Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial

Alinne Z Barrera, Alex R Kelman, Ricardo F Muñoz, Alinne Z Barrera, Alex R Kelman, Ricardo F Muñoz

Abstract

Background: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools.

Objective: The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial.

Methods: Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study.

Results: The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (i.e., high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001).

Conclusions: The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population's conceptualization of health issues being studied.

Trial registration: ClinicalTrials.gov NCT00816725; https://ichgcp.net/clinical-trials-registry/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP).

Keywords: Internet intervention; Spanish speaking; depression, postpartum; prevention; research subject recruitment; women.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Google ads in Spanish and English for a prevention of postpartum depression trial.
Figure 2
Figure 2
Screenshot of the study landing page.

References

    1. Muñoz RF. Using evidence-based Internet interventions to reduce health disparities worldwide. J Med Internet Res. 2010;12(5):e60. doi: 10.2196/jmir.1463.
    1. Griffiths KM, Christensen H. Review of randomised controlled trials of Internet interventions for mental disorders and related conditions. Clinical Psychologist. 2006;10(1):16–29. doi: 10.1080/13284200500378696.
    1. Im EO, Chee W. Recruitment of research participants through the Internet. Comput Inform Nurs. 2004;22(5):289–97.
    1. Proudfoot J, Klein B, Barak A, Carlbring P, Cuijpers P, Lange A, Ritterband L, Andersson G. Establishing guidelines for executing and reporting Internet intervention research. Cognitive Behaviour Therapy. 2011 Jun;40(2):82–97. doi: 10.1080/16506073.2011.573807.
    1. Temple EC, Brown RF. A comparison of Internet-based participant recruitment methods: Experiences engaging the hidden population of cannabis users in research. Journal of Research Practice. 2011;7(2):1–20.
    1. Jones RB, Goldsmith L, Williams CJ, Kamel Boulos MN. Accuracy of geographically targeted Internet advertisements on Google AdWords for recruitment in a randomized trial. J Med Internet Res. 2012;14(3):e84. doi: 10.2196/jmir.1991.
    1. Morgan AJ, Jorm AF, Mackinnon AJ. Internet-based recruitment to a depression prevention intervention: lessons from the Mood Memos study. J Med Internet Res. 2013;15(2):e31. doi: 10.2196/jmir.2262.
    1. Ramo DE, Hall SM, Prochaska JJ. Reaching young adult smokers through the Internet: comparison of three recruitment mechanisms. Nicotine Tob Res. 2010 Jul;12(7):768–75. doi: 10.1093/ntr/ntq086.
    1. Reips UD, Lengler R. The Web Experiment List: a Web service for the recruitment of participants and archiving of Internet-based experiments. Behav Res Methods. 2005 May;37(2):287–92.
    1. Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med. 2008 Apr;31(2):169–77. doi: 10.1007/s10865-007-9144-1.
    1. Boland AL, Pauline MM, Vollman A. comScore. 2010. Jun 30, [2013-12-17]. Women on the Web: How women are shaping the Internet .
    1. Lamberg L. Online empathy for mood disorders: patients turn to Internet support groups. JAMA. 2003 Jun 18;289(23):3073–7. doi: 10.1001/jama.289.23.3073.
    1. Anderson GD, Nelson-Becker C, Hannigan EV, Berenson AB, Hankins GD. A patient-centered health care delivery system by a university obstetrics and gynecology department. Obstet Gynecol. 2005 Jan;105(1):205–10. doi: 10.1097/01.AOG.0000146288.28195.27.
    1. Britt DW, Norton JD, Hubanks AS, Navidad SA, Perkins RJ, Lowery CL. A two-period assessment of changes in specialist contact in a high-risk pregnancy telemedical program. Telemed J E Health. 2006 Feb;12(1):35–41. doi: 10.1089/tmj.2006.12.35.
    1. Dennis CL, Kingston D. A systematic review of telephone support for women during pregnancy and the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2008;37(3):301–14. doi: 10.1111/j.1552-6909.2008.00235.x.
    1. Hod M, Kerner R. Telemedicine for antenatal surveillance of high-risk pregnancies with ambulatory and home fetal heart rate monitoring--an update. J Perinat Med. 2003;31(3):195–200. doi: 10.1515/JPM.2003.026.
    1. Homko CJ, Santamore WP, Whiteman V, Bower M, Berger P, Geifman-Holtzman O, Bove AA. Use of an Internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technol Ther. 2007 Jun;9(3):297–306. doi: 10.1089/dia.2006.0034.
    1. Moore D, Ayers S. A review of postnatal mental health websites: help for healthcare professionals and patients. Arch Womens Ment Health. 2011 Dec;14(6):443–52. doi: 10.1007/s00737-011-0245-z.
    1. Logsdon MC, Barone M, Lynch T, Robertson A, Myers J, Morrison D, York S, Gregg J. Testing of a prototype Web based intervention for adolescent mothers on postpartum depression. Appl Nurs Res. 2013 Aug;26(3):143–5. doi: 10.1016/j.apnr.2013.01.005.
    1. Le HN, Perry DF, Sheng X. Using the Internet to screen for postpartum depression. Matern Child Health J. 2009 Mar;13(2):213–21. doi: 10.1007/s10995-008-0322-8.
    1. Kim H, Bracha Y, Tipnis A. Automated depression screening in disadvantaged pregnant women in an urban obstetric clinic. Arch Womens Ment Health. 2007;10(4):163–9. doi: 10.1007/s00737-007-0189-5.
    1. Maloni JA, Przeworski A, Damato EG. Web recruitment and Internet use and preferences reported by women with postpartum depression after pregnancy complications. Arch Psychiatr Nurs. 2013 Apr;27(2):90–5. doi: 10.1016/j.apnu.2012.12.001.
    1. Wisner KL, Logsdon MC, Shanahan BR. Web-based education for postpartum depression: conceptual development and impact. Arch Womens Ment Health. 2008 Dec;11(5-6):377–85. doi: 10.1007/s00737-008-0030-9.
    1. O'Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med. 2013 Oct 23;:1–15. doi: 10.1017/S0033291713002092.
    1. O'Mahen HA, Woodford J, McGinley J, Warren FC, Richards DA, Lynch TR, Taylor RS. Internet-based behavioral activation--treatment for postnatal depression (Netmums): a randomized controlled trial. J Affect Disord. 2013 Sep 25;150(3):814–22. doi: 10.1016/j.jad.2013.03.005.
    1. Danaher BG, Milgrom J, Seeley JR, Stuart S, Schembri C, Tyler MS, Ericksen J, Lester W, Gemmill AW, Lewinsohn P. Web-based intervention for postpartum depression: Formative research and design of the MomMoodBooster program. JMIR Res Protoc. 2012;1(2):e18. doi: 10.2196/resprot.2329.
    1. Haga SM, Drozd F, Brendryen H, Slinning K. Mamma mia: a feasibility study of a Web-based intervention to reduce the risk of postpartum depression and enhance subjective well-being. JMIR Res Protoc. 2013;2(2):e29. doi: 10.2196/resprot.2659.
    1. Jones BA, Griffiths KM, Christensen H, Ellwood D, Bennett K, Bennett A. Online cognitive behaviour training for the prevention of postnatal depression in at-risk mothers: a randomised controlled trial protocol. BMC Psychiatry. 2013 Oct 17;13(1):265. doi: 10.1186/1471-244X-13-265.
    1. Muñoz RF, Le H, Ippen CG, Diaz MA, Urizar GG, Soto J, Mendelson T, Delucchi K, Lieberman AF. Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/Mothers and Babies course. Cognitive and Behavioral Practice. 2007 Feb;14(1):70–83. doi: 10.1016/j.cbpra.2006.04.021.
    1. Kraut R, Olson J, Banaji M, Bruckman A, Cohen J, Couper M. Psychological research online: report of Board of Scientific Affairs' Advisory Group on the Conduct of Research on the Internet. Am Psychol. 2004;59(2):105–17. doi: 10.1037/0003-066X.59.2.105.
    1. Alexander GL, Divine GW, Couper MP, McClure JB, Stopponi MA, Fortman KK, Tolsma DD, Strecher VJ, Johnson CC. Effect of incentives and mailing features on online health program enrollment. Am J Prev Med. 2008 May;34(5):382–8. doi: 10.1016/j.amepre.2008.01.028.
    1. Bowen A, Williams M, Horvath K. Using the Internet to recruit rural MSM for HIV risk assessment: sampling issues. AIDS Behav. 2004 Sep;8(3):311–9. doi: 10.1023/B:AIBE.0000044078.43476.1f.
    1. Hedman E, Ljótsson B, Rück C, Furmark T, Carlbring P, Lindefors N, Andersson G. Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation. Computers in Human Behavior. 2010 Jul;26(4):736–740. doi: 10.1016/j.chb.2010.01.010.
    1. Jones RB, Goldsmith L, Hewson P, Williams CJ. Recruitment to online therapies for depression: pilot cluster randomized controlled trial. J Med Internet Res. 2013;15(3):e45. doi: 10.2196/jmir.2367.
    1. Woodford J, Farrand P, Bessant M, Williams C. Recruitment into a guided Internet based CBT (iCBT) intervention for depression: lesson learnt from the failure of a prevalence recruitment strategy. Contemp Clin Trials. 2011 Sep;32(5):641–8. doi: 10.1016/j.cct.2011.04.013.
    1. Graham AL, Fang Y, Moreno JL, Streiff SL, Villegas J, Muñoz RF, Tercyak KP, Mandelblatt JS, Vallone DM. Online advertising to reach and recruit Latino smokers to an Internet cessation program: impact and costs. J Med Internet Res. 2012;14(4):e116. doi: 10.2196/jmir.2162.
    1. Crutzen R, Roosjen JL, Poelman J. Using Google Analytics as a process evaluation method for Internet-delivered interventions: an example on sexual health. Health Promot Int. 2013 Mar;28(1):36–42. doi: 10.1093/heapro/das008.
    1. Google. [2013-12-17]. Google AdWords: Online advertising by Google .
    1. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977 Jun 01;1(3):385–401. doi: 10.1177/014662167700100306.
    1. Muñoz RF. Preventing major depression by promoting emotion regulation: A conceptual framework and some practical tools. Int J Ment Health Promot. 1998 Sep;(Inaugural Issue):23–40.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Washington, DC: American Psychiatric Association; 2000.
    1. Vázquez FL, Muñoz RF, Blanco V, López M. Validation of Muñoz's mood screener in a nonclinical Spanish population. European Journal of Psychological Assessment. 2008 Jan 21;24(1):57–64. doi: 10.1027/1015-5759.24.1.57.
    1. Nadeem E, Lange JM, Miranda J. Perceived need for care among low-income immigrant and US-born black and Latina women with depression. J Womens Health (Larchmt) 2009 Mar;18(3):369–75. doi: 10.1089/jwh.2008.0898.
    1. Hulme PA. Somatization in Hispanics. J Psychosoc Nurs Ment Health Serv. 1996 Mar;34(3):33–7.
    1. Fox S. Health topics: 80% of Internet users look for health information online. Washington, DC: Pew Internet & American Life Project; 2011. Feb 01, [2013-12-03]. .
    1. Pogorelc D. Google’s top health searches for: cancer, pregnancy symptoms and…hemorrhoid? 2012. [2013-09-27].
    1. Internet World Stats. 2012. [2006-01-15]. World Internet Users Statistics Usage and World Population Stats .
    1. Nour NM. An introduction to maternal mortality. Rev Obstet Gynecol. 2008;1(2):77–81.
    1. Belizán JM, Cafferata ML, Belizán M, Tomasso G, Chalmers B. Goals in maternal and perinatal care in Latin America and the Caribbean. Birth. 2005 Sep;32(3):210–8. doi: 10.1111/j.0730-7659.2005.00372.x.
    1. Dalberg Global Development Advisors . Women and the Web: Bridging the Internet gap and creating new global opportunities in low and middle-income countries. Intel Corporation; 2012. [2013-12-17]. .
    1. Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011 Dec;135(1-3):128–38. doi: 10.1016/j.jad.2011.07.004.
    1. Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442. doi: 10.1371/journal.pmed.1001442.
    1. O'hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996 Jan;8(1):37–54. doi: 10.3109/09540269609037816.
    1. Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, Holmes W. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012 Feb 1;90(2):139G–149G. doi: 10.2471/BLT.11.091850.
    1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005 Nov;106(5 Pt 1):1071–83. doi: 10.1097/01.AOG.0000183597.31630.db.
    1. Romano AM. A changing landscape: Implications of pregnant women's Internet use for childbirth educators. J Perinat Educ. 2007;16(4):18–24. doi: 10.1624/105812407X244903.

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