Outreach to new mothers through direct mail and email: recruitment in the Early Check research study

Abstract

Meeting recruitment targets for clinical trials and health research studies is a notable challenge. Unsuccessful efforts to recruit participants from traditionally underserved populations can limit who benefits from scientific discovery, thus perpetuating inequities in health outcomes and access to care. In this study, we evaluated direct mail and email outreach campaigns designed to recruit women who gave birth in North Carolina for a statewide research study offering expanded newborn screening for a panel of rare health conditions. Of the 54,887 women who gave birth in North Carolina from September 28, 2018, through March 19, 2019, and were eligible to be included on the study’s contact lists, we had access to a mailing address for 97.9% and an email address for 6.3%. Rural women were less likely to have sufficient contact information available, but this amounted to less than a one percentage point difference by urbanicity. Native American women were less likely to have an email address on record; however, we did not find a similar disparity when recruitment using direct‐mail letters and postcards was concerned. Although we sent letters and emails in roughly equal proportion by urbanicity and race/ethnicity, we found significant differences in enrollment across demographic subgroups. Controlling for race/ethnicity and urbanicity, we found that direct‐mail letters and emails were effective recruitment methods. The enrollment rate among women who were sent a recruitment letter was 4.1%, and this rate increased to 5.0% among women who were also sent an email invitation. WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Under‐representation by traditionally underserved populations in clinical trials and health research is a challenge that may in part reflect inequitable opportunities to participate. WHAT QUESTION DID THIS STUDY ADDRESS? Are direct‐mail and email outreach strategies effective for reaching and recruiting women from traditionally underserved and rural populations to participate in large‐scale, population‐based research? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? Despite sending recruitment letters and email invitations in roughly equal proportion by urbanicity and race/ethnicity, women living in rural areas were less likely to enroll (2.8%) than women from urban areas (4.2%). Additionally, enrollment rates decreased as the probability that women were members of a racial or ethnic minority group increased. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? Results from this study might encourage researchers to take a holistic and participant‐centered view of barriers to study enrollment that may disproportionately affect underserved communities, including differences in willingness to participate, trust, and access to resources needed for uptake.

Assessing the effect of four types of direct mail messages to promote the uptake of residential lead remediation funds

“…Unfortunately, the expected booster effect of wave 2 mailing was not observed. Similar to the study by Paquin et al [ 37 ], sending booster mailers was ineffective. However, the cost-effectiveness analysis should be interpreted with caution since the mailers were not exclusively sent to eligible households.…”

“…Therefore, direct mailing proved to be a feasible, cost-effective and safe approach to inform eligible residents about the LHC grant, eligibility criteria and to motivate application for these funds during the pandemic. Direct mailing has been used to engage, interact with, and communicate public health information to assess public health information and/or encourage behavior change because of its relative ease, reach and equity [ [35] , [36] , [37] , [38] ].…”

Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study

“…We found that a majority of women who received a my UNC Chart research invitation opened it, and of those who opened it, 4.88%, expressed in predicted probability, enrolled their newborn. In comparison, a previous analysis of the other primary recruitment method for Early Check, postnatal letters and emails to new mothers showed an overall statewide enrollment rate of 4% [ 36 ]. For those women who were sent a postnatal letter in addition to the recruitment invitation through my UNC Chart , the receipt of the postnatal letter did not increase the odds of enrollment.…”

“…We resumed social media advertising on Facebook and Instagram on April 1, 2020. An evaluation of the direct mail outreach impact on study enrollment showed that approximately 4% of all women who were sent a recruitment letter enrolled their newborn in the study, and the enrollment rate among women who also received a recruitment email was approximately 5% [ 36 ]. An analysis of the social media campaign from March 2019 to September 2019 showed that paid ads on social media resulted in 3.5 additional daily enrollments in the study for each day ads were run [ 37 ].…”

Research Gaps in Fragile X Syndrome: An Updated Literature Review to Inform Clinical and Public Health Practice

“…One of the main considerations was how to best recruit families. [61][62][63] Barriers to full-scale newborn screening for FXS include public health burden to conduct the screening; the need for inexpensive, high-throughput screening methodologies; lack of demonstrated treatment for asymptomatic children; and insufficient capacity for long-term followup. 64,65 Health Care Needs and Access Indirect and direct health care costs are sizable for individuals with FXS.…”