Do incentives exert undue influence on survey participation? Experimental evidence

Responsible inclusion: A systematic review of consent to social-behavioral research with adults with intellectual disability in the US

BACKGROUND

In recognition of their status as a health disparities population, there is growing emphasis on conducting research inclusive of adults with intellectual disability to generate new knowledge and opportunities to improve health and equity. Yet they are often excluded from research, and human research participant protection experts and researchers lack agreement on effective consent protocols for their inclusion.

OBJECTIVE

We sought to identify approaches to consent in US-based social-behavioral research with adults with intellectual disability.

METHODS

We conducted a systematic review on approaches to self-consent with adults with intellectual disability published between 2009 and 2023, identified via searching eight databases and reference list hand searches. We identified 13 manuscripts and conducted a thematic analysis.

RESULTS

Our analysis identified themes related to guiding principles, strategies to enhance informed and voluntary consent, approaches to consent capacity, involving individuals subject to guardianship, and strategies for expressing decisions and enhancing ongoing decisions.

CONCLUSIONS

Manuscripts largely reflected an emphasis on identifying approaches to consent that reflect disability rights principles to promote the right to be included and make one's own decisions based on assessment of relevant information, risks and benefits, and to employ reasonable modifications to achieve inclusion. To avoid the risks of exclusion and advance the responsible inclusion of adults with intellectual disability, we make recommendations to align consent approaches anchored in contemporary thinking about human research participant protections, including through integration with disability rights.

An experimental test of whether financial incentives constitute undue inducement in decision-making

Around the world, laws limit the incentives that can be paid for transactions such as human research participation, egg donation or gestational surrogacy. A key reason is concerns about 'undue inducement'-the influential but empirically untested hypothesis that incentives can cause harm by distorting individual decision-making. Here I present two experiments (n = 671 and n = 406), including one based on a highly visceral transaction (eating insects). Incentives caused biased information search-participants offered a higher incentive to comply more often sought encouragement to do so. However, I demonstrate theoretically that such behaviour does not prove that incentives have harmful effects; it is consistent with Bayesian rationality. Empirically, although a substantial minority of participants made bad decisions, incentives did not magnify them in a way that would suggest allowing a transaction but capping incentives. Under the conditions of this experiment, there was no evidence that higher incentives could undermine welfare for transactions that are permissible at low incentives.

Survey response rates in health sciences education research: A 10-year meta-analysis

Growth in the online survey market may be increasing response burden and possibly jeopardizing higher response rates. This meta-analysis evaluated survey trends over one decade (2011-2020) to determine: (1) changes in survey publication rates over time, (2) changes in response rates over time, (3) typical response rates within health sciences education research, (4) the factors influencing survey completion levels, and (5) common gaps in survey methods and outcomes reporting. Study I estimated survey publication trends between 2011 and 2020 using articles published in the top three health sciences education research journals. Study II searched the anatomical sciences education literature across six databases and extracted study/survey features and survey response rates. Time plots and a proportional meta-analysis were performed. Per 2926 research articles, the annual estimated proportion of studies with survey methodologies has remained constant, with no linear trend (p > 0.050) over time (Study I). Study II reported a pooled absolute response rate of 67% (95% CI = 63.9-69.0) across 360 studies (k), totaling 115,526 distributed surveys. Despite response rate oscillations over time, no significant linear trend (p = 0.995) was detected. Neither survey length, incentives, sponsorship, nor population type affected absolute response rates (p ≥ 0.070). Only 35% (120 of 339) of studies utilizing a Likert scale reported evidence of survey validity. Survey response rates and the prevalence of studies with survey methodologies have remained stable with no linear trends over time. We recommend researchers strive for a typical absolute response rate of 67% or higher and clearly document evidence of survey validity for empirical studies.

Applying Responsive Survey Design to Small-Scale Surveys: Campus Surveys of Sexual Misconduct

Responsive survey design is a technique aimed at improving the efficiency or quality of surveys by using incoming data from the field to make design changes. The technique was pioneered on large national surveys, but the tools can also be applied on the smaller-scale surveys most commonly used by sociologists. We demonstrate responsive survey design in a small-scale, list-based sample survey of students on the topic of sexual misconduct. We investigate the impact of individual incentive levels and a two-phase responsive design with changes to mode of contact as approaches for limiting the potential of nonresponse bias in data from such surveys. Our analyses demonstrate that a two-phase design introducing telephone and face-to-face reminders to complete the survey can produce stronger change in response rates and characteristics of those who respond than higher incentive levels. These findings offer tools for sociologists designing smaller-scale surveys of special populations or sensitive topics.

Possible Measures to Improve Both Participation and Response Quality in Japan’s National Health and Nutrition Survey: Results from a Workshop by Local Government Personnel in Charge of the Survey

Increasing participation rates are crucial to ensure the representativeness of national survey results of the population. This study aimed to identify measures that could be taken by local government personnel in charge of the National Health and Nutrition Survey (NHNS), Japan, to improve participation rates. The subjects were twenty-one health personnel who worked in 19 local governments and participated in the training course at the National Institute of Public Health. Qualitative data were collected through a workshop. They discussed the problems that seem to affect participation rates and identified possible solutions. The contents were coded and grouped to create categories, using the Jiro Kawakita (KJ) method. For data analysis, researchers combined and reviewed all codes and categories. The measures that could improve participation rates were divided into the following 12 categories: 1. standardization of survey methods, 2. investigator skills, 3. survey organization, 4. venue setting, 5. accessing target households, 6. time of survey, 7. responses during the investigation, 8. confirming meal contents reported in the nutritional intake status survey, 9. rewards/incentives, 10. possible rewards, 11. feedback on survey results, and 12. survey practices during the COVID-19 pandemic. These findings represent viable initiatives for local health personnel to increase participation rates for the NHNS.

How do Research Ethics Committee Members Respond to Hypothetical Studies with Children? Results from the MESSI Study

Hypothetical scenarios were used to assess the influence of the sensitivity of the study topic, payments, and study methods on research ethics committee (HREC) members' approval of social research studies involving children. A total of 183 Australian HREC members completed an online survey. The higher the perceived sensitivity of the study topic, the less likely the study would be approved by an HREC member. HREC members were most likely to approve each of the hypothetical studies if no payment was offered. Payment was the most common reason for not approving the low risk studies, while risks were the most common reasons for not approving the more sensitive studies. Face-to-face interviews conducted at home with children elicited substantially higher rates of approval from HREC members with more sensitive study topics. Both HRECs and researchers may benefit from additional guidance on managing risks and payments for children and young people in research.

Factors Influencing Perceived Helpfulness and Participation in Innovative Research: A Pilot Study of Individuals with and without Mood Symptoms

Little is known about how individuals with and without mood disorders perceive the inherent risks and helpfulness of participating in innovative psychiatric research, or about the factors that influence their willingness to participate. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents' perceptions of risk and helpfulness in study vignettes associated with two innovative research projects (intravenous ketamine therapy and wearable devices), as well as their willingness to participate in these projects. Respondents with and without mood disorders perceived risk similarly across projects. Respondents with no mood disorders viewed both projects as more helpful to society than to research volunteers, while respondents with mood disorders viewed the projects as equally helpful to volunteers and society. Individuals with mood disorders perceived ketamine research, and the two projects on average, as more helpful to research volunteers than did individuals without mood disorders. Our findings add to a limited empirical literature on the perspectives of volunteers in innovative psychiatric research.

The unspoken benefit of participation in a clinical trial

BACKGROUND

Publicly funded trials do not usually offer financial incentives to volunteers. An intensive level of medical care could act as an additional motivator for participation. Our aim was to establish whether patients may draw any clinical benefit from volunteering in a clinical trial.

METHODS

We analysed the recruitment process of a phase II randomised controlled trial, the Inorganic Nitrate in Angina Study.

RESULTS

Two-hundred and thirteen patients with a history of stable angina and who had been under at least annual primary care review were screened for participation by history taking, examination, 12-lead electrocardiography, treadmill test and echocardiography. Thirty-five (16.4%) patients were found to have significant unstable or new clinical pathology, requiring urgent clinical attention. We identified 17 (7.9%) patients with unstable angina. Furthermore, we found new undiagnosed pathologies: amyloidosis in two (0.9%), hypertrophic cardiomyopathy in two (0.9%), left ventricular systolic dysfunction (ejection fraction <45%) in three (1.4%), left ventricular thrombus in one (0.4%), significant valvular disease in five (2.4%) and arrhythmias in six (2.8%).

CONCLUSION

Compared with routine care, patients screened for a clinical trial may come under an increased level of scrutiny that may affect their clinical management. This may act as additional motivator to attract patients to future studies.

How Covid-19 financially hit urban refugees: evidence from mixed-method research with citizens and Syrian refugees in Turkey

Peering through a lens of disasters and inequalities, this article measures the financial impacts of Covid-19 on citizens and refugee communities in Turkey during a relatively early phase of the global pandemic. Our data comes from an online survey (N = 1749) conducted simultaneously with Turkish citizens and Syrian refugees living in Turkey, followed by in-depth online interviews with Syrian refugees. Our findings indicate that the initial Covid-19 measures had a higher financial impact on Syrians than on citizens when controlled for employment, wealth, and education, among other variables. In line with the literature, our research confirms that disasters' socio-economic effects disproportionally burden minority communities. We additionally discuss how Covid-19 measures have significantly accelerated effects on refugees compared to the local population, mainly due to the structural and policy context within which forcibly displaced Syrians have been received in Turkey.

Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study

Background

Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients’ behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability.

Objective

The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance.

Methods

The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on “being user versus nonuser” (acceptability), which was the main outcome measure.

Results

Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability.

Conclusions

Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment.

Trial Registration

ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347

Capability, opportunity, and motivation: an across contexts empirical examination of the COM-B model

BACKGROUND

There is limited evidence for successful weight gain prevention interventions targeting young adults. Developing effective interventions necessitates a theoretical model that can identify barriers and enablers for healthy eating and physical activity among young adults to support weight management. This study empirically examines the utility of the COM-B model as a framework for intervention planning across two behavioural contexts: eating and physical activity.

METHODS

A cross-sectional survey research design was employed to empirically test the COM-B model in the contexts of young adult's eating and physical activity behaviours. Informed by the Theoretical Domains Framework, pre-validated measures appropriate for capturing the latency of the COM (Capability, Opportunity, and Motivation) constructs were sourced. Both surveys (eating and physical activity) were administered online to two independent samples of young adults aged 18-35 years. Models were specified and tested using structural equation modelling.

RESULTS

A total of 582 (mean age = 22.8 years; 80.3% female) and 455 (mean age = 24.9 years; 80.8% female) participants were included in the physical activity and eating analyses, respectively. The COM-B model explained 31% of variance in physical activity behaviour and 23% of variance in eating behaviour. In the physical activity model (N = 582), capability and opportunity were found to be associated with behaviour through the mediating effect of motivation. In the eating model (N = 455), capability was found to be associated with behaviour through the mediating effect of motivation. Capability was also found to mediate the association between opportunity and motivation. Consistencies and variations were observed across both models in terms of COM indicators.

CONCLUSIONS

Findings support the COM-B model's explanatory potential in the context of young adult's physical activity and eating behaviours. Barriers and enablers underlying young adult's physical activity and eating behaviours were identified that represent potential targets for future intervention design. Further research is needed to validate present study findings across different populations and settings.

Use of Ecological Momentary Assessment to Study Suicidal Thoughts and Behavior: a Systematic Review

PURPOSE OF REVIEW

Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior.

RECENT FINDINGS

Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.

Disturbed sleep as a clinical marker of wish to die: A smartphone monitoring study over three months of observation

BACKGROUND

Smartphone monitoring could contribute to the elucidation of the correlates of suicidal thoughts and behaviors (STB). In this study, we employ smartphone monitoring and machine learning techniques to explore the association of wish to die (passive suicidal ideation) with disturbed sleep, altered appetite and negative feelings.

METHODS

This is a prospective cohort study carried out among adult psychiatric outpatients with a history of STB. A daily questionnaire was administered through the MEmind smartphone application. Participants were followed-up for a median of 89.8 days, resulting in 9,878 person-days. Data analysis employed a machine learning technique called Indian Buffet Process.

RESULTS

165 patients were recruited, 139 had the MEmind mobile application installed on their smartphone, and 110 answered questions regularly enough to be included in the final analysis. We found that the combination of wish to die and sleep problems was one of the most relevant latent features found across the sample, showing that these variables tend to be present during the same time frame (96 hours).

CONCLUSIONS

Disturbed sleep emerges as a potential clinical marker for passive suicidal ideation. Our findings stress the importance of evaluating sleep as part of the screening for suicidal behavior. Compared to previous smartphone monitoring studies on suicidal behavior, this study includes a long follow-up period and a large sample.

Promoting Ethical Payment in Human Infection Challenge Studies

To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SARS-CoV-2 HICS participants should be paid. Because the goals of paying HICS participants, as well as the relevant ethical concerns, are the same as those arising for other types of clinical research, the same basic framework for ethical payment can apply. This framework divides payment into reimbursement, compensation, and incentives, focusing on fairness and promoting adequate recruitment and retention as counterweights to concerns about undue inducement. Within the basic framework, several factors are especially salient for HICS, and for SARS-CoV-2 HICS in particular, including the nature of participant confinement, anticipated discomfort, risks and uncertainty, participant motivations, and trust. These factors are reflected in a payment worksheet created to help sponsors, researchers, and ethics reviewers systematically develop and assess ethically justifiable payment amounts.

A CTSA One Health Alliance guidance on institutional review of veterinary clinical studies

Harmonized institutional processes and reviewer training are vital to maintain integrity and ethical rigor of the veterinary clinical research pipeline and are a prerequisite to future work that might establish centralized or single-site ethical and regulatory review to ease initiation of multi-center studies. Funded by a CTSA One Health Alliance (COHA) pilot award, a diverse working group of veterinary clinicians and institutional representatives was convened in February 2020 to develop a guidance document detailing broadly agreed upon practices for ethical review and approval of veterinary clinical studies conducted in the United States.The working group defined key areas of need for consensus, developed a set of associated guidelines, and circulated these for review by COHA's fifteen member institutions. Six focus areas were identified by the working group and included vital items of protocol review, composition of the review committee, post-approval monitoring and adverse event reporting, consideration of special circumstances such as satellite sites and the use of healthy veterinary subjects in research, and the informed consent process.This document outlines a broadly agreed-upon framework through which to approach vital items associated with veterinary clinical study protocol review and approval. These approaches represent current best practice in the review and approval of veterinary clinical studies, and can serve as a guidance for veterinary clinician-scientists and regulatory experts, to ensure robust and ethically conducted studies that can contribute to the advancement of both animal and human health.

Payment in challenge studies: ethics, attitudes and a new payment for risk model

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated.

Smartphone-based ecological momentary assessment (EMA) in psychiatric patients and student controls: A real-world feasibility study

BACKGROUND

Smartphone-based ecological momentary assessment (EMA) is a promising methodology for mental health research. The objective of this study is to determine the feasibility of smartphone-based active and passive EMA in psychiatric outpatients and student controls.

METHODS

Two smartphone applications -MEmind and eB²- were developed for behavioral active and passive monitoring. The applications were tested in psychiatric patients with a history of suicidal thoughts and/or behaviors (STB), psychiatric patients without a history of STB, and student controls. Main outcome was feasibility, measured as response to recruitment, retention, and EMA compliance. Secondary outcomes were patterns of smartphone usage.

RESULTS

Response rate was 87.3% in patients with a history of STB, 85.1% in patients without a history of STB, and 75.0% in student controls. 457 participants installed the MEmind app (120 patients with a history of STB and 337 controls) and 1,708 installed the eB² app (139 patients with a history of STB, 1,224 patients with no history of STB and 346 controls). For the MEmind app, participants were followed-up for a median of 49.5, resulting in 22,622 person-days. For the eB² application, participants were followed-up for a median of 48.9 days, resulting in 83,521 person-days. EMA compliance rate was 65.00% in suicidal patients and 75.21% in student controls. At the end of the follow-up, over 60% of participants remained in the study.

LIMITATIONS

Cases and controls were not matched by age and sex. Cases were patients who were receiving adequate psychopharmacological treatment and attending their appointments, which may result in an overstatement of clinical compliance.

CONCLUSIONS

Smartphone-based active and passive monitoring are feasible methods in psychiatric patients in real-world settings. The development of applications with friendly interfaces and directly useful features can help increase engagement without using incentives. The MEmind and eB² applications are promising clinical tools that could contribute to the management of mental disorders. In the near future, these applications could serve as risk monitoring devices in the clinical practice.

Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology

Background

Precision medicine has enormous potential to improve cancer outcomes. Over one third of the 1.5 million Americans diagnosed with cancer each year have genetic mutations that could be targeted with an FDA-approved drug to treat their disease more effectively. However, the current uptake of targeted cancer therapy in clinical practice is suboptimal. Tumor testing is not widely used, and treatments based on molecular and genomic profiling are often not prescribed when indicated. Challenges with the uptake of precision medicine may disproportionately impact cancer patients in rural communities and other underserved populations. The objective of this study is to identify the determinants of adoption and implementation of precision cancer therapy to design an implementation strategy for community oncology practices, including those in rural areas.

Methods

This study is an explanatory sequential mixed methods study to identify factors associated with the use of targeted cancer therapy. Levels of targeted therapy use will be ascertained by secondary analysis of medical records to identify concordance with 18 national guideline recommendations for use of precision medicine in the treatment of breast, colorectal, lung, and melanoma skin cancer. Concurrently, facilitators and barriers associated with the use of precision cancer therapy will be elicited from interviews with up to a total of 40 oncologists, administrators, pathology, and pharmacy staff across the participating sites. Qualitative analysis will be a template analysis based on the Theoretical Domains Framework. Quantitative data aggregated at the practice level will be used to rank oncology practices’ adherence to targeted cancer therapy guidelines. Determinants will be compared among high and low users to isolate factors likely to facilitate targeted therapy use. The study will be conducted in eight community oncology practices, with an estimated 4121 targeted therapy treatment decision-making opportunities over a 3-year period.

Discussion

Despite unprecedented investment in precision medicine, translation into practice is suboptimal. Our study will identify factors associated with the uptake of precision medicine in community settings. These findings will inform future interventions to increase equitable uptake of evidence-based targeted cancer treatment.

"You would not be in a hurry to go back home": patients' willingness to participate in HIV/AIDS clinical trials at a clinical and research facility in Kampala, Uganda

Background

Few studies have examined factors associated with willingness of people living with HIV (PLHIV) to participate in HIV treatment clinical trials in Sub-Saharan Africa. We assessed the factors associated with participation of PLHIV in HIV treatment clinical trials research at a large urban clinical and research facility in Uganda.

Methods

A mixed methods study was conducted at the Infectious Diseases Institute (IDI), adult HIV clinic between July 2016 and January 2017. Data were collected using structured questionnaires, focused group discussions with respondents categorised as either participated or never participated in clinical trials and key informant interviews with IDI staff. A generalized linear model with a logit link function was used for multivariate analyses while the qualitative data were summarized using a thematic approach.

Results

We enrolled a total of 202 and analysed 151 participants, 77 (51%) of whom were male with mean age of 41 years. The majority 127 (84%) expressed willingness to participate in treatment clinical trials if given an opportunity. At bivariate analysis, willingness to participate was significantly associated with respondents’ perception of a satisfactory compensation package (P-value < 0.002, 0.08–0.56), special status accorded (P-value < 0.001, 0.05–0.39) and belief that their health status would improve (P-value< 0.08, 0.03–0.58) while on the clinical trial. At multivariate analysis, a satisfactory compensation package (P-value< 0.030, 0.08–0.88) and special status accorded in clinical trials (P-value< 0.041, 0.01–0.91) remained significant. The qualitative data analysis confirmed these findings as participants valued the privilege of jumping the clinic waiting queues and spending less time in clinic, the wide range of free tests offered to trial participants, unrestricted access to senior physicians and regular communication from study team. Additionally, free meals offered during clinic visits meant that participants were not in a hurry to go back home. Barriers to participation included the perception that new drugs were being tested on them, fear of side effects like treatment failure and the uncertainty about privacy of their data.

Conclusion

We found overwhelming willingness to participate in HIV treatment clinical trials. This was largely extrinsically influenced by the perceived material and health-related benefits. Investigators should pay attention to participants’ concerns for benefits which may override the need to understand study procedures and risks.

Harnessing health plan enrollee data to boost membership in patient-powered research networks

BACKGROUND

Patient-powered research networks (PPRNs) have been employing and exploring different methods to engage patients in research activities specific to their conditions. One way to intensify patient engagement is to partner with payer stakeholders. The objective of this study was to evaluate the effectiveness of two common payer-initiated outreach methods (postal mail versus email) for inviting prospective candidates to participate in their initiatives.

METHODS

This descriptive study linked members of a nationally-representative private insurance network to four disease-specific PPRN registries. Eligible members meeting diagnostic criteria who were not registered in any of the four PPRNs by 02/28/2018 were identified, and randomly assigned to either the mail or email group. They were contacted in two outreach efforts: first on 04/23/2018, and one follow-up on 05/23/2018. New registration rates by outreach method as of 8/31/2018 were determined by relinking. We compared registrants and non-registrants using bivariate analysis.

RESULTS

A total of 14,571 patients were assigned to the mail group, and 14,574 to the email group. Invitations were successfully delivered to 13,834 (94.9%) mail group and 10,205 (70.0%) email group members. A small but significantly larger proportion of mail group members, (n = 78; 0.54, 95% Confidence Interval [CI] {0.42-0.67%}) registered in PPRNs relative to the email group (n = 24; 0.16, 95% CI {0.11-0.25%}), p < 0.001. Members who registered had more comorbidities, were more likely to be female, and had marginally greater medical utilization, especially emergency room visits, relative to non-registrants (52.0% vs. 42.5%, p = 0.05).

CONCLUSION

A health plan outreach to invite members to participate in PPRNs was modestly effective. Regular mail outperformed less costly email. Providing more value-add to participants may be a possible way to increase recruitment success.

What do patients value as incentives for participation in clinical trials? A pilot discrete choice experiment

Incentivising has shown to improve participation in clinical trials. However, ethical concerns suggest that incentives may be coercive, obscure trial risks and encourage individuals to enrol in clinical trials for the wrong reasons. The aim of our study was to develop and pilot a discrete choice experiment (DCE) to explore and identify preferences for incentives. A DCE was designed by including following attributes (and levels) of incentives: value, method, and time involvement. To account for trial benefit and risk, each was included as an attribute with levels low, medium and high. For testing purposes, the DCE was administrated using SurveyMonkey in a population of third level students. A total of 245 students, representative of the general student population, participated in the online DCE. The results provide a template to assess and explore the use of different incentive methods in clinical trials. The template can be used in its current format or adapted to particular scenarios. This pilot study provides a feasible methodology to explore the use of incentives for participation in clinical trials and can be adapted to specific trial requirements to provide information for ethical applications or identify the most favourable incentive for participation in clinical trials.

Factors Associated With Payments to Research Participants: A Review of Sociobehavioral Studies at a Large Southern California Research University

Along with a dearth of regulatory guidance, little empirical research has examined factors related to participant payment in research. We conducted a cross-sectional study of 100 institutional review board (IRB)-approved sociobehavioral human subjects research protocols at a large research university in Southern California. The proportion of studies that paid participants differed significantly by type of research (p < .001) and study population (p = .009). The average payment amount also differed significantly by study population (p < .001) and type of participation (in-person vs. remote; p < .001). In addition, studies that required more visits (p < .001) and more time (p = .011) paid significantly more than studies with fewer and shorter visits, respectively. These findings provide data to help inform future ethical payment practices.

Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients

BACKGROUND

Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown.

OBJECTIVES

The authors sought to evaluate social media preferences of patients seeking aesthetic surgery.

METHODS

We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk).

RESULTS

A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred.

CONCLUSIONS

The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.

Means of increasing response rates in a Norwegian dietary survey among infants - results from a pseudo-randomized pilot study

Background

Postal surveys are widely used in scientific studies, including dietary surveys, but few studies about methods to increase participation in national dietary surveys are published. In the present study we compared response rates in a pilot study to a national dietary survey among infants using two different incentives (gift certificate or lottery), personalization in the form of handwritten name and address vs. a printed label and mode of sending out invitations (e-mail or postal invitation).

Methods

In this parallel-design pseudo-randomized pilot trial, a nationally representative sample of 698 mothers of infants aged 6 and 12 months was drawn from the Norwegian National Registry and invited to complete a food frequency questionnaire about their infant’s diet. One half of the mothers of 6 month olds were randomized by alternation to the lottery group (n = 198) and offered to participate in a lottery of two prizes (500 EUR and 1000 EUR). The other half (n = 200) was offered a gift certificate (50 EUR) upon completion of the questionnaire. Each incentive group was randomized by alternation to receiving an invitation with handwritten name and address or a printed label. For the mothers of infants aged 12 months (n = 300), 150 mothers received an e-mail invitation and 150 mothers received a postal invitation. Logistic regression was used for testing differences between the groups.

Results

The response rate was significantly higher (p = 0.028) in the gift certificate group (72%) than in the lottery group (62%). No difference was seen between those receiving an invitation with a handwritten name and address (68%) compared to a printed label (66%, p = 0.72). A somewhat higher response rate was seen when using the postal (50%) compared to the e-mail invitation (43%, p = 0.25).

Conclusions

In this pseudo-randomized parallel-design trial of women participating in a national dietary survey among infants, the response rate was higher when offered a gift certificate than when participating in a lottery. Handwritten name and address did not affect participation compared to a printed label. Only a moderate difference was seen between the postal and e-mail invitation. Others conducting similar methodological studies are encouraged to publish their results to expand the knowledge basis in this area.

Cash vs. vouchers vs. gifts in web surveys of a mature panel study--Main effects in a long-term incentives experiment across three panel waves

In this study, we evaluate short- and long-term effects of three different prepaid incentives: a ballpoint-pen (gift worth approximately 2 Swiss francs), a voucher (cash card worth 10 Swiss francs) and cash (a 10-Swiss-francs' banknote) on young panellists' cooperation and response rate in three waves of a mature panel study with a sequential multi-mode design (web-based online survey, CATI, and PAPI). The survey experiment involved an alternative procedure to analyse the effect of different types of prepaid incentives, taking selective attrition into account as well as considering problems related to causal inference. The subjects were students, from randomly-selected school classes, who had finished their compulsory school in 2013. The findings are clear: cash provides the strongest direct, positive effect on the overall response rate and also on the latency until response after first contact. The other incentives did not work as efficiently as did cash. Additionally, cash is the most likely to minimise social selectivity in response. Finally, cash provides the potential to convert refusals in previous waves into cooperation.

Are Payments to Human Research Subjects Ethically Suspect?

Bioethicists and institutional review boards often worry that paying human subjects too much money for research participation might compromise informed consent by coercing or unduly influencing individuals to enroll in studies against their better judgment. However, empirical research does not support the hypothesis that payments adversely impact judgment and decision-making concerning research participation, and the opposite problem - underpayment - also raises significant ethical concerns, such as exploitation, and under-enrollment. In this article, I argue that our ethical qualms about the negative impact of money on decisions concerning research participation are largely unfounded and reflect more general concerns about the need to avoid repeating abuses of human subjects that occurred in the past. I shall also argue that the best way to promote the rights and welfare of human research subjects is to treat them as competent adults who have the capacity to make wise choices involving money. What this argument means in practice is that offering human subjects money for their participation should not be regarded as ethically suspect, absent substantial evidence to the contrary.

The prevalence of self-reported diagnosed endometriosis in the Australian population: results from a nationally-representative survey

OBJECTIVE

Currently, it is estimated that one in 10 women of reproductive age are affected by the reproductive condition known as endometriosis. However, there has been limited research and policy attention on the prevalence of endometriosis in Australia. Utilising a nationally-representative Australian sample (N = 2025), this study aimed to report on the prevalence of endometriosis in the general population and to examine the sociodemographic factors associated with the condition.

RESULTS

The results identified a prevalence rate for endometriosis of 3.4%, which aligns with previous Australian research on this topic. However, the prevalence rate from this data set is lower than the estimate prevalence from the Global Burden of Disease Study. In addition, this study reported that women self-reporting diagnosis of endometriosis, were between 40-49 years of age, with a higher proportion living in South Australia (18.2%) compared to women within the general population (8.4%). The findings highlight endometriosis as a significant health care issue warranting further research and policy attention. While acknowledging some limitations, the study provides an important foundation for further large-scale research to be conducted on this important women's health topic.

Children in Social Research: Do Higher Payments Encourage Participation in Riskier Studies?

The MESSI (Managing Ethical Studies on Sensitive Issues) study used hypothetical scenarios, presented via a brief online survey, to explore whether payment amounts influenced Australian children and young people to participate in social research of different sensitivity. They were more likely to participate in the lower sensitivity study than in the higher at all payment levels (A$200 prize draw, no payment, $30, or $100). Offering payments to children and young people increased the likelihood that they would agree to participate in the studies and, in general, the higher the payments, the higher the likelihood of their participating. No evidence of undue influence was detected: payments can be used to increase the participation of children and young people in research without concerns of undue influence on their behavior in the face of relatively risky research. When considering the level of payment, however, the overriding consideration should be the level of risk to the children and young people.

Willingness to Participate and Associated Factors in a Zika Vaccine Trial in Indonesia: A Cross-Sectional Study

One of the crucial steps during trials for Zika and other vaccines is to recruit participants and to understand how participants' attitudes and sociodemographic characteristics affect willingness to participate (WTP). This study was conducted to assess WTP, its explanatory variables, and the impact of financial compensation on WTP in Indonesia. A health facility-based cross-sectional study was conducted in eleven regencies in the Aceh and West Sumatra provinces of Indonesia. Participants were recruited via a convenience sampling method and were interviewed. The associations between explanatory variables and WTP were assessed using a two-step logistic regression analysis. A total of 1,102 parents were approached, and of these 956 (86.8%) completed the interview and were included in analysis. Of those, 144 (15.1%) were willing to participate in a Zika vaccine trial without a financial compensation. In the multivariate analysis, WTP was tied to an age of more than 50 years old, compared to 20⁻29 years (odds ratio (OR): 5.0; 95% confidence interval (CI): 2.37⁻10.53), to being female (OR: 2.20; 95% CI: 1.11⁻4.37), and to having heard about Zika (OR: 2.41; 95% CI: 1.59⁻3.65). Participants' WTP increased gradually with higher financial compensation. The rate of WTP increased to 62.3% at the highest offer (US$ 350.4), and those who were still unwilling to participate (37.7%) had a poorer attitude towards childhood vaccination. This study highlights that pre-existing knowledge about Zika and attitudes towards childhood vaccination are important in determining community members being willing to participate in a vaccine trial. Financial incentives are still an important factor to enhance participant recruitment during a vaccine trial.

Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning

Objectives

To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs.

Methods

Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training.

Participant

Dentists working in and patients treated in primary dental care in London.

Intervention

Twenty-four-month training in endodontics.

Comparison

Dentists enrolled in the training at different time points.

Outcome

Measuring outcome of endodontic treatment.

Results

Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up.

Conclusions

Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

The effect of a voucher incentive on a survey response rate in the clinical setting: a quasi-randomized controlled trial

Background

Financial rewards have been shown to be an important motivator to include normal healthy volunteers in trials. Less emphasis has been put on non-healthy volunteers. No previous study has investigated the impact of a voucher incentive for participants in a cross-sectional study in a clinical setting. The objective of this study was to examine the impact of a small voucher incentive on a survey response rate in a clinical setting at the point-of-care in a quasi-randomized controlled trial (q-RCT).

Methods

This was an ancillary study to a survey of patients subsequent to their appointment with a physician investigating physician-patient communication. We randomized participants to receive or not receive a voucher for a coffee (costs: 1 €) enclosed in the survey package. Alternation of groups was performed on a weekly basis. The exact Chi-square test was used to compare response rates between study arms.

Results

In total, 472 participants received the survey package. Among them, 249 participants were quasi-randomized to the voucher arm and 223 to the control group. The total response rate was 46%. The response rates were 48% in the voucher arm and 44% in the control group. The corresponding risk ratio was 1.09 (95% CI: 0.89, 1.32).

Conclusions

A small voucher incentive to increase the response rate in a survey investigating physician-patient communication was unlikely to have an impact. It can be speculated whether the magnitude of the voucher was too low to generate an impact. This should be further investigated in future real-world studies.

Prevalence of food allergy in Vietnam: comparison of web-based with traditional paper-based survey

Background

Web-based surveys (WBS) are increasingly applied in epidemiological studies as an appealing alternative to traditional survey methods. Rapid data collection, reduced expenditure and ease of access to large populations are some of the clear advantages of online surveys. However, WBS are still subject to limitations in terms of sample size, response rate and other additional biases compared to traditional survey methods. In the present study, we seek to validate data on food allergy (FA) in two independent sample populations collected from a WBS, and compare it to a paper-based survey (PBS).

Methods

Data collected from two survey modes were compared by hypothesis testing for independent sample population. The WBS included 1185 respondents, while the PBS included 9039 respondents.

Results

Overall, the data from the WBS were comparable to the PBS conducted over the same period of time in Vietnamese adults. There were no effects of different survey modes on the lifetime prevalence of doctor-diagnosed FA (5.7%; P = 0.7795, β = 0.05) and IgE-mediated FA (5.8%; P = 0.9590, β = 0.05). Both surveys showed the dominance of seafood allergy in this population (up to 2.6%), followed by beef allergy. Close correlation was seen in the patterns of FAs and different clinical symptoms. The contribution of family history of allergic diseases and place of residence to FA were confirmed in both surveys.

Conclusions

The consistency of the WBS results with the PBS indicates a promising application of online surveys as an economic and validated model for future epidemiological studies, specifically in developing countries.

Electronic supplementary material

The online version of this article (10.1186/s40413-018-0195-2) contains supplementary material, which is available to authorized users.

"They Can't Search Her": How Gender Imbalances in the Police Force Contribute to Perceptions of Procedural Unfairness

Research suggests that gender imbalances in police forces can significantly affect individuals' experiences when interacting with police. Of importance, yet rarely examined, is the extent to which predominantly male police forces, in conjunction with adherence to gendered departmental policies, can simultaneously send signals of procedural justice and procedural injustice. Drawing on data from 253 in-depth interviews of San Francisco-based male and female drug-dealing gang members, we investigated how interactions with a male-dominated police force, who were required to search only suspects of the same gender, affected perceptions of fair policing. Our findings revealed that the study participants raised concerns that the police unfairly enforced the law to the detriment of the men in the study. The gang members were aware that male officers could only search same-sex suspects, and this exacerbated the gendered experiences of the gang members. Specifically, it contributed to the perception that male officers targeted male gang members to the omission of women and, if women were stopped, they were frequently released. These findings suggest that the gender composition of the police force is important in shaping attitudes toward equitable enforcement of the law and procedural fairness. Of theoretical importance, these findings highlight a contradiction that compliance with rules can contribute, counter intuitively, to perceptions of procedural injustice. Procedurally unfair police behavior may be a systemic problem where the gender composition of the police force itself creates an inherently unfair system.

Research altruism as motivation for participation in community-centered environmental health research

Protection of human subjects in research typically focuses on extrinsic rather than intrinsic motivations for participation in research. Recent sociological literature on altruism suggests that multiple kinds of altruism exist and are grounded in a sense of connection to common humanity. We interviewed participants in eight community-centered research studies that sampled for endocrine disrupting compounds and that shared research findings with participants. The results of our analysis of participation in these studies indicate that altruistic motivations were commonly held. We found that these sentiments were tied to feeling a sense of connection to society broadly, a sense of connection to science, or a sense of connection with the community partner organization. We develop a new concept of banal altruism to address mundane practices that work towards promoting social benefits. Further, we offer that research altruism is a specific type of banal altruism that is a multi-faceted and important reason for which individuals choose to participate in community-centered research.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention

BACKGROUND

Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%.

OBJECTIVE

The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans' stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention.

METHODS

Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up.

RESULTS

Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs.

CONCLUSIONS

Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program's long-term effects on pain and pain self-management.

Using survey methods in telehealth research: A practical guide

Surveys are a common method for assessing patient and clinician perceptions, attitudes and outcomes of telehealth. However, inadequacies in both the conduct and reporting of survey studies are common in telehealth research. This article provides clinicians and researchers with practical guidance on the appropriate selection, use and reporting of survey tools for telehealth research. We identify common survey outcomes and instruments used in telehealth research, and methods to assess the validity and psychometric properties of survey tools. Enhancing the quality and reporting of telehealth research is important to improve our understanding of which telehealth-supported models of care improve outcomes and for which patient groups.

Ethical and Safety Issues in Doing Sex Work Research: Reflections From a Field-Based Ethnographic Study in Kolkata, India

While much has been said about the risks and safety issues experienced by female sex workers in India, there is a considerable dearth of information about the difficulties and problems that sex work researchers, especially female researchers, experience when navigating the highly political, ideological, and stigmatized environment of the Indian sex industry. As noted by scholars, there are several methodological and ethical issues involved with sex work research, such as privacy and confidentiality of the participants, representativeness of the sample, and informed consent. Yet, there has been reluctance among scholars to comment on their research process, especially with regard to how they deal with the protocols for research ethics when conducting social and behavioral epidemiological studies among female sex workers in India and elsewhere. Drawing on my 7 months of field-based ethnographic research with "flying" or non-brothel-based female sex workers in Kolkata, India, I provide in this article a reflexive account of the problems encountered in implementing the research process, particularly the ethical and safety issues involved in gaining access and acceptance into the sex industry and establishing contact and rapport with the participants. In doing so, it is my hope that future researchers can develop the knowledge necessary for the design of ethical and non-exploitative research projects with sex workers.

The effectiveness of a monetary incentive offer on survey response rates and response completeness in a longitudinal study

Background

Achieving adequate response rates is an ongoing challenge for longitudinal studies. The World Trade Center Health Registry is a longitudinal health study that periodically surveys a cohort of ~71,000 people exposed to the 9/11 terrorist attacks in New York City. Since Wave 1, the Registry has conducted three follow-up surveys (Waves 2–4) every 3–4 years and utilized various strategies to increase survey participation. A promised monetary incentive was offered for the first time to survey non-respondents in the recent Wave 4 survey, conducted 13–14 years after 9/11.

Methods

We evaluated the effectiveness of a monetary incentive in improving the response rate five months after survey launch, and assessed whether or not response completeness was compromised due to incentive use. The study compared the likelihood of returning a survey for those who received an incentive offer to those who did not, using logistic regression models. Among those who returned surveys, we also examined whether those receiving an incentive notification had higher rate of response completeness than those who did not, using negative binomial regression models and logistic regression models.

Results

We found that a $10 monetary incentive offer was effective in increasing Wave 4 response rates. Specifically, the $10 incentive offer was useful in encouraging initially reluctant participants to respond to the survey. The likelihood of returning a survey increased by 30% for those who received an incentive offer (AOR = 1.3, 95% CI: 1.1, 1.4), and the incentive increased the number of returned surveys by 18%. Moreover, our results did not reveal any significant differences on response completeness between those who received an incentive offer and those who did not.

Conclusions

In the face of the growing challenge of maintaining a high response rate for the World Trade Center Health Registry follow-up surveys, this study showed the value of offering a monetary incentive as an additional refusal conversion strategy. Our findings also suggest that an incentive offer could be particularly useful near the end of data collection period when an immediate boost in response rate is needed.

Formative Evaluation of Participant Experience With Mobile eConsent in the App-Mediated Parkinson mPower Study: A Mixed Methods Study

Background

To fully capitalize on the promise of mobile technology to enable scalable, participant-centered research, we must develop companion self-administered electronic informed consent (eConsent) processes. As we do so, we have an ethical obligation to ensure that core tenants of informed consent—informedness, comprehension, and voluntariness—are upheld. Furthermore, we should be wary of recapitulating the pitfalls of “traditional” informed consent processes.

Objective

Our objective was to describe the essential qualities of participant experience, including delineation of common and novel themes relating to informed consent, with a self-administered, smartphone-based eConsent process. We sought to identify participant responses related to informedness, comprehension, and voluntariness as well as to capture any emergent themes relating to the informed consent process in an app-mediated research study.

Methods

We performed qualitative thematic analysis of participant responses to a daily general prompt collected over a 6-month period within the Parkinson mPower app. We employed a combination of a priori and emergent codes for our analysis. A priori codes focused on the core concepts of informed consent; emergent codes were derived to capture additional themes relating to self-administered consent processes. We used self-reported demographic information from the study’s baseline survey to characterize study participants and respondents.

Results

During the study period, 9846 people completed the eConsent process and enrolled in the Parkinson mPower study. In total, 2758 participants submitted 7483 comments; initial categorization identified a subset of 3875 germane responses submitted by 1678 distinct participants. Respondents were more likely to self-report a Parkinson disease diagnosis (30.21% vs 11.10%), be female (28.26% vs 20.18%), be older (42.89 years vs 34.47 years), and have completed more formal education (66.23% with a 4-year college degree or more education vs 55.77%) than all the mPower participants (P<.001 for all values). Within our qualitative analysis, 3 conceptual domains emerged. First, consistent with fully facilitated in-person informed consent settings, we observed a broad spectrum of comprehension of core research concepts following eConsent. Second, we identified new consent themes born out of the remote mobile research setting, for example the impact of the study design on the engagement of controls and the misconstruction of the open response field as a method for responsive communication with researchers, that bear consideration for inclusion within self-administered eConsent. Finally, our findings highlighted participants’ desire to be empowered as partners.

Conclusions

Our study serves as a formative evaluation of participant experience with a self-administered informed consent process via a mobile app. Areas for future investigation include direct comparison of the efficacy of self-administered eConsent with facilitated informed consent processes, exploring the potential benefits and pitfalls of smartphone user behavioral habits on participant engagement in research, and developing best practices to increase informedness, comprehension, and voluntariness via participant coengagement in the research endeavor.

Paying Research Participants: Regulatory Uncertainty, Conceptual Confusion, and a Path Forward

The practice of offering payment to individuals in exchange for their participation in clinical research is widespread and longstanding. Nevertheless, such payment remains the source of substantial debate, in particular about whether or the extent to which offers of payment coerce and/or unduly induce individuals to participate. Yet, the various laws, regulations, and ethical guidelines that govern the conduct of human subjects research offer relatively little in the way of specific guidance regarding what makes a payment offer ethically acceptable-or not. Moreover, there is a lack of definitional agreement regarding what the terms coercion and undue inducement mean in the human subjects research context. It is, therefore, unsurprising that investigators and Institutional Review Boards (IRBs) experience confusion about how to evaluate offers of payment, and lean toward conservative approaches. These trends are exemplified by our pilot data regarding the ways in which some IRB members and investigators (mis)understand the concepts of coercion and undue inducement, as well as the ways in which certain research institutions oversee offers of payment at a local level. This article systematically examines the legal and ethical dimensions of offering payment to research participants. It argues that many concerns about offers of payment to research participants can be attributed to the misguided view that such offers ought to be treated differently than offers of payment in other contexts, a form of "research exceptionalism." We show that rejection of research exceptionalism with respect to payment helps settle open debates about both how best to define coercion and undue influence, and how to understand the relation between these concepts and offers of payment. We argue for adoption of our preferred definitions, ideally by regulatory authorities, and against the conventional conservatism toward payment of research participants. Instead, we draw attention to the rarely asked, even radical, question: are research participants paid enough? We conclude by arguing that we ought to change the default to favor, rather than encourage suspicion of, offers of payment to research participants.

Paying patient and caregiver research participants: putting theory into practice

AIM

To review and discuss the ethical and practical considerations about paying patient and caregiver participants in nursing research and, based on this review, to develop a set of guiding principles about payment of participants.

BACKGROUND

To increase recruitment and retention, it is becoming increasingly common in nursing research to provide some form of payment to participants. The risk is that the promise of a payment may influence a patient or caregiver's decision to participate in research. However, research ethics protocols seldom provide explicit guidance about paying participants. Even where formal policies or fee schedules exist, there is little consistency in determining how payments should be calculated or administered. This has resulted in highly variable payment practices between locations, disciplines and institutions.

DESIGN

Discussion paper.

DATA SOURCES

PubMed, MEDLINE with Full Text, CINAHL and Health Source (Nursing/Academic Edition) were searched for terms related to paying research participants published between 2000 - August 2016.

IMPLICATIONS FOR NURSING

Nurse researchers must comply with international, national and institutional ethical standards. Important ethical and practical considerations should guide the decision-making process about whether to pay research participants and how to determine the nature or value of the payment. Guiding principles can support researchers by highlighting key factors that may direct their decision-making in this regard.

CONCLUSION

A deeper understanding of the fundamental ethical and practical considerations is needed to support researchers in their deliberations about paying participants in nursing research.

Methodological approaches to evaluate the impact of FDA drug safety communications

BACKGROUND

When the US FDA approves a new prescription drug there is still a great deal remaining to be learned about the safe and proper use of that product. When new information addressing these topics emerges post-approval, the FDA may issue a Drug Safety Communication (DSC) to alert patients and physicians. The effectiveness of the communication-how drug safety messaging conveyed in FDA DSCs changes patient or prescriber behavior-may depend on multiple factors, including the way physicians and patients learn about the information, their understanding of the issues conveyed, and their perception of the importance of the information. In 2013, the FDA issued two DSCs addressing critical new warnings related to products containing the sedative/hypnotic zolpidem.

OBJECTIVE

In this article, we describe a core set of research initiatives that can be used to study how zolpidem-related DSCs affected subsequent physician and patient decision making.

METHODS

These research initiatives include analyzing drug utilization patterns and related health outcomes; comparing zolpidem-containing products against a comparator with similar indications [eszopiclone (Lunesta)] not covered by the 2013 DSCs; and surveying patients and qualitatively evaluating the dissemination of information regarding these drugs in traditional and social-media channels.

CONCLUSIONS

Using an integrated, multidisciplinary approach, we can obtain information that can be used to optimize regulatory communications by seeking to understand the impact of the information contained in FDA risk communications.

Bioethical Issues in Providing Financial Incentives to Research Participants

Offering research subjects financial incentives for their participation is a common practice that boosts recruitment but also raises ethical concerns, such as undue inducement, exploitation, and biased enrollment. This article reviews the arguments for providing participants with financial incentives, ethical concerns about payment, and approaches to establishing appropriate compensation levels. It also makes recommendations for investigators, institutions, and oversight committees.

Tailored Panel Management: A Theory-Based Approach to Building and Maintaining Participant Commitment to a Longitudinal Study

Many psychological processes unfold over time, necessitating longitudinal research designs. Longitudinal research poses a host of methodological challenges, foremost of which is participant attrition. Building on Dillman's work, we provide a review of how social influence and relationship research informs retention strategies in longitudinal studies. Objective: We introduce the tailored panel management (TPM) approach, which is designed to establish communal norms that increase commitment to a longitudinal study, and this commitment, in turn, increases response rates and buffers against attrition. Specifically, we discuss practices regarding compensation, communication, consistency, and credibility that increase longer term commitment to panel participation. Research design: Throughout the article, we describe how TPM is being used in a national longitudinal study of undergraduate minority science students. TheScienceStudy is a continuing panel, which has 12 waves of data collected across 6 academic years, with response rates ranging from 70% to 92%. Although more than 90% of participants have either left or graduated from their undergraduate degree program, this highly mobile group of people remains engaged in the study. TheScienceStudy has usable longitudinal data from 96% of the original panel. Conclusion: This article combines social psychological theory, current best practice, and a detailed case study to illustrate the TPM approach to longitudinal data collection. The approach provides guidance for other longitudinal researchers, and advocates for empirical research into longitudinal research methodologies.

Does incentivising pill-taking 'crowd out' risk-information processing? Evidence from a web-based experiment

The use of financial incentives for changing health-related behaviours raises concerns regarding their potential to undermine the processing of risks associated with incentivised behaviours. Uncertainty remains about the validity of such concerns. This web-based experiment assessed the impact of financial incentives on i) willingness to take a pill with side-effects; ii) the time spent viewing risk-information and iii) risk-information processing, assessed by perceived-risk of taking the pill and knowledge of its side-effects. It further assesses whether effects are moderated by limiting cognitive capacity. Two-hundred and seventy-five UK-based university staff and students were recruited online under the pretext of being screened for a fictitious drug-trial. Participants were randomised to the offer of different compensation levels for taking a fictitious pill (£0; £25; £1000) and the presence or absence of a cognitive load task (presentation of five digits for later recall). Willingness to take the pill increased with the offer of £1000 (84% vs. 67%; OR 3.66, CI 95% 1.27-10.6), but not with the offer of £25 (79% vs. 67%; OR 1.68, CI 95% 0.71-4.01). Risk-information processing was unaffected by the offer of incentives. The time spent viewing the risk-information was affected by the offer of incentives, an effect moderated by cognitive load: Without load, time increased with the value of incentives (£1000: M = 304.4sec vs. £0: M = 37.8sec, p < 0.001; £25: M = 66.6sec vs. £0: M = 37.8sec, p < 0.001). Under load, time decreased with the offer of incentives (£1000: M = 48.9sec vs. £0: M = 132.7sec, p < 0.001; £25: M = 60.9sec vs. £0: M = 132.7sec, p < 0.001), but did not differ between the two incentivised groups (p = 1.00). This study finds no evidence to suggest incentives "crowd out" risk-information processing. On the contrary, incentives appear to signal risk, an effect, however, which disappears under cognitive load. Although these findings require replication, they highlight the need to maximise cognitive capacity when presenting information about incentivised health-related behaviours.

African American men's and women's perceptions of clinical trials research: focusing on prostate cancer among a high-risk population in the South

While African Americans are at a significantly higher risk for developing certain cancers, they also have low rates of participation in cancer research, particularly clinical trials. This study assessed both African American men's and African American women's (1) knowledge of and participation in cancer-related clinical research and (2) barriers to and motivations for participating in clinical research. Data were collected from a total of 81 participants. Phase I of this research consisted of qualitative focus groups (all 81 participants). Phase II included quantitative pre/post survey data from an education program (56 participants). Findings from the study revealed that African American men and women had poor knowledge about clinical trials and the informed consent process, limited experience in participating in clinical trials, and they feared and mistrusted cancer research. Participants identified incentives, assurance of safety, knowledge and awareness, and benefiting others as motivators to participate in clinical trials research.