Social Media Use for Research Participant Recruitment: Integrative Literature Review

Educator's blueprint: Key considerations for using social media in survey-based medical education research

In this paper, we present a set of recommendations for using social media as a tool for participant recruitment in survey-based medical education research. Drawing from a limited but growing body of literature, we discuss the opportunities and challenges inherent to social media recruitment. This article builds on the authors' previous educator's blueprints about survey design and administration. We highlight the advantages of social media, including its wide reach, cost-effectiveness, and capability to access diverse and geographically dispersed populations, which can significantly enhance the representativeness of research samples. However, we also caution against potential pitfalls, such as ethical concerns, sampling bias, and the fluid nature of social media platforms. Our recommendations are informed by both empirical evidence and best practices, aiming to provide researchers with practical advice for effectively leveraging social media in survey-based medical education research. We emphasize the importance of selecting suitable platforms and engaging with targeted demographics thoughtfully. By sharing our insights, we hope to assist fellow medical education researchers in navigating the complexities of social media recruitment, thereby enriching the quality and impact of survey-based research in this field.

Motivations for and experiences of childbirth abroad amongst Nigerian women: A qualitative study

Birth tourism, the practice of a woman travelling out of her country of residence to another country to give birth, is common globally. Despite this, there is limited literature on the motivations and experiences of women who gave birth abroad. This study aims to address this gap by seeking to understand the motivations for and experiences of childbirth abroad among Nigerian women. Using purposive and snowball sampling, 27 Nigerian women who had children abroad were recruited via social media platforms. In-depth interviews were conducted remotely, audio-recorded, transcribed, and analysed thematically. Braun and Clarke's six-step thematic analysis was used, which included data familiarisation, code generation, searching for themes, reviewing themes, defining themes, and producing the report. We found that motivations for seeking childbirth abroad varied based on the mother's desires for their children, needs, and circumstances. These motivations were formed at different times before and after pregnancy and evolved over time. The experience of childbirth abroad is mostly good. However, there are also bad experiences, with some women feeling like they were treated differently because they were "self-paying" patients, "black", or not country residents. The cost of care is deemed exorbitant, but most pay their bills. Support of loved ones around childbirth abroad was considered crucial, although not always available. Through it all, realising the expected and collateral benefits of childbirth abroad made it all worth it. In conclusion, motivation for childbirth abroad varies and evolves. While globalisation, broken health systems, and ongoing sustained economic challenges in Nigeria and similar settings continue to motivate women to seek childbirth abroad, their experiences of childbirth abroad suggest that though it might be greener on the other side, it is not necessarily dark green. Systems are needed to elevate their voices in the public discourse and safeguard them from bad experiences of childbirth abroad.

Social Marketing Perspective on Participant Recruitment in Informatics-Based Intervention Studies

Effective recruitment strategies are pivotal for informatics-based intervention trials success, particularly for people living with HIV (PLWH), where engagement can be challenging. Although informatics interventions are recognized for improving health outcomes, the effectiveness of their recruitment strategies remains unclear. We investigated the application of a social marketing framework in navigating the nuances of recruitment for informatics-based intervention trials for PLWH by examining participant experiences and perceptions. We used qualitative descriptive methodology to conduct semi-structured interviews with 90 research participants from four informatics-based intervention trials. Directed inductive and deductive content analyses were guided by Howcutt et al.'s social marketing framework on applying the decision-making process to research recruitment. The majority were male (86.7%), living in the Northeast United States (56%), and identified as Black (32%) or White (32%). Most participants (60%) completed the interview remotely. Sixteen subthemes emerged from five themes: motivation, perception, attitude formation, integration, and learning. Findings from our interview data suggest that concepts from Howcutt et al.'s framework informed participants' decisions to participate in an informatics-based intervention trial. We found that the participants' perceptions of trust in the research process were integral to the participants across the four trials. However, the recruitment approach and communication medium preferences varied between older and younger age groups. Social marketing framework can provide insight into improving the research recruitment process. Future work should delve into the complex interplay between the type of informatics-based interventions, trust in the research process, and communication preferences, and how these factors collectively influence participants' willingness to engage.

The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses

INTRODUCTION

Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses.

METHODS

A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience.

RESULTS

Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams.

DISCUSSION

Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Internet-based enrollment of a myositis patient cohort-a national experience

INTRODUCTION

Recruitment for idiopathic inflammatory myopathies (IIM) research is a challenge due to the rarity of the disease and the scarcity of specialized myositis centers. Online recruitment may be a feasible alternative to reach rare disease patients. We evaluated various online recruitment methods in a large longitudinal IIM cohort.

METHODS

The "Myositis Patient Centered Tele-Research" (My Pacer) is a prospective 6-month observational study of IIM, recruited online and through traditional clinic visits. We utilized diverse recruitment methods, such as physician referrals, social media, websites, direct emails, and partnerships with patient-support organizations. Participants self-enrolled and completed pre-screening, e-consenting, and release of medical information via the study-specific app or website. We compared the effectiveness of various recruitment and enrollment methods and the characteristics of the population recruited.

RESULTS

A total of 841 participants completed the pre-screening; 408 completed e-consent and registration. From those, 353 (86.5%) were remotely recruited. Email (201; 49.26%) and social media (77; 18.87%) were important recruitment tools. Patient-support organizations were responsible for disseminating the study to 312 (75.46%) participants. The study app was used by 232 (65.72%) individuals for enrollment, with app users being slightly younger than website users (p = 0.001). Participants were mostly female 317 (77.76%), mean age of 54.84 years, White 328 (80.42%), Black 49 (12%), Asian 13 (3.26%), and non-Hispanic 378 (92.65%). Our study reached all U.S. regions and 45 (90%) U.S. states.

CONCLUSIONS

Social media and partnerships with patient-support organizations lead to a high rate of recruitment, with a wide reach, and a reasonably diverse population.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSION

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

Understanding how nurses can effectively utilise social media for increasing public involvement, recruitment and impact dissemination of Clinical Research Trials

Background

The methodologies for clinical research trials are evolving to greater usage of social media platforms, providing opportunities to incorporate smart technologies in their delivery. Research Nurses should consider how they can utilise platforms for public engagement in trials.

Aim

To explore the experiences of social media platforms and clinical research trials in a healthy population group, to gain insight into how clinical researchers can utilise these platforms professionally and ethically.

Methods

Using a critical realist qualitative focus group design with template analysis, we recruited 16 healthy members of the public aged 18-75 years. The data expands upon their thoughts and behaviours regarding social media platforms with their understanding of clinical research.

Results

Three main themes along with their specific subthemes (1) Design: Patient and Public Involvement (Subtheme: Understanding of clinical research, Diversity of social media users), (2) Implementation: Recruitment to active studies, (Subtheme: Motivators for volunteering, Trustworthy), (3) Dissemination: Impact and Awareness of Results, (Subtheme: Information overload, Motivations for users to share information).

Conclusions

This study has highlighted the need to consider the way different population groups use social media platforms and the information they share when looking to engage them in clinical research trials.

Social marketing and the challenges of participant recruitment

Recruitment of research participants often has not obtained a desired sample size, thereby becoming a major problem inhibiting investigators' ability to adequately test the specified hypotheses. Social marketing with its four Ps, originally developed by the business world to sell products and adapted for public health initiatives, is proposed as a dynamic comprehensive conceptual framework to apply marketing principles and practices to enhance participant recruitment. Applying a social marketing approach to research recruitment would require initial investigation to understand the motivations of the target audience in regard to research participation, and continued research throughout the main project to adapt the recruitment efforts as limitations arise. Additional funding would be needed for successful social marketing research recruitment programs to be systematically implemented and evaluated as part of research projects. In this paper, we define social marketing concepts, briefly review the available literature supporting social marketing applied to recruitment for research studies, and consider ethical issues that may arise when using a social marketing approach.

Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study

BACKGROUND

Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media-based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact.

OBJECTIVE

The aim of this study is to describe one center's social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies.

METHODS

Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform's native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region.

RESULTS

Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P≤.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts.

CONCLUSIONS

These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment.

The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study

BACKGROUND

The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection.

OBJECTIVE

This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection.

METHODS

This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud.

RESULTS

The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55).

CONCLUSIONS

Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions.

Practical social media recommendations for dementia prevention researchers

INTRODUCTION

Practical social media recommendations are needed to facilitate greater engagement in dementia prevention research. Alongside relevant experts, our aim was to develop a set of consensus recommendations that reflect the values and priorities of prospective participants to guide social media use.

METHODS

We conducted a three-round, modified Delphi consisting of three online surveys and three conferences calls. The diverse, international Delphi panel comprised 16 experts with lived (n = 10) and professional (n = 6) experiences. Consensus was defined a priori as ≥ 70% agreement.

RESULTS

Twenty-six items achieved consensus. Two items reached consensus in round 1: ethical considerations of closed social media groups (88%) and of social media users sharing prevention content with connections who are not on social media (79%). Nine items reached consensus in round 2, related to misinformation (79%), stigma (93%), and other key aspects of social media communication. After revisions, 15 items reached consensus in the final round. These items included: identifying when researchers ought to engage, managing closed social media groups, rankings of short form content, prioritizing lay summaries and multimedia resources, and rankings of preferred language. One item about the language of prevention for audiences living with dementia did not reach consensus. Final consensus items formed the new set of recommendations, which we organized into seven social media use cases. These use cases include setting up a social media page or community, handling online misinformation, actively challenging stigma, handling difficult online interactions, introducing new research to the public, help with study recruitment, and the language of prevention when writing posts.

DISCUSSION

These consensus recommendations can help dementia prevention researchers harness social media use for the purposes of public engagement and uphold the norms and values specific to the dementia research and broader communities.

Highlights

We created social media recommendations with research and community experts.Recommendations cover key ethical considerations for dementia prevention research.Areas include misinformation, stigma, information updates, and preferred language.Full consensus recommendations are organized into seven social media use cases.

The participation of hard-to-reach older people in the research and development process of health technologies from the perspective of multipliers-A qualitative analysis

Introduction

The participation of older people in research and development processes has long been called for but has not been sufficiently put into practice. In addition, participation is often late and not particularly intensive, so that certain older groups of people are underrepresented in the development of health technologies (HT). Heterogeneity, e.g., between urban and rural populations, in access to and motivation for participation is also rarely taken into account. The aim of this study was to investigate form and phases of participation for hard-to-reach older people in the research and development process of HT.

Methods

The qualitative study among multipliers was conducted using focus groups and telephone interviews and took place in a city and an adjacent rural area in northwestern Lower Saxony, Germany. A content analysis of the data was undertaken using deductive-inductive category formation.

Results

Seventeen participants (13 female) took part in the study (median age 61, 33-73). Participants from both areas identified particular forms and phases of participation in the research and development process. Longer forms of participation for hard-to-reach groups and the development process of technologies for older people from the rural area were viewed as challenges. Passive and active access strategies are needed to achieve sufficient heterogeneity in the research and development process. Trusted multipliers can play an important role in gaining access to hard-to-reach older people, but also during the research process. Apart from facilitating factors (e.g., age-specific study materials), inhibiting factors such as contact anxieties are also indicated. Only urban participants mention financial/material incentives and community as possible motivations.

Conclusions

The results provide important insights from the perspective of multipliers. They show specificities in access and participation for rural areas and for hard-to-reach older people. Many older people may have uncertainties about research projects and HT. Multipliers can assume a key role to help reduce these uncertainties in the future.

Engaging Long-Term Care Workers in Research: Recruitment Approaches and Participant Characteristics From a Randomized Controlled Trial to Improve COVID-19 Vaccine Confidence

OBJECTIVE

To describe and compare the recruitment methods employed in a randomized controlled trial targeting long-term care workers, and resulting participant baseline characteristics.

DESIGN

We used a multifaceted recruitment process to enroll long-term care workers in our 3-arm randomized controlled trial comparing 2 interventions to enhanced usual practice, for improving COVID-19 vaccine confidence and other outcomes.

SETTING AND PARTICIPANTS

Adult long-term care workers living in the United States employed within the last 2 years were invited to join the study. Participants also had to meet specific screening criteria related to their degree of worry about the vaccine and/or their vaccination status.

METHODS

We used a participatory approach to engage our long-term care stakeholders in codesigning and executing a combination of recruitment methods, including targeted e-recruitment, paid e-recruitment, and in-person recruitment. Participants were screened, consented, and enrolled online. We implemented a participant verification process to ensure the integrity of our study data, and used a tailored participant management platform to manage enrollment.

RESULTS

We enrolled 1930 long-term care workers between May 2022 and January 2023. We met our enrollment target, despite each recruitment method having limitations. Total variable costs of approximately $102,700 were incurred and differed on a per-enrolled participant basis across methods: $25.73 for targeted e-recruitment, $57.12 for paid e-recruitment, and $64.92 for in-person methods. Our sample differed from the national population in age, gender, race/ethnicity, education, and role in long-term care. Differences were also observed between online and in-person recruitment methods.

CONCLUSIONS AND IMPLICATIONS

Our results support the feasibility of enrolling a large number of long-term care workers in a randomized controlled trial to increase COVID-19 vaccine confidence. Findings build upon the evidence base for engaging this important population in research, a critical step to improving long-term care resident health and well-being. Results from our trial are anticipated in 2024.

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

PURPOSE

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

METHODS

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

FINDINGS

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

CONCLUSIONS

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

Establishing and Affirming Social Connections: Recruiting Non-Hispanic Black Adults with Type 2 Diabetes

The underrepresentation of non-Hispanic Black adults in clinical research impacts the generalizability and usefulness of research findings. The purpose of this article is to discuss recruitment strategies used in a research study examining the self-care of diabetes and diabetes distress in non-Hispanic Black adults with type 2 diabetes. In this cross-sectional correlation study, the participants were non-Hispanic Black adults with type 2 diabetes living in North Carolina. A questionnaire collected sociodemographic and clinical characteristics. This study was analyzed using descriptive statistics. In total, 512 individuals accessed the online survey. After data screening, 275 participants were used for data analysis. Sixteen recruitment sites provided letters of support, and 13 were active in the recruitment process. Most participants learned about the research study via social media. Social connections resulting in recruitment partners and using social media supported the successful recruitment. The recruitment strategies implemented can inform researchers of effective evidence-based recruitment strategies to increase the participation of non-Hispanic Black adults in clinical research.

Challenges and best practices for recruiting families of children with intellectual disabilities for health research

Research focused on children with intellectual disabilities has been of increasing interest over the last two decades. However, a considerable lag in the amount of research that is representative and generalizable to this population in comparison to neurotypical children remains, largely attributed to issues with participant engagement and recruitment. Challenges and barriers associated with engaging and recruiting this population include lack of research to provide a sound foundation of knowledge, ethical considerations, parental attitudes, family commitments, and organizational gatekeeping. Researchers can engage children and their families using participatory research methods, honouring the child's right to assent, and collaborating with parents. Recruitment strategies include partnering with organizations, working with parent and patient partners, and using remote methods. Employing evidence-informed engagement and recruitment strategies may provide substantial social and scientific value to the research field by ensuring that this underrepresented population benefits equitably from research findings.

Remote work arrangement: a blessing in disguise for socially anxious individuals

This research examines the link between social anxiety disorder (SAD), psychological distance (PD), and burnout using survey data from 463 software development workers who are currently working remotely. According to the results of the study, SAD was associated with higher PD, but, in contrast to what had been shown in earlier studies, this higher PD had no effect on the participants' reported levels of burnout. Both psychological safety and workplace attachment orientation (WAO) were tested for their moderating effects in this study. According to the study's findings, the link between SAD and PD was moderated by WAO but not by psychological safety. The findings of this study underscore the importance of conducting additional research on the challenges faced by people with social anxiety in the workplace and the steps that can be taken by employers to better accommodate them.

Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment

INTRODUCTION

Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care.

METHODS

Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis.

RESULTS

The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatal health care.

DISCUSSION

The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.

Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food-Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study

BACKGROUND

Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines.

OBJECTIVE

The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated.

METHODS

In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food-based dietary guidelines (FBDGs) in addition to lifestyle factors.

RESULTS

At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except "water" (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in "moderate to vigorous intensity" was underestimated with the DIGIKOST-FFQ. However, estimated time in "moderate to vigorous intensity," "vigorous intensity," and "sedentary time" showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations.

CONCLUSIONS

The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in "moderate to vigorous physical activity," "sedentary time," and "sleep."

Differences in perceptions of community stigma towards opioid use disorder between community substance use coalition members and the general public

INTRODUCTION

To examine differences in perceptions about community stigma towards individuals with opioid use disorder (OUD) between community members involved in the opioid response (i.e., coalition members) and the general public, and how community geography may moderate this relationship.

METHODS

This study administered identical cross-sectional surveys about perceived community opioid-related stigma to two distinct populations in 66 communities participating in the HEALing Communities Study prior to the intervention period (i.e., coalition members, November 2019-January 2020; residents, March-April 2020). Linear-mixed models compared survey responses of populations, including the moderating effect of community rural/urban location.

RESULTS

A total of 826 coalition members and 1131 residents completed the surveys. The study found no differences between the coalition members and residents for general perceived community opioid-related stigma. In both urban and rural communities, coalition members reported greater perceived community stigma than residents reported towards medication for opioid use disorder (MOUD), naloxone, and drug treatment as an alternative to incarceration.

CONCLUSION

Our findings suggest similar perceived community opioid-related stigma between coalition members and residents, yet differences emerge related to evidence-based practices (i.e., MOUD, naloxone, and drug treatment as an alternative to incarceration) to reduce opioid overdose deaths.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04111939.

A change in social participation affects cognitive function in middle-aged and older Chinese adults: analysis of a Chinese longitudinal study on aging (2011-2018)

Background

One of the biggest challenges facing older adults is cognitive decline and social participation has always been considered a protective factor. However, it is not clear whether social participation predicts cognitive function in this population, rather than depressive symptoms, self-reported health, and activities of daily life, with sufficient capacity to detect unique effects.

Methods

This study included adults aged 45 and above in China (N = 5,258) who participated in a large national older adult health survey and provided data from 2011, 2013, 2015, and 2018. The unique associations between the predictors of social participation and cognitive function over time and context were evaluated in the Latent Growth Model (LGM).

Results

Among the 5,258 participants in our study, an overall cognitive decline was observed. Social participation predicts two dimensions of cognitive function, with a degree of impact comparable to depressive symptoms, self-reported health, and activities of daily life. Among them, social participation exhibits a noteworthy prognostic impact on episodic memory during the same period. The regression coefficient is approximately 0.1 (p < 0.05) after controlling other mixed variables (depressive symptoms, self-reported health, and activities of daily life). In contrast, social participation is also a significant predictor of mental intactness in the same period, with a regression coefficient of 0.06 (p < 0.05), even if all mixed variables are controlled.

Conclusion

Over time, the correlation strength of social participation is comparable to other recognized cognitive function prediction indicators, indicating that promoting social participation among middle-aged and older Chinese adults is a meaningful way to improve cognitive function degradation, which has important policy and practical significance.

Cost-effectiveness analysis of recruitment strategies in a large diabetes prevention trial conducted across two sites in Sydney, Australia

BACKGROUND

Diabetes prevention trials require large samples and community-based recruitment, which can be protracted and expensive. We analysed the cost-effectiveness of recruitment strategies used in a randomised placebo-controlled supplement trial in adults with prediabetes and overweight or obesity conducted in Sydney, Australia.

METHODS

Recruitment strategies included advertising through local radio stations and newspapers, television news coverage, online advertising and editorials, advertising in and referral from primary care settings, university- and hospital-based advertising, and attending or hosting local events. For each strategy, the number of expressions of interest, screenings booked, and randomised participants were collated. The percentage contribution from each strategy, overall cost, and cost per participant were calculated.

RESULTS

Of 4498 expressions of interest, 551 (12%) were eligible for onsite screening and 401 (9%) were randomised. Recruitment costs totalled AU$218,501, averaging AU$545 per participant. The recruitment strategy was recorded for 49% who expressed interest in the trial, and for 75% randomised into the trial. From these data, advertising on local radio stations was the most cost-effective strategy, contributing 46% of participants at AU$286 per participant, then advertising in and referral from primary care settings (57 participants [19%], AU$1438 per participant). The least cost-effective strategy was television news coverage, which was not targeted to the Sydney-based audience, contributing only six participants (AU$10,000 per participant).

CONCLUSION

Radio advertising and recruitment through healthcare were the most effective recruitment strategies in this trial. Recruitment strategies should be location-specific and appropriate for the target population, prioritising low-effort high-yield strategies. Trial investigators should seek opportunities for free advertising.

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care.

METHODS

We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.

RESULTS

Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures.

CONCLUSIONS

LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Exploring the use of social media and online methods to engage persons with lived experience and healthcare professionals in creating research agendas: Lessons from a pediatric cancer research priority-setting partnership

Social media is increasingly used to engage persons with lived experience and healthcare professionals in research, however, there remains sparse guidance on how to effectively use social media to engage these groups in research agenda-setting. Here we report our process and experience utilizing a social media campaign to engage Canadians within the pediatric cancer community in a research priority-setting exercise. Following the James Lind Alliance method, we launched a priority-setting partnership (PSP) to develop a child with cancer-, survivor-, family member-, and healthcare professional-based Canadian pediatric cancer research agenda. Social media-based strategies were implemented to recruit participants for two PSP surveys, including preparatory activities, developing a website, launching graphics and advertisements, and engaging internal and external networks. Descriptive statistics of our data and analytics provided by the platforms are used presently to report our process. The framework we implemented involved preparing for social media use, identifying a target audience, developing campaign content, conducting the campaign, refining the campaign as needed, and evaluating its success. Our process resulted in a substantial social media-based reach, good survey completion rates, and a successfully developed pediatric cancer community-specified research agenda. Social media may represent a useful approach to engage persons with lived experience and healthcare professionals in research agenda development. Based on our experience, we present strategies to increase social media campaign engagement that may be useful to those seeking to conduct health research priority-setting exercises.

Digital technologies used in clinical trial recruitment and enrollment including application to trial diversity and inclusion: A systematic review

Background

Many clinical trials fail because of poor recruitment and enrollment which can directly impact the success of biomedical and clinical research outcomes. Options to leverage digital technology for improving clinical trial management are expansive, with potential benefits for improving access to clinical trials, encouraging trial diversity and inclusion, and potential cost-savings through enhanced efficiency.

Objectives

This systematic review has two key aims: (1) identify and describe the digital technologies applied in clinical trial recruitment and enrollment and (2) evaluate evidence of these technologies addressing the recruitment and enrollment of racial and ethnic minority groups.

Methods

We conducted a cross-disciplinary review of articles from PubMed, IEEE Xplore, and ACM Digital Library, published in English between January 2012 and July 2022, using MeSH terms and keywords for digital health, clinical trials, and recruitment and enrollment. Articles unrelated to technology in the recruitment/enrollment process or those discussing recruitment/enrollment without technology aspects were excluded.

Results

The review returned 614 results, with 21 articles (four reviews and 17 original research articles) deemed suitable for inclusion after screening and full-text review. To address the first objective, various digital technologies were identified and characterized, which included articles with more than one technology subcategory including (a) multimedia presentations (19%, n = 4); (b) mobile applications (14%, n = 3); (c) social media platforms (29%, n = 6); (d) machine learning and computer algorithms (19%, n = 4); (e) e-consenting (24%, n = 5); (f) blockchain (5%, n = 1); (g) web-based programs (24%, n = 5); and (h) virtual messaging (24%, n = 5). Additionally, subthemes, including specific diseases or conditions addressed, privacy and regulatory concerns, cost/benefit analyses, and ethnic and minority recruitment considerations, were identified and discussed. Limited research was found to support a particular technology's effectiveness in racial and ethnic minority recruitment and enrollment.

Conclusion

Results from this review illustrate that several types of technology are currently being explored and utilized in clinical trial recruitment and enrollment stages. However, evidence supporting the use of digital technologies is varied and requires further research and evaluation to identify the most valuable opportunities for encouraging diversity in clinical trial recruitment and enrollment practices.

Hope for the best, but prepare for the worst: Social media posted by participants in stem cell clinical trials

This article examines the influence of social media posts on clinical trials involving stem cell-based interventions. Based on the literature review, we identified three potential risks associated with social media posts regarding clinical trials that involve stem cell-based interventions: (1) threats to scientific validity, (2) amplification of excessive expectations, and (3) breaches of confidentiality. Additionally, preliminary recommendations are provided to safeguard the value of stem cell clinical trials for future patients in the age of social media. Our approach aims to safeguard the well-being of forthcoming participants and ensure the scientific validity of stem cell research, as well as possibly aid in the further development of shared guidelines for posting stem cell clinical trial information on social media platforms.

Enhancing Efficiency and Reach Using Facebook to Recruit Breast Cancer Survivors for a Telephone-Based Supportive Care Randomized Trial During the COVID-19 Pandemic

PURPOSE

Evidence supporting social media-based recruitment of cancer survivors is limited. This paper describes how we used Facebook during the COVID-19 pandemic to augment our recruitment of breast cancer survivors for our two-site telephone-based randomized clinical trial (RCT) at Dartmouth-Hitchcock Medical Center and the University of Alabama at Birmingham.

METHODS

Originally a two-site RCT of a telephone-delivered breast cancer survivorship intervention, we extended our clinic-based recruitment to Facebook. Participant characteristics, geographic reach, and baseline outcomes were compared across recruitment sources (ie, two clinics and Facebook) using descriptive statistics and effect sizes.

RESULTS

Enrollment rates (20%-29%) were comparable across recruitment sources. The 21-month Facebook marketing campaign accounted for 59% (n = 179/303) of our total sample and had the greatest geographic reach, recruiting women from 24 states. The Facebook campaign reached a total of 51,787 unique individuals and cost $88.44 in US dollars (USD) per enrolled participant. Clinic samples had a greater proportion of women who were widowed (8% v 1%; P = .03) and Facebook had a higher proportion of women with a household income over $40,000 USD (83% v 71%; P = .02). There were no statistically significant differences between Facebook and the two clinics on baseline survey scores.

CONCLUSION

Augmenting traditional recruitment with Facebook increased our RCT's geographic and sociodemographic reach and supported meeting recruitment goals in a timely way. In the wake of the COVID-19 pandemic, cancer survivorship researchers should consider using social media as a recruitment strategy while weighing the advantages and potential biases introduced through such strategies.

Twitter (X) in Medicine: Friend or Foe to the Field of Interventional Cardiology?

Twitter, which recently changed its name to "X," is a popular social media platform that is used widely across the world due to its easy accessibility through the internet. Due to more public familiarity, we referred to this social media platform as "Twitter (X)" in this article. Users can create posts, also called as "tweets" with a limitation of 280 characters and can add images, videos, and weblinks. While there are several social media platforms used by health care professionals, eg, Facebook, Instagram, Snapchat, TikTok, LinkedIn, and Periscope, Twitter (X) is an extremely popular platform among physicians, especially cardiologists. Due to its persistent growth and ever-expanding outreach, Twitter (X) is facilitating dissemination of scientific information including complex medical knowledge leading the way in collaborations, and in organizing and networking of various health care professionals, patients, and caregivers with shared medical interests. While there are several advantages of Twitter (X) as an important tool in our contemporary medical armamentarium, there are also some drawbacks. False information can be distributed effortlessly and can entrench unscientific beliefs as there is no peer-review process. Occasionally, discourteous discussions between health care professionals can be misinterpreted by users with limited medical knowledge. Other disadvantages include Health Insurance Portability and Accountability Act violations and hacking of accounts. Therefore, it is imperative for health care professionals interested to use this valuable tool to be familiar with and cautious about its potential risks and limitations.

A Digital Gaming Intervention to Strengthen the Social Networks of Older Dutch Adults: Mixed Methods Process Evaluation of a Digitally Conducted Randomized Controlled Trial

BACKGROUND

Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely.

OBJECTIVE

We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults.

METHODS

We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment.

RESULTS

In total, 371 people aged 18 years or older signed up for the RCT, of which 64% (238/371) were aged 65 years or older. Of the total sample, 20% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires.

CONCLUSIONS

Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires.

Merits and Pitfalls of Social Media as a Platform for Recruitment of Study Participants

Efficient and effective methods of recruiting participants for studies have characteristically come with many challenges. The unprecedented rise of social media platforms such as Facebook and Instagram has revolutionized the ease of recruiting participants as compared to more traditional methods such as newspaper or radio advertisements. While these new advancements may seem to increase the success of recruitment, they are not without their own faults and limitations. In this paper, we intend to dissect the advantages and disadvantages of social media platforms in recruiting participants. Specifically, we will discuss the advantages of targeted and rapid recruitment, engagement, and cost reduction as well as the disadvantages of representativeness, privacy concerns, limited control, and limited access.

Outreach Through Facebook: Do Patients With Atopic Dermatitis Provide Clinically Relevant Information When Recruited for Surveys on Social Media?

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Utilization of online systems to promote youth participation in research: A methodological study

BACKGROUND

Online surveys can align with youth's increased use of the internet and can be a mechanism for expanding youth participation in research. This is particularly important during the coronavirus disease 2019 (COVID-19) pandemic, when in-person interactions are limited. However, the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies.

AIM

To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey.

METHODS

This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application, Health-E You/Salud iTuTM, for adolescent girls attending school-based health centers (SBHCs) across the United States. SBHC staff gave adolescent girls a web link to an online eligibility and consent survey. Participants were then asked to complete two online surveys (baseline and 3-month follow-up). Surveys, reminders, and incentives to complete them were distributed through short message service (SMS) text messages. Upon completing each survey, participants were also sent an email with a link to an electronic gift card as a thank-you for their participation. Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC.

RESULTS

This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States. Between September 2021 and June 2022, 415 adolescent girls were screened using the Qualtrics online survey platform, and 182 were eligible to participate. Of those eligible, 78.0% (n = 142) completed the baseline survey. Participants were racially, geographically, and linguistically diverse. Most of the participants (89.4%) were non-White, and 40.8% spoke Spanish. A total of 62.0% (n = 88) completed the 3-month follow-up survey. Limitations of this system included reliance on internet access (via Wi-Fi or cell service), which was not universally available or reliable. In addition, an individual unrelated to the study obtained the survey link, filled out multiple surveys, and received multiple gift cards before the research team discovered and stopped this activity. As a result, additional security protocols were instituted.

CONCLUSION

Online systems for health research can increase the reach and diversity of study participants, reduce costs for research personnel time and travel, allow for continued study operation when in-person visits are limited (such as during the COVID-19 pandemic), and connect youth with research using technology. However, there are challenges and limitations to online systems, which include limited internet access, intermittent internet connection, data security concerns, and the potential for fraudulent users. These challenges should be considered prior to using online systems for research.

Participant recruitment for paediatric research using social media: A practical 'how-to' guide for researchers

AIM

Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies.

METHODS

The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process.

RESULTS

A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase.

CONCLUSION

Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

Social Media in Neuro-Ophthalmology: Paradigms, Opportunities, and Strategies

BACKGROUND

Social media (SoMe) is an integral part of life in the 21st century. Its potential for rapid dissemination and amplification of information offers opportunities for neuro-ophthalmologists to have an outsized voice to share expert-level knowledge with the public, other medical professionals, policymakers, and trainees. However, there are also potential pitfalls, because SoMe may spread incorrect or misleading information. Understanding and using SoMe enables neuro-ophthalmologists to influence and educate that would otherwise be limited by workforce shortages.

EVIDENCE ACQUISITION

A PubMed search for the terms "social media" AND "neuro-ophthalmology," "social media" AND "ophthalmology," and "social media" AND "neurology" was performed.

RESULTS

Seventy-two neurology articles, 70 ophthalmology articles, and 3 neuro-ophthalmology articles were analyzed. A large proportion of the articles were published in the last 3 years (2020, 2021, 2022). Most articles were analyses of SoMe content; other domains included engagement analysis such as Altmetric analysis, utilization survey, advisory opinion/commentary, literature review, and other. SoMe has been used in medicine to share and recruit for scientific research, medical education, advocacy, mentorship and medical professional networking, and branding, marketing, practice building, and influencing. The American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society have developed guidelines on the use of SoMe.

CONCLUSIONS

Neuro-ophthalmologists may benefit greatly from harnessing SoMe for the purposes of academics, advocacy, networking, and marketing. Regularly creating appropriate professional SoMe content can enable the neuro-ophthalmologist to make a global impact.

The development and validation of a multidimensional organisational trust measure

Motivation for the study

Workplaces are changing with employees increasingly working remotely and flexibly, which has created larger physical distance between team members. This shift has consequences for trust research and implications for how trust is built and maintained between employees and leaders.

Research design

Three studies collectively aimed to demonstrate how employee trust in leaders has adapted to a hybrid work environment. A validation of a seminal multidimensional employee trust in leaders measure was conducted. Also, an alternative multidimensional measure was developed, piloted, and then validated using exploratory and confirmatory factor analyses.

Main findings

Findings showed the Affective and Cognitive Trust scale not to be sufficiently reliable or valid after testing with a sample working in a hybrid model of virtual and face to face work environments. However, the new measure demonstrated good reliability and validity.

Implication

Findings reinforced that there are behavioural and relational elements to organisational trust, and there are two discreet dimensions to trustworthy behaviour: communication and authenticity.

Quality of Life, Fatigue, and Physical Symptoms Post-COVID-19 Condition: A Cross-Sectional Comparative Study

The magnitude of post-COVID-19 syndrome was not thoroughly investigated. This study evaluated the quality of life and persistence of fatigue and physical symptoms of individuals post-COVID-19 compared with noninfected controls. The study included 965 participants; 400 had previous COVID-19 disease and 565 controls without COVID-19. The questionnaire collected data on comorbidities, COVID-19 vaccination, general health questions, and physical symptoms, in addition to validated measures of quality of life (SF-36 scale), fatigue (fatigue severity scale, FSS), and dyspnea grade. COVID-19 participants complained more frequently of weakness, muscle pain, respiratory symptoms, voice disorders, imbalance, taste and smell loss, and menstrual problems compared to the controls. Joint symptoms, tingling, numbness, hypo/hypertension, sexual dysfunction, headache, bowel, urinary, cardiac, and visual symptoms did not differ between groups. Dyspnea grade II-IV did not differ significantly between groups (p = 0.116). COVID-19 patients scored lower on the SF-36 domains of role physical (p = 0.045), vitality (p < 0.001), reported health changes (p < 0.001), and mental-components summary (p = 0.014). FSS scores were significantly higher in COVID-19 participants (3 (1.8-4.3) vs. 2.6 (1.4-4); p < 0.001). COVID-19 effects could persist beyond the acute infection phase. These effects include changes in quality of life, fatigue, and persistence of physical symptoms.

Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment

BACKGROUND

Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.

RESEARCH AIM

To explore experiences of breastfeeding mothers with infants having undergone "tongue-tie" surgery.

METHOD

This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.

RESULTS

The sample was predominantly white (n = 86; 95%), non-Hispanic (n = 84; 93%), married/cohabitating (n = 85; 94%), and currently providing their own milk (n = 81; 89%).Difficult latch was the primary reason for seeking help. Participants reported lingual (n = 84; 93%), labial (n = 79; 88%), and buccal (n = 16; 17%) tissue-release, with 80% (n = 73) reporting > 1 released. For each tissue released, > 80% (n = 72) of participants felt "very confident" in their ability to correctly identify it and 97% (n = 87) felt "very involved" and "strongly agreed" with surgical release. International Board Certified Lactation Consultants^® were the most frequently identified source of information (n = 45; 50%) and referrals (n = 38; 42%), while pediatric dentists most frequently performed interventions (n = 60; 67%).

CONCLUSIONS

Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.

Lifestyle factors in Black female breast cancer survivors—Descriptive results from an online pilot study

Background

Breast cancer (BC) research examining disparities in cancer survivorship and modifiable risk behaviors has been mostly cancer-specific, leaving relevant gaps in disparities research relating to other cancer survivorship outcomes, including cardiovascular disease (CVD). Maintaining healthy lifestyle behaviors is a critical component of successful cancer survivorship, where unhealthy behaviors may increase the risk for recurrence, second primary cancers, and incidence of new comorbid conditions, including CVD. The current study describes BC survivorship factors among an online pilot study of Black BC survivors in Maryland, with a focus on the burden of obesity, comorbidity, and behavioral factors associated with CVD risk.

Methods

Utilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey. Descriptive characteristics (demographic, clinical, and lifestyle factors) were analyzed in terms of frequencies, means, standard deviations (SD) overall and by county.

Results

The average ages at time of survey and at primary BC diagnosis were 58.6 years (SD = 10.1) and 49.1 years (SD = 10.2), respectively. More than half of the survivors reported having hypertension (51%); and while only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post BC diagnosis. Only 28% of the survivors reported meeting weekly exercise recommendations. While 70% were never smokers, most ever smokers resided in Baltimore City/Baltimore County (n = 18 ever smokers).

Conclusion

Our pilot study identified at-risk BC survivors in Maryland due to the high prevalence of CVD risk factors (hypertension, obesity, limited exercise). These pilot study methods will inform a future statewide multilevel prospective study to improve health behaviors among Black BC survivors.

Considerations on the Obstacles That Lead to Slow Recruitment in a Pain Management Clinical Trial: Experiences from the Belgian PELICAN (PrEgabalin Lidocaine Capsaicin Neuropathic Pain) Pragmatic Study

Background

A qualitative evaluation study of the prematurely terminated PrEgabalin Lidocaine Capsaicin Neuropathic Pain (PELICAN) study was performed. The PELICAN study aimed to examine pain management for localized neuropathic pain (LNP), as epidemiological figures have shown a high percentage of LNP patients in Belgium. The study compared systemic and topical medications according to pain relief, adverse effects, and several measures of quality of life.

Objective

Achieving better study patient recruitment through qualitative research. To investigate and determine the causes of the observed recruitment problems in the PELICAN study, pain centers involved in the study as well as nonrecruiting pain centers were included. Furthermore, it aimed to highlight the positive and negative lessons learned from the conducted study and the number of obstacles the team had to overcome.

Methods

A qualitative study, using a mixed methods approach, was performed. Multiple pain centers in Belgium completed an online survey, after which a structured interview was conducted to elaborate the responses in more detail. The broad topics of these meetings were feedback about the study, reviewing survey answers, and actions undertaken to enhance recruitment.

Results

Different factors contributed to the low recruitment rate in the PELICAN study, such as limited and late referral from the general practitioners to the Belgian pain centers, insufficient internal referrals from nonpain specialists, lack of specific expertise on LNP in some centers, scarcity of staff, limited reimbursement to administer complex analgesic schemes, overestimation of the patient population, and the reluctance of patients to participate in pain research. Additionally, shortcomings in the implemented study design and the need for more logistical investments were identified.

Conclusion

The findings of the qualitative study demonstrate the need for further, more varied LNP research in Belgium, not limited to pharmacological studies. It also sheds important light on the recruitment obstacles that may be faced during these studies. Future studies could support this research by offering better proposals for feasibility and recruitment, for instance, by designing and conducting a compelling pilot study or applying social media during the recruitment phase. Clinical Trials. This trial is registered with NCT03348735. EUDRACT number 2018-003617-17.

Evaluation of response to incentive recruitment strategies in a social media-based survey

Objective

This study aimed to examine varying incentives on acceptance to participate in an online survey on social media and to identify related demographic factors.

Methods

The study used Facebook and targeted its users aged 18 to 24 years in the United States. During recruitment, participants were randomized to one of the three types of incentives for survey completion, (1) a $5 gift card, (2) a lottery for a $200 gift card, and (3) a $5 gift card plus a lottery for a $200 gift card. Acceptance rates for survey participation were compared across three incentives using percentages, 95% logit-transformed confidence intervals, and Pearson's chi-squared tests. The survey asked about cognition and behaviors around smoking and vaping.

Results

The ads had 1,782,931 impressions, 1,104,139 reaches, and 11,878 clicks. The average ad frequency was 1.615, and the click-through rate was 0.67%. Males clicked less than females when seeing the ads. The acceptance rates for the three incentives were 63.7%, 37.2%, and 64.6%, respectively. A Chi-square test confirmed that the lottery-only group had a lower acceptance rate compared to those guaranteed an incentive, including the gift card group and the gift card and lottery group. Further analyses indicated that males did not opt into the survey as often as females when given the lottery-only incentive option, and those who did not meet their financial expenses opted into the survey more often than those who had more money than their expenses when given the lottery-only incentive option.

Conclusions

This study suggests that incentives guaranteed to all participants, even if the incentive's value is small, may lead to higher acceptance rates compared to a lottery for a greater incentive in social media-based surveys.

Using Social Media to Collect Dietary Information for Public Health Policy

There is no regular, routine measurement of food and nutrient intake regionally in the UK. Our goal was to identify a method to support policy makers tracking the local population food intakes. The aim of this study was to test the feasibility of using social media to obtain a large sample in a short time, with a regional focus; collecting dietary information using online tools. A Facebook (FB) boost approach was used to recruit a regional (Yorkshire and Humberside) sample of adults to complete a brief online survey followed by a detailed measure of food and nutrient intakes for the previous day using myfood24®. The FB posts were boosted for 21 days and reached 76.9 k individuals. 1428 participants completed the main questionnaire and 673 participants completed the diet diary. The majority of respondents were older women. 22% of respondents reported experiencing moderate food insecurity during 2021. Overall nutrient values recorded were similar to national survey data. Intakes of fibre and iron were low. Despite some challenges, this study has demonstrated the potential to use social media, in this case Facebook, to recruit a large sample in a short timeframe. Participants were able to use online tools to report food and nutrient intakes. This data is relevant to local and national policy makers to monitor and evaluate public health programmes.