Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study

Abstract

Background Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic. Objective Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data. Methods Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling. Results In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P<.001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise). Conclusions Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants. Trial Registration ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733

Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes

“…Adults with T1D were recruited to participate between November 2019 and August 2020 by a combination of social media advertising, snowball sampling, in-person, and other approaches previously described. 23 The inclusion criteria were aged 18 to 65 years with ≥6 months' diagnosis of T1D or other absolute insulin deficiency diabetes, inadequate baseline exercise patterns (<3 exercise sessions/wk), 2,24 English literacy, current user of a smartphone, and CGM. Exclusion criteria were chronic disease or physical disability requiring exercise adjustments outside the scope of the mobile intervention.…”

“…Methods for our clinical assessments (Table 2) are detailed in our earlier manuscript. 23 Psychosocial instruments were also taken (see File , Supplemental Digital Content 1 , http://links.lww.com/JSM/A333).…”

Optimizing Recruitment for Qualitative Research: A Comparison of Social Media, Emails, and Offline Methods

“…Participant recruitment for in-person interviews through social media platforms, emails, and offline methods have had varying levels of success (Antoun et al, 2016; Ash et al, 2021; Gu et al, 2016; Nolte et al, 2015; Ramo & Prochaska, 2012). The most prevalent method appears to be Facebook, which is also well-documented within the medical research community as an effective recruitment method for sampling participants (Ash et al, 2021; Kapp et al, 2013; Pedersen & Kurz, 2016; Ramo & Prochaska, 2012; Smith et al, 2021; van Gelder et al, 2019). However, more research is needed to understand the effectiveness of Facebook outside of health studies.…”

Going Viral: Assessing the Impact of Social Media on Enrollment in a Coronavirus Disease 2019 (COVID-19) Cohort Study

“…Previous studies have demonstrated the successful use of social media to improve study enrollment [2][3][4][5], particularly in recruiting children, a population traditionally challenging to reach [6][7][8]. In this study, we report the impact of using non-targeted, organic social media engagement to improve enrollment of children in a clinical research study of children with mild COVID-19 and assess the sociodemographic characteristics of enrollees.…”