Comparison of Communication Channels for Large-Scale Type 2 Diabetes Risk Screening and Intervention Recruitment: Empirical Study

Abstract

Background Clinical trials have shown that type 2 diabetes (T2D) is preventable through lifestyle interventions targeting high-risk people. Nevertheless, large-scale implementation of risk identification followed by preventive interventions has proven to be challenging. Specifically, recruitment of participants into preventive interventions is an important but often overlooked part of the intervention. Objective This study aims to compare the reach and yield of different communication channels to engage people at increased risk of T2D to fill in a digital screening questionnaire, with emphasis on reaching those at most risk. The participants expressing their willingness to participate is the final step in the risk screening test, and we aim to determine which channels had the most participants reach this step. Methods We established a stepwise web-based T2D risk screening tool with automated feedback according to the T2D risk level and, for those who were eligible, an invitation to participate in the StopDia prevention intervention study conducted in a primary health care setting. The risk estimate was based on the Finnish Diabetes Risk Score; history of repeatedly measured high blood glucose concentration; or, among women, previous gestational diabetes. We used several channels to invite people to the StopDia web-based screening tool, and respondents were classified into 11 categories based on the channel through which they reported having learned about StopDia. The demographics of respondents reached via different communication channels were compared using variance analysis. Logistic regression was used to study the respondents’ likelihood of progressing through risk screening steps. Results A total of 33,399 persons started filling the StopDia screening tool. Of these, 86.13% (28,768/33,399) completed the test and named at least one communication channel as the source of information about StopDia. Altogether, 26,167 persons filled in sufficient information to obtain risk estimates. Of them, 53.22% (13,925/26,167) were at increased risk, 30.06% (7866/26,167) were men, and 39.77% (10,136/25,485) had low or middle education levels. Most frequently mentioned channels were workplace (n=6817), social media or the internet (n=6712), and newspapers (n=4784). The proportion of individuals at increased risk was highest among those reached via community pharmacies (415/608, 68.3%) and health care (1631/2535, 64.33%). The communication channel reaching the largest percentage of interested and eligible men (1353/3979, 34%) was relatives or friends. Health care (578/1069, 54.07%) and radio or television (225/487, 46.2%) accounted for the largest proportion of people with lower education. Conclusions Communication channels reaching a large number of people, such as social media and newspapers, were the most effective channels for identifying at-risk people. Personalized approaches increased the engagement of men and less-educated people. Community pharmacies and health care services reached people with a particularly high T2D risk. Thus, communication and recruitment channels should be selected and modified based on the intended target group. International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-6574-y

Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial

“…The participants were recruited from several communication channels, such as social media, newspapers, radio, television, websites, health care and social service units, and community pharmacies, by encouraging people to visit the website of the project to fill in the StopDia Digital Screening Tool [17]. The participants were adults aged 18 to 74 years living in 3 provinces of Finland and being at increased risk of T2D as identified with the StopDia Digital Screening Tool including the Finnish Diabetes Risk Score (FINDRISC) developed to estimate the 10-year risk of developing drug-treated T2D [18].…”

Real-world effectiveness of digital and group-based lifestyle interventions as compared with usual care to reduce type 2 diabetes risk – A stop diabetes pragmatic randomised trial

“…This could have introduced measurement bias. The participants were also recruited to the RCT through workplaces, social media, the internet, newspapers, community pharmacies, and health care 15 that could have resulted in larger proportion of women participating the study. Finally, the larger number of women than men in our study sample is a weakness that may limit the generalizability of our findings to men.…”

“…Adults aged 18-74 with a Finnish Diabetes Risk Score (FINDRISC) at least 12 indicating a moderate risk of developing T2D representing a one in six chance of developing T2D within the next 10 years were recruited through multiple channels from three provinces in Finland and screened for eligibility using the anonymous StopDia Digital Screening Tool between March 1 st , 2017, and February 28 th , 2018, as described in detail earlier. 14 , 15 The inclusion and exclusion criteria are listed in the flow chart ( Figure 1 ). The individuals deemed eligible were invited to participate in the RCT and were provided with instructions on how to book an appointment with the designated nurse in a local healthcare centre for the verification of the inclusion and exclusion criteria and for clinical measurements, including a 2-hour oral glucose tolerance test (OGTT) to rule out prevalent, unknown diabetes.…”

Challenges to Recruiting Men on Active Surveillance for Prostate Cancer in Clinical Chemoprevention Trials

“…Since clinics were operating with reduced capacity and reduced in-person visits, recruiters were required to work virtually. Although other interventions (exercise, yoga) were administered via telemedicine [53,54], chemoprevention trials with a study drug under IND were not conducive to telemedicine interventions. With consistent evidence that clinical trials that enroll patients at proposed rates are critical to ensure internal validity and improve cancer mortality and morbidity, our goal is to recruit subjects in clinical trials efficiently and achieve our recruitment goals in a timely manner.…”