Clinical Trial Recruitment and Retention of College Students with Type 1 Diabetes via Social Media: An Implementation Case Study

Abstract

Background: We sought to quantify the efficiency and acceptability of Internet-based recruitment for engaging an especially hard-to-reach cohort (college-students with type 1 diabetes, T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools inclusive of participant safety and validity concerns.

Method: We recruited youth (ages 17-25 years) with T1D via a variety of social media platforms and other outreach channels. We quantified response rate and participant characteristics across channels with engagement metrics tracked via Google Analytics and participant survey data. We developed decision rules to identify invalid (duplicative/false) records (N = 89) and compared them to valid cases (N = 138).

Results: Facebook was the highest yield recruitment source; demographics differed by platform. Invalid records were prevalent; invalid records were more likely to be recruited from Twitter or Instagram and differed from valid cases across most demographics. Valid cases closely resembled characteristics obtained from Google Analytics and from prior data on platform user-base. Retention was high, with complete follow-up for 88.4%. There were no safety concerns and participants reported high acceptability for future recruitment via social media.

Conclusions: We demonstrate that recruitment of college students with T1D into a longitudinal intervention trial via social media is feasible, efficient, acceptable, and yields a sample representative of the user-base from which they were drawn. Given observed differences in characteristics across recruitment channels, recruiting across multiple platforms is recommended to optimize sample diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.

Trial registration: ClinicalTrials.gov NCT02883829.

Keywords: Internet; adolescent; alcohol; diabetes mellitus (type 1); health education; social media; young adult.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Trial recruitment flow diagram. Figure depicts engagement metrics, both meta-data and participant reported data, across sampling frames and by recruitment modalities/platforms. “Engagements” includes the sum of active interactions with a post and were provided by either the College Diabetes Network (CDN) or TuDiabetes. For Facebook this includes shares and likes; for newsletter this includes a click on recruitment post within the newsletter email; for Twitter this includes retweets, likes, links clicked, @replies, or mentions; for Instagram this includes likes and comments on the recruitment post; engagements with the website banner were not quantified. Information on the total number of page views and unique users who interacted with each unique recruitment landing page were derived from Google Analytics; as the CDN newsletter email also contained the link that was intended for their Facebook post, these metrics may be conservative (indicated with an asterisk). Removal of invalid records (N = 89) from the analytic sample and associated decision rules are shown.

Figure 2.

Acceptability of recruitment methods. At two-week follow-up, all participants (N = 122 valid cases) were asked to report their likelihood of participating in a study if they heard about it through each of seven potential recruitment methods, rating their likelihood on a five-point Likert scale from “very unlikely” (red) to “very likely” (purple). Prevalence of reported likelihood for each method is shown in the horizontal bars. Respondents who endorsed being unlikely or very unlikely to participate for a hypothetical recruitment method where then asked to explain why; selected free-text responses that are representative of these reasons are provided.