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

Abstract

BackgroundMobile 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.ObjectiveThe 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.MethodsThe 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.ResultsA 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.ConclusionsOnline 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.

Key Lessons and Impact of the Growing Healthy mHealth Program on Milk Feeding, Timing of Introduction of Solids, and Infant Growth: Quasi-Experimental Study (Preprint)

“…The findings of this study support mHealth as an acceptable mode of delivery for obesity prevention interventions in infancy, particularly those targeting infant feeding, with high rates of recruitment [40] and a retention rate of 80% at nine months follow up. It is important to acknowledge that the high retention rates might reflect in part, the payment offered for survey completion and the use of three reminders.…”

“…However a home visiting trial in disadvantaged communities, managed to recruit three quarters of participants without a university education [46]. Surprisingly, we found no difference in the education levels of mothers when recruited by primary health care practitioners in disadvantaged communities and those recruited via social media [40]. It may be that primary health care practitioners were more selective in offering the program to less vulnerable parents.…”

“…Enrolment to both groups of the study involved the completion of an online screening form, a consent form and a baseline survey. Further details of the recruitment process and outcomes have been published elsewhere [34].…”

A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children’s nutrition

“…The strategy used to reach intended users will also influence engagement with digital nutrition promotion interventions. Social media approaches (predominately Facebook, Instagram and targeted website advertisements) have a wide reach and are low cost but are less effective at reaching target users [78,79]. In comparison, traditional methods such as word-of-mouth and paper-based marketing reach fewer people but result in better access to target participants [78,80].…”

A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Simple Architecture (Part 1) (Preprint)

“…The system then alerts a physician or patient of the study eligibility or provides a list of potential trial participants to a study investigator [9]. Similarly, web-based recruitment strategies have become increasingly popular, especially for electronic and mobile health (eHealth/mHealth) studies [10,11,12]. A 2011 systematic review concluded that pre-screening is the most effective part of the recruitment process addressed by CTRSS [13].…”