The touro 12-step: a systematic guide to optimizing survey research with online discussion boards

Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus

OBJECTIVE

Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia.

METHODS

A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia.

RESULTS

Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018).

CONCLUSION

Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.

Self-reported Subjective Effects of Analytically Confirmed New Psychoactive Substances Consumed by e-Psychonauts: Protocol for a Longitudinal Study Using a New Internet-Based Methodology

Background

During the last few years, the continuous emergence of new psychoactive substances (NPS) has become an important public health challenge. The use of NPS has been rising in two different ways: buying and consuming NPS knowingly and the presence of NPS in traditional drugs as adulterants. The rise of NPS use is increasing the number of different substances in the market to an extent impossible to study with current scientific methodologies. This has caused a remarkable absence of necessary information about newer drug effects on people who use drugs, mental health professionals, and policy makers. Current scientific methodologies have failed to provide enough data in the timeframe when critical decisions must be made, being not only too slow but also too square. Last but not least, they dramatically lack the high resolution of phenomenological details.

Objective

This study aims to characterize a population of e-psychonauts and the subjective effects of the NPS they used during the study period using a new, internet-based, fast, and inexpensive methodology. This will allow bridging an evidence gap between online surveys, which do not provide substance confirmation, and clinical trials, which are too slow and expensive to keep up with the new substances appearing every week.

Methods

To cover this purpose, we designed a highly personalized, observational longitudinal study methodology. Participants will be recruited from online communities of people who use NPS, and they will be followed online by means of a continuous objective and qualitative evaluation lasting for at least 1 year. In addition, participants will send samples of the substances they intend to use during that period, so they can be analyzed and matched with the effects they report on the questionnaires.

Results

The research protocol was approved by the Institutional Review Board of the Hospital del Mar Research Institute on December 11, 2018. Data collection started in August 2019 and was still ongoing when the protocol was submitted (September 2020). The first data collection period of the study ended in October 2020. Data analysis began in November 2020, and it is still ongoing. The authors expect to submit the first results for publication by the end of 2021. A preliminary analysis was conducted when the manuscript was submitted and was reviewed after it was accepted in February 2021.

Conclusions

It is possible to conduct an institutional review board–approved study using this new methodology and collect the expected data. However, the meaning and usefulness of these data are still unknown.

International Registered Report Identifier (IRRID)

DERR1-10.2196/24433

Recruiting migrants for health research through social network sites: an online survey among chinese migrants in australia

BACKGROUND

Traditionally, postal surveys or face to face interviews are the main approaches for health researchers to obtain essential research data. However, with the prevalence of information technology and Internet, Web-based surveys are gaining popularity in health research.

OBJECTIVE

This study aims to report the process and outcomes of recruiting Chinese migrants through social network sites in Australia and to examine the sample characteristics of online recruitment by comparing the sample which was recruited by an online survey to a sample of Australian Chinese migrants collected by a postal survey.

METHODS

Descriptive analyses were performed to describe and compare the process and outcomes of online recruitment with postal survey questionnaires. Chi square tests and t tests were performed to assess the differences between the two samples for categorical and continuous variables respectively.

RESULTS

In total, 473 Chinese migrants completed the online health survey from July to October 2013. Out of 426 participants recruited through the three Chinese social network sites in Australia, over 86.6% (369/426) were recruited within six weeks. Participants of the Web-based survey were younger, with a higher education level or had resided in Australia for less time compared to those recruited via a postal survey. However, there was no significant difference in gender, marital status, and professional occupation.

CONCLUSIONS

The recruitment of Chinese migrants through social network sites in our online survey was feasible. Compared to a postal survey of Chinese migrants, the online survey attracted different group of Chinese migrants who may have diverse health needs and concerns. Our findings provided insightful information for researchers who are considering employing a Web-based approach to recruit migrants and ethnic minority participants.

Using online social media for recruitment of human immunodeficiency virus-positive participants: a cross-sectional survey

Background

There are many challenges in recruiting and engaging participants when conducting research, especially with HIV-positive individuals. Some of these challenges include geographical barriers, insufficient time and financial resources, and perceived HIV-related stigma.

Objective

This paper describes the methodology of a recruitment approach that capitalized on existing online social media venues and other Internet resources in an attempt to overcome some of these barriers to research recruitment and retention.

Methods

From May through August 2013, a campaign approach using a combination of online social media, non-financial incentives, and Web-based survey software was implemented to advertise, recruit, and retain participants, and collect data for a survey study with a limited budget.

Results

Approximately US $5,000 was spent with a research staff designated at 20% of full-time effort, yielding 2034 survey clicks, 1404 of which met the inclusion criteria and initiated the survey, for an average cost of US $3.56 per survey initiation. A total of 1221 individuals completed the survey, yielding 86.97% retention.

Conclusions

These data indicate that online recruitment is a feasible and efficient tool that can be further enhanced by sophisticated online data collection software and the addition of non-financial incentives.

Elements of the management of norms and their effects on the sense of virtual community

Purpose

– The purpose of this paper is to investigate how decisions of managers and administrators of online communities on norms and rules affect the sense of virtual community (SOVC), which is an important factor of the quality of online information.

Design/methodology/approach

– The study followed a two-level research design based on 970 online community members, nested within 36 online communities. Data collection consisted of two stages: first a web survey of a sample of online community members was conducted, followed by a web survey of administrators of the same online communities. A two-level hierarchical regression analysis was used to test the hypotheses.

Findings

– The empirical results suggest that prominence of rules under the condition of members’ participation in their creation, presence of reputation mechanisms, and content moderation contribute significantly to the SOVC , while presence of lighter sanctions and interactive moderation do not.

Research limitations/implications

– Since this study is based on web forums, the validity of the proposed hypotheses for other types of online communities cannot be firmly established. Additional elements of online community management could be considered for a stronger system-level explanation of the SOVC.

Practical implications

– The study demonstrates that online community administrators need to be considerate in creating and enforcing norms, as their decisions have an impact on the SOVC and consequently on the quality of online information.

Originality/value

– The literature considers many factors of the SOVC but none of the previous studies have considered how community management is associated with this phenomenon.

Characteristics and Behaviors of Older Male Anabolic Steroid Users

OBJECTIVE

To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic-androgenic steroid (AAS) users and nonusers.

DESIGN

Cross-sectional survey.

SETTING

Thirty-eight online fitness, weight lifting, bodybuilding, and steroid Web sites.

PARTICIPANTS

A total of 67 male AAS users and 76 male nonusers ≥40 years old.

MAIN OUTCOMES MEASURED

Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses.

RESULTS

The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P < .001), were more likely to binge drink (47.8% vs 29.0%; P = .025), report heavy alcohol use (21.0% vs 7.9%; P = .031), meet criteria for substance dependence disorder (27.4% vs 4.0%; P < .001), and report an anxiety disorder diagnosis (12.0% vs 2.6%; P = .046) than nonusers.

CONCLUSIONS

AAS misuse is prevalent among older men and is associated with polypharmacy, more aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men.

Using information technology and social networking for recruitment of research participants: experience from an exploratory study of pediatric Klinefelter syndrome

Background

Recruiting pediatric samples for research may be challenging due to parental mistrust of the research process, privacy concerns, and family time constraints. Recruitment of children with chronic and genetic conditions may further complicate the enrollment process.

Objective

In this paper, we describe the methodological challenges of recruiting children for research and provide an exemplar of how the use of information technology (IT) strategies with social networking may improve access to difficult-to-reach pediatric research participants.

Methods

We conducted a cross-sectional descriptive study of boys between the ages of 8 and 18 years with Klinefelter syndrome. This study presented unique challenges for recruitment of pediatric participants. These challenges are illustrated by the report of recruitment activities developed for the study. We reviewed the literature to explore the issues of recruiting children for research using conventional and IT approaches. Success rates of conventional recruitment approaches, such as brochures, flyers in medical offices, and physician referrals, are compared with IT-based outreach. The IT approaches included teleconferencing via a Klinefelter syndrome support group, services of a Web-based commercial recruitment-matching company, and the development of a university-affiliated research recruitment website with the use of paid advertising on a social networking website (Facebook).

Results

Over a 3-month period, dissemination of over 150 recruitment brochures and flyers placed in a large urban hospital and hospital-affiliated clinical offices, with 850 letters to physicians and patients were not successful. Within the same period, face-to-face recruitment in the clinical setting yielded 4 (9%) participants. Using Web-based and social networking approaches, 39 (91%) agreed to participate in the study. With these approaches, 5 (12%) were recruited from the national Klinefelter syndrome advocacy group, 8 (19%) from local and teleconference support groups, 10 (23%) from a Web-based research recruitment program, and 16 (37%) from the university-affiliated recruitment website. For the initial 6 months, the university website was viewed approximately 2 to 3 times per day on average. An advertisement placed on a social networking site for 1 week increased website viewing to approximately 63 visits per day. Out of 112 families approached using all of these methods, 43 (38%) agreed to participate. Families who declined cited either travel distance to the study site (15, 22%) or unwillingness to disclose the Klinefelter syndrome diagnosis to their sons (54, 78%) as the reasons for nonparticipation.

Conclusions

Use of Web-based technologies enhances the recruitment of difficult-to-reach populations. Of the many approaches employed in this study, the university-affiliated recruitment website supported by a Facebook advertisement appeared to be the most successful. Research grant budgets should include expenses for website registration and maintenance fees as well as online advertisements on social networking websites. Tracking of recruitment referral sources may be helpful in planning future recruitment campaigns.

Psychological and physical impact of anabolic-androgenic steroid dependence

STUDY OBJECTIVE

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence.

DESIGN

Subanalysis of data from the Anabolic 500, a cross-sectional survey.

PARTICIPANTS

One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009.

MEASUREMENTS AND MAIN RESULTS

Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users.

CONCLUSION

Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

Internet-based recruitment to a depression prevention intervention: lessons from the Mood Memos study

Background

Recruiting participants to randomized controlled trials of health interventions can be very difficult. Internet-based recruitment is becoming an increasingly important mode of recruitment, yet there are few detailed accounts of experiences recruiting participants to mental health interventions.

Objective

To report on our experience with Internet-based recruitment to an online depression prevention intervention and pass on lessons we learned.

Methods

Participants were recruited to the Mood Memos study, an online preventive depression intervention, purely through Internet-based sources. The study was targeted to adults with subthreshold depression symptoms from several English-speaking countries. A variety of online recruitment sources were trialed, including search engine advertising (Google, Yahoo!, Bing), Facebook advertising, posts in forums and online noticeboards, and promotion through relevant websites and email newsletters of mental health organizations.

Results

The study website received visits from 94,808 individuals over the 14-month recruitment period. The recruitment target was reached with 1699 individuals signing up to the randomized controlled trial and 1326 fully enrolling. Most visitors arrived via Google advertising, which promoted a depression-screening questionnaire. Google advertising accounted for nearly half of the total participants who signed up to the study, at an average cost of AUD $12 per participant. Promoting the study through trustworthy organizations and websites known to participants was also effective. Recruitment techniques that were less effective were contacting forums, email groups, and community noticeboards.

Conclusions

Several techniques, including Google advertising, were successful in recruiting participants to a trial evaluating an online depression intervention. Results suggest that Internet-based recruitment to mental health interventions is feasible and can be relatively affordable.

Trial Registration

ACTRN12609000925246

The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training

STUDY OBJECTIVE

To contrast the characteristics of two groups of men who participated in strength-training exercise-those who reported anabolicandrogenic steroid (AAS) use versus those who reported no AAS use.

DESIGN

Analysis of data from the Anabolic 500, a cross-sectional survey.

PARTICIPANTS

Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009.

MEASUREMENTS AND MAIN RESULTS

Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005).

CONCLUSION

Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.

Women and anabolic steroids: an analysis of a dozen users

OBJECTIVE

To provide an in-depth analysis of 12 female self-reported anabolic-androgenic steroid (AAS) users.

DESIGN

Web-based survey.

SETTING

A Web-based survey was posted on 38 discussion boards of various fitness, bodybuilding, weightlifting, and steroid Web sites between February and June 2009.

INTERVENTIONS

Participants completed a survey regarding demographics and use of AAS and other performance-enhancing agents (PEAs).

PARTICIPANTS

A cohort of 1519 strength-trained subjects fully completed and submitted a valid survey. Five hundred eighteen subjects were self-reported AAS users consisting of 12 women and 506 men. One thousand one subjects were non-AAS users consisting of 230 women and 771 men.

MAIN OUTCOME MEASURES

Demographic data and use of AAS and other PEAs.

RESULTS

The female AAS users reported using an average of 8.8 PEAs in their routine. Compared with male AAS users and female non-AAS users, respectively, female AAS users were more likely to have met criteria for substance-dependence disorder (58.3% vs 23.4%; P = 0.01; 58.3% vs 9.1%; P < 0.001), have been diagnosed with a psychiatric illness (50.0% vs 17.4%; P = 0.01; 50.0% vs 22.2%; P = 0.04), and have reported a history of sexual abuse (41.7% vs 6.1%; P < 0.001; 41.7% vs 15.3%; P = 0.03).

CONCLUSIONS

Female AAS users practice polypharmacy. Female AAS users are more likely to have qualified for substance-dependence disorder, have been diagnosed with a psychiatric illness, and have a history of sexual abuse than both male AAS users and female non-AAS users.