An Evaluation of Web- and Print-Based Methods to Attract People to a Physical Activity Intervention

Decentralized clinical trials are better for the participants and for the planet: the case study of a double-blind randomized controlled trial in Singapore (PROMOTE study)

Introduction

Novel technologies have enabled the decentralization of many aspects of clinical trials, but little research has been done on the impact of these changes on the participant experience, trial operations, or the environment.

Methods

A fully decentralized clinical trial conducted in Singapore is used as a case study to evaluate the operational outcomes, environmental impact (via life cycle assessment), and participants experience (qualitative interviews) of the decentralized model compared to a traditional study with in-person visits.

Results

The decentralized study achieved high participant retention rates (97%) and high completion rates for clinical data, even for biological samples. Participants found the decentralized model to be convenient and safe, especially during the pandemic. Moreover, the decentralized model was found to be more environmentally friendly and less detrimental to human health compared to traditional face-to-face clinical trials, primarily by reducing participants' use of cars for site visits.

Discussion

While this study focused on the environmental impact, it is important to consider other factors such as participant safety, convenience, and data quality when evaluating the suitability of a decentralized clinical trial approach. Careful planning of data flow, database structure, and data protection measures is essential. This study contributes to improving the environmental footprint of clinical trials. Environmental sustainability should be among the factors that are evaluated when selecting trial models. Decentralized and hybrid clinical trials offer efficiency, effectiveness, and environmental benefits. Further research and adoption of these approaches are encouraged.

Patient Decision Aids for Breast Cancer Reconstruction: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Breast cancer has surpassed lung cancer to become the most frequently diagnosed cancer in women. There has been a dramatic increase in the use of breast reconstruction after mastectomy. However, struggle in making decisions regarding breast reconstruction has existed. Thus, a study of decision aids (DAs) needs to be conducted, and further studies are needed to promote better DAs. This review discusses how DAs can be used to help women make decisions about breast reconstruction after mastectomy. In addition, the review was the first to compare different DA formats to determine which one is most effective.

METHODS

The authors searched for relevant studies published before October of 2022 in PubMed and Embase using the medical subject headings "breast reconstruction" and "decision aid." Demographic data and decision, outcomes, and instruments used for assessment were also collected. Risk of bias was measured by the Cochrane Risk of Bias 2 tool.

RESULTS

A network meta-analysis of 14 RCTs with a total of 1401 patients were included. A total of 90.9% participants presented usable results for evaluation of decisional conflict, and web-based DA (-0.3; 95% CI, -0.56 to -0.05) showed significant improvement; 50.3% of participants provided results of decisional regret, and no subgroups showed significant reduction; 60.3% of participants contributed to results for knowledge, and web-based DA (0.61; 95% CI, 0.01 to 1.21) showed the most positive effect. A total of 44.5% of participants were included for evaluation of satisfaction, and web-based DA (0.44; 95% CI, 0.15 to 0.72) revealed significant increase.

CONCLUSION

The review concluded that web-based DAs are the favorable format of DA.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

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.

Recruiting families using social media versus pediatric obesity clinics: A secondary analysis of the Aim2Be RCT

BACKGROUND

Recruitment of participants continues to be a challenge that researchers must overcome to yield successful study results. Over the past decade, there has been a dramatic increase in the use of social media platforms to recruit research participants. We conducted a secondary analysis of the Aim2Be randomized controlled trial (RCT) to examine if there was variability between participants recruited via social media versus pediatric obesity clinics.

METHODS

Parents and their children living with overweight or obesity were recruited through social media (i.e., Facebook advertisements) (n = 119) or pediatric obesity management clinics (n = 95) to participate in the Aim2Be RCT. We compared recruitment costs, recruitment rate, participant retention, intervention engagement, obesity-related risk factors, and behavioral habits.

RESULTS

Facebook recruitment resulted in more participant contacts, but higher attrition during 'high effort' stages of the recruitment process. Group differences emerged regarding costs (Facebook: $407 versus clinics: $699). There were no group differences in participant retention or intervention engagement. Families recruited from Facebook were younger parents (42.6 versus 46.0 years; p < 0.001) and children (12.2 versus 13.9 years; p < 0.001), a higher percentage male children, and fewer had previously participated in a pediatric weight management program. Parents recruited from Facebook self-reported greater screen time for themselves, and their children reported lower physical activity levels and higher caloric and sugar intake.

CONCLUSIONS

Social media and clinical site recruitment are complementary strategies that appear to draw in families with different profiles, but regardless of how they were recruited, all families had the potential to benefit from pediatric obesity management.

Social Media Use for Research Participant Recruitment: Integrative Literature Review

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Recruiting Fathers for Parenting Research: An Evaluation of Eight Recruitment Methods and an Exploration of Fathers' Motivations for Participation

Objective

We evaluated eight recruitment methods (Craigslist, Facebook ads, Google AdWords, in-person, newspaper, parenting magazines, ResearchMatch, and direct mailing) in terms of their ability to accrue fathers of 3- to 7-year-old children into a laboratory-based behavioral trial for parents. The trial was related to child obesity risk and parental health behaviors.

Design

Each recruitment method was implemented such that half its occurrences advertised for fathers only, and half advertised for mothers and fathers. Methods were evaluated in terms of number of fathers recruited, cost- and time-efficiency, response rates, and demographic characteristics of individuals recruited. We also assessed fathers' and mothers' motivations for participating in the study. 101 fathers and 260 mothers were recruited.

Results

Father-targeted ads were essential for father recruitment; 79% of accruals from father-targeted ads were male, whereas only 14% of accruals from parent-targeted ads were male. Craigslist, ResearchMatch, and Facebook ads were the most cost-efficient for accruing fathers. A greater proportion of fathers was motivated by increasing fathers' representation in research (16%) compared to mothers who wished to increase mothers' representation in research (5.4%). Similar proportions of fathers and mothers were motivated by improving their parenting knowledge and improving their child's health.

Conclusions

Future researchers should employ father-targeted recruitment materials (rather than parent-targeted) that capitalize on fathers' unique motivations for participating in research.

Use of Facebook, Instagram, and Twitter for recruiting healthy participants in nutrition-, physical activity-, or obesity-related studies: a systematic review

BACKGROUND

There are limited systematic reviews exploring the use of social media for recruiting participants specifically for nutrition-, physical activity-, and obesity-related studies.

OBJECTIVES

The aim was to conduct a systematic review on the effectiveness of using social media (Facebook, Instagram, and Twitter) for recruiting healthy participants in nutrition-, physical activity-, or obesity-related studies.

METHODS

Studies were identified from 5 databases and included if they reported the number of participants recruited by social media (Facebook, Instagram, or Twitter) vs. traditional (print, e-mail, etc.). The effectiveness of recruitment was compared between methods by study procedures (in-person vs. online procedures). The cost-effectiveness of methods was also explored. The protocol was published in the Prospero database (ID# CRD42020204414).

RESULTS

Twenty-six studies were included. Among studies with both types of recruitment methods, 49% of the sample was reached through traditional methods, 40% through social media, and the rest by other methods. For in-person study procedures, the median number of participants recruited using social media was 19 (range: 3-278) and for online study procedures, it was 298 (range: 3-17,069). Median recruitment cost using social media (n = 14 studies) was $11.90 (range: $0-517) per participant, while this varied considerably for traditional methods depending on how it was calculated ($214, $18.9-$777). The ratio of participants reached vs. recruited was 0.12%; the overall ratio of participants interactions vs. recruited was 21.2%.

CONCLUSIONS

For in-person study procedures, traditional recruitment methods were more effective than social media, but for online study procedures, about half reported that social media was more effective. While more potential participants were reached through social media, only 21.2% of those who interacted with ads were enrolled. With the increased use of social media, their use for recruitment may be more frequent; therefore, future reviews may show different results.

Use and Effectiveness of Social-Media-Delivered Weight Loss Interventions among Teenagers and Young Adults: A Systematic Review

Obesity is a risk factor that exponentially increases morbidity and mortality in the world. Today, new health strategies are being implemented based on the use of social media but the use and effectiveness for these interventions needs to be assessed. The objective of this systematic review is to assess the impact of social-media-delivered weight loss interventions among teenagers and young adults. We searched PubMed, Scopus, Google Scholar, PsycINFO, and OVID to identify articles that focused on this topic. Fourteen studies were included in the final review. The commitment of the participants was found to be fundamental factor when assessing the impact of social-media-delivered weight loss interventions, but also the social context in which the interventions were carried out. Our study highlights the potential of social media platforms to address weight loss interventions among younger groups. The works evaluated showed the usefulness of social media for the adequate monitoring and control in these groups. Finally, the current variety of study designs in this field highlights the need for greater homogeneity in their methodology and applications, which is a fundamental step before these tools could be considered a suitable tool for overweight management in clinical practice.

The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study

Background

Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data.

Objective

This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement.

Methods

A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups’ engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression.

Results

App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] −6.9, 95% CI −7.6 to −6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR −0.7, 95% CI −0.9 to −0.4) and Fitbit Only (OR −0.5, 95% CI −0.7 to −0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR −201.9, 95% CI −387.7 to −116.0) and Fitbit Only (OR −492.9, 95% CI −679.9 to −305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups.

Conclusions

Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement.

Impact of a Social Media Campaign on Reach, Uptake, and Engagement with a Free Web- and App-Based Physical Activity Intervention: The 10,000 Steps Australia Program

Social media campaigns provide broad-reach and convenience for promoting freely-available health programs. However, their effectiveness and subsequent engagement of new users is unknown. This study aimed to assess the reach and new member registration rates resulting from a dedicated 10,000 Steps social media campaign (SMC) and to compare program engagement and time to non-usage attrition of new users from the SMC with other users. SMC reach (using Facebook, Instagram, and display advertisements engagement metrics), new-user numbers, engagement (usage of the website and its features), and time to non-usage attrition were assessed using generalized linear regression, binary logistic regression, and Cox proportion hazards regression models. During the SMC, Instagram and display advertisement impressions, Facebook reach and new daily registrations were significantly higher compared with six weeks and one year prior. There were no between-group differences in the average usage of most website/program features. Risk of non-usage attrition was higher among new users from the SMC than new users from one year prior. The SMC was effective in promoting awareness of the 10,000 Steps program. Further research to identify long-term engagement strategies and the most effective combination of social media platforms for promotion of, and recruitment to, health programs is warranted.

Cost and Effectiveness of Using Facebook Advertising to Recruit Young Women for Research: PREFER (Contraceptive Preferences Study) Experience

BACKGROUND

Social media is a popular and convenient method for communicating on the Web. The most commonly used social networking website, Facebook, is increasingly being used as a tool for recruiting research participants because of its large user base and its ability to target advertisements on the basis of Facebook users' information.

OBJECTIVE

We evaluated the cost and effectiveness of using Facebook to recruit young women into a Web-based intervention study (PREFER). The PREFER study aimed to determine whether an educational video could increase preference for and uptake of long-acting reversible contraception (LARC).

METHODS

We placed an advertisement on Facebook over a 19-day period from December 2017 to January 2018, inviting 16- to 25-year-old women from Australia to participate in a Web-based study about contraception. Those who clicked on the advertisement were directed to project information, and their eligibility was determined by using a screening survey.

RESULTS

Our Facebook advertisement delivered 130,129 impressions, resulting in over 2000 clicks at an overall cost of Aus $918 (Aus $0.44 per click). Web-based project information was accessed by 493 women. Of these, 462 women completed the screening survey, and 437 (437/463, 95%) women were eligible. A total of 322 young women participated in Surveys 1 and 2 (74% response rate), and 284 women participated in Survey 3 (88% retention rate), with an advertising cost of Aus $2.85 per consenting participant.

CONCLUSIONS

Facebook proved to be a quick, effective, and cost-efficient tool for recruiting young Australian women into a study that was investigating contraceptive preferences. However, Web-based recruitment may result in sociodemographic biases. Further research is required to evaluate whether Facebook is suitable for recruiting older study populations.

To end disease tomorrow, begin with trials today: Digital strategies for increased awareness of a clinical trials finder

INTRODUCTION

Individuals experiencing different medical conditions, as well as healthy volunteers, may often be interested in trial participation, and researchers similarly need to find participants to advance medical knowledge. The ResearchMatch (RM) Trials Today clinical trial searching tool leverages clinicaltrials.gov data to enable potential participants to look for trial opportunities relevant to their situation. To facilitate expanded use of this tool, we undertook a national digital public awareness campaign to increase awareness of Trials Today among members of the general public.

METHODS

The awareness campaign promoted Trials Today using Facebook and digital banner messages in 2017, encompassing nine cities across the USA. The digital strategy was complemented by print media in several outlets. We employed descriptive statistics to summarize campaign metrics and site usage data during the campaign.

RESULTS

The campaign was successful in increasing visits to Trials Today, with 142,303 sessions logged during its run, as compared to pre-campaign data indicating 104,688 total sessions during the entire 2-year period since the site's inception. The city-specific click-through rate for all digital impressions, combining Facebook and banner messaging, ranged from 0.50% to 1.09%, resulting in a cost-per-click range of $0.69-$1.15. In addition, visitors conducted 29,697 searches and viewed individual trial records 173,512 times.

CONCLUSION

The public awareness campaign was successful in increasing use of the RM Trials Today clinical trial searching tool. Our findings support the value of digital media messaging as a cost-effective vehicle for promoting clinical trial awareness, especially for chronic ailments.

Evaluating recruitment strategies for AUSPICE, a large Australian community-based randomised controlled trial

OBJECTIVES

To examine the effectiveness of different strategies for recruiting participants for a large Australian randomised controlled trial (RCT), the Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE).

DESIGN, SETTING, PARTICIPANTS

Men and women aged 55-60 years with at least two cardiovascular risk factors (hypertension, hypercholesterolaemia, overweight/obesity) were recruited for a multicentre placebo-controlled RCT assessing the effectiveness of 23-valent pneumococcal polysaccharide vaccine (23vPPV) for preventing cardiovascular events.

METHODS

Invitations were mailed by the Australian Department of Human Services to people in the Medicare database aged 55-60 years; reminders were sent 2 weeks later. Invitees could respond in hard copy or electronically. Direct recruitment was supplemented by asking invitees to extend the invitation to friends and family (snowball sampling) and by Facebook advertising.

MAIN OUTCOME

Proportions of invitees completing screening questionnaire and recruited for participation in the RCT.

RESULTS

21 526 of 154 992 invited people (14%) responded by completing the screening questionnaire, of whom 4725 people were eligible and recruited for the study. Despite the minimal study burden (one questionnaire, one clinic visit), the overall participation rate was 3%, or an estimated 10% of eligible persons. Only 16% of eventual participants had responded within 2 weeks of the initial invitation letter (early responders); early and late responders did not differ in their demographic or medical characteristics. Socio-economic disadvantage did not markedly influence response rates. Facebook advertising and snowball sampling did not increase recruitment.

CONCLUSIONS

Trial participation rates are low, and multiple concurrent methods are needed to maximise recruitment. Social media strategies may not be successful in older age groups.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12615000536561.

Website Analytics of a Google Ads Campaign for a Men's Mental Health Website: Comparative Analysis

BACKGROUND

Men with mental health and addictions problems seek information and help from health service providers and community support less often than women with such problems. Online health resources offer men rapid access to self-care recommendations and resources and anonymity; however, only a few websites are specifically developed for men. Headstrong - Taking Things Head-On was a community pharmacy and online health promotion initiative for men living with mental health and addictions problems. The Headstrong website was developed to offer a curated collection of print and online recommended resources (primarily self-help oriented) for depression, anxiety, insomnia, tobacco and alcohol use problems, and suicide. To increase awareness of the initiative and use of the website's content and resource recommendations, a Google Ads campaign was developed.

OBJECTIVE

This study aimed to compare user acquisition and behavior on the Headstrong website during and after a Google Ads campaign.

METHODS

The Google Ads campaign was launched on December 21, 2017, and run until February 28, 2018. Website analytics (acquisition of new users, behavior in terms of at-website actions and duration, devices used, and conversions [link-outs to recommended resources]) in a 30-day period during the campaign (January 26, 2018 to February 24, 2018) were compared to a similar 30-day period after the campaign (March 23, 2018 to April 21, 2018). A cost analysis of the ad campaign was also performed.

RESULTS

The ad campaign generated 3011 clicks and 4.5 million impressions in total. In addition, the campaign received 1311 website users during the 30-day period of the ad campaign as compared to 241 users during the 30-day period after the ad campaign (P<.001). Return visitor (17.7% vs 27.8%) and nonbounce (19.5% vs 39.8%) user rates as well as session duration (42 vs 102 seconds) and page views per session (1.4 vs 2.1) were lower during the ad campaign than after the campaign (P<.01 for all). The 30-day period of the ad campaign included 9 sessions with conversions initiated by an ad click. Paid and display ads accounted for 63% of the site traffic during the ad campaign, most of which came from mobile phone users. Desktops were the most-common device used after the ad campaign acquired the website via direct and organic searches primarily (92%). The estimated cost per session with one or more conversions was Can $54.69 and cost per conversion was Can $32.81.

CONCLUSIONS

A Google Ads campaign designed to direct men to the Headstrong website increased the number of user visits by more than five-fold. However, engagement by users responding to the ad campaign was substantially lower than that by users who visited the website via other acquisition methods, possibly reflecting the nonspecific online targeting of men by the ad campaign. General targeting of men online to promote men's mental health appears to have limited value.

Using Facebook to Recruit Parents to Participate in a Family Program to Prevent Teen Drug Use

Despite strong evidence that family programs are effective in preventing adolescent substance use, recruiting parents to participate in such programs remains a persistent challenge. This study explored the feasibility of using Facebook to recruit parents of middle school students to a self-directed family program to prevent adolescent drug use. The study used paid Facebook ads aiming to recruit 100 parents in Washington and Colorado using marijuana- or parenting-focused messages. All ad-recruited parents were also invited to refer others in order to compare Facebook recruitment to web-based respondent-driven sampling. Despite offering a $15 incentive for each successfully referred participant, the majority of the screened (70.4%) and eligible (65.1%) parents were recruited through Facebook ads. Yet, eligibility and consent rates were significantly higher among referred (76.6 and 57.3%, respectively) than Facebook-recruited parents (60.0 and 36.6%, respectively). Click-through rates on Facebook were higher for marijuana-focused than parenting-focused ads (0.72 and 0.65%, respectively). The final sample (54% Facebook-recruited) consisted of 103 demographically homogeneous parents (female, educated, non-Hispanic White, and mostly from Washington). Although Facebook was an effective and efficient method to recruit parents to a study with equal to better cost-effectiveness than traditional recruitment strategies, the promise of social media to reach a diverse population was not realized. Additional approaches to Facebook recruitment are needed to reach diverse samples in real-world settings and increase public health impact of family programs.

Cost-effectiveness of the BRECONDA decision aid for women with breast cancer: Results from a randomized controlled trial

OBJECTIVE

To report on the cost-effectiveness of BRECONDA (Breast RECONstruction Decision Aid), a web-based decision aid to facilitate decisions regarding breast reconstruction surgery, with usual care for women with breast cancer.

METHODS

The economic evaluation was conducted alongside a randomized controlled trial. Women diagnosed with breast cancer or ductal carcinoma in situ and eligible for breast reconstruction following mastectomy were randomized to access BRECONDA for 6 months + usual care (n = 106) or usual care (n = 116) and were assessed at baseline preintervention, and then 1-month and 6-months post-randomization. Decisional conflict, satisfaction with information, decisional regret, and utilities were assessed by using maximum-likelihood linear mixed effects models. Costs included the fixed costs of BRECONDA, health care provider time, and health care resource use. Nonparametric bootstrapping was used to estimate incremental cost-effectiveness ratios.

RESULTS

BRECONDA resulted in significantly less decisional conflict and greater satisfaction with information over time. Quality-adjusted life years did not differ between participants who received the decision aid compared with usual care. The cost of BRECONDA was estimated to be small (AUD$10) relative to other health care interventions and resulted in decreased health care costs overall (AUD$764). Based on the point estimates, the decision aid was more effective and less costly (dominant) for all measures of effectiveness. It was estimated that the decision aid has an 87% probability of being cost-effective at $60 000 per quality-adjusted life year gained.

CONCLUSIONS

The BRECONDA web-based intervention designed to facilitate decisions regarding breast reconstruction surgery is likely to be cost-effective compared with usual care for women with breast cancer.

Facilitator and Participant Use of Facebook in a Community-Based Intervention for Parents: The InFANT Extend Program

BACKGROUND

Social networking sites such as Facebook afford new opportunities for behavior-change interventions. Although often used as a recruitment tool, few studies have reported the use of Facebook as an intervention component to facilitate communication between researchers and participants. The aim of this study was to examine facilitator and participant use of a Facebook component of a community-based intervention for parents.

METHODS

First-time parent groups participating in the intervention arm of the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) Program were invited to join their own private Facebook group. Facilitators mediated the Facebook groups, using them to share resources with parents, arrange group sessions, and respond to parent queries. Parents completed process evaluation questionnaires reporting on the usefulness of the Facebook groups.

RESULTS

A total of 150 parents (from 27 first-time parent groups) joined their private Facebook group. There were a mean of 36.9 (standard deviation 11.1) posts/group, with the majority being facilitator posts. Facilitator administration posts (e.g., arranging upcoming group sessions) had the highest average comments (4.0), followed by participant health/behavior questions (3.5). The majority of participants reported that they enjoyed being a part of their Facebook group; however, the frequency of logging on to their groups' page declined over the 36 months of the trial, as did their perceived usefulness of the group.

CONCLUSIONS

Facebook appears to be a useful administrative tool in this context. Parents enjoyed being part of their Facebook group, but their reported use of and engagement with Facebook declined over time.

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program

Background

Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs.

Objective

The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention.

Methods

The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants’ baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews.

Results

A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app.

Conclusions

Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment.