed) were accessed, 305 (40%) from fee-based strategies and 455 (60%) from free alternatives. Accounting for researcher time, fee-based strategies were more expensive ($7.8 per response compared to $3.8 per response for free alternatives) and identified a less motivated audience (Click-Through-Rate of 5% compared to 57% using free alternatives) but were more time efficient for the researcher (2 minutes per response compared to 16 minutes per response for free methods). Facebook was the most effective free strategy, providing 239 (31%) responses, where a single message to 4 existing communities yielded 133 (18%) responses within 7 days.

CONCLUSIONS

The Internet can efficiently reach large numbers of patients. Free and fee-based recruitment strategies both have merits. Facebook communities are a rich resource for Internet researchers.