Using facebook to recruit young adult veterans: online mental health research

Eric R Pedersen, Eric D Helmuth, Grant N Marshall, Terry L Schell, Marc PunKay, Jeremy Kurz, Eric R Pedersen, Eric D Helmuth, Grant N Marshall, Terry L Schell, Marc PunKay, Jeremy Kurz

Abstract

Background: Veteran research has primarily been conducted with clinical samples and those already involved in health care systems, but much is to be learned about veterans in the community. Facebook is a novel yet largely unexplored avenue for recruiting veteran participants for epidemiological and clinical studies.

Objective: In this study, we utilized Facebook to recruit a sample of young adult veterans for the first phase of an online alcohol intervention study. We describe the successful Facebook recruitment process, including data collection from over 1000 veteran participants in approximately 3 weeks, procedures to verify participation eligibility, and comparison of our sample with nationally available norms.

Methods: Participants were young adult veterans aged 18-34 recruited through Facebook as part of a large study to document normative drinking behavior among a large community sample of veterans. Facebook ads were targeted toward young veterans to collect information on demographics and military characteristics, health behaviors, mental health, and health care utilization.

Results: We obtained a sample of 1023 verified veteran participants over a period of 24 days for the advertising price of approximately US $7.05 per verified veteran participant. Our recruitment strategy yielded a sample similar to the US population of young adult veterans in most demographic areas except for race/ethnicity and previous branch of service, which when we weighted the sample on race/ethnicity and branch a sample better matched with the population data was obtained. The Facebook sample recruited veterans who were engaged in a variety of risky health behaviors such as binge drinking and marijuana use. One fourth of veterans had never since discharge been to an appointment for physical health care and about half had attended an appointment for service compensation review. Only half had attended any appointment for a mental health concern at any clinic or hospital. Despite more than half screening positive for current probable mental health disorders such as post-traumatic stress disorder, depression, anxiety, only about 1 in 3 received mental health care in the past year and only 1 in 50 received such care within the past month.

Conclusions: This work expands on the work of other studies that have examined clinical samples of veterans only and suggests Facebook can be an adequate method of obtaining samples of veterans in need of care.

Trial registration: Clinicaltrials.gov NCT02187887; https://ichgcp.net/clinical-trials-registry/NCT02187887 (Archived by WebCite at http://www.webcitation.org/6YiUKRsXY).

Keywords: Facebook; Internet; alcohol; mental health; online; young adult veterans.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Examples of Facebook ads.
Figure 2
Figure 2
Flow diagram of sample participants.

References

    1. Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug Alcohol Depend. 2011 Jul 01;116(1-3):93–101. doi: 10.1016/j.drugalcdep.2010.11.027.
    1. Schell TL, Marshall GN. Survey of individuals previously deployed for OEF/OIF. In: Tanielian T, Jaycox LH, editors. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND; 2008.
    1. Jakupcak M, Tull MT, McDermott MJ, Kaysen D, Hunt S, Simpson T. PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addict Behav. 2010 Sep;35(9):840–843. doi: 10.1016/j.addbeh.2010.03.023.
    1. Ouimette P, Vogt D, Wade M, Tirone V, Greenbaum MA, Kimerling R, Laffaye C, Fitt JE, Rosen CS. Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychol Serv. 2011;8(3):212–223. doi: 10.1037/a0024360.
    1. Bray RM, Hourani LL. Substance use trends among active duty military personnel: Findings from the United States Department of Defense Health Related Behavior Surveys, 1980-2005. Addiction. 2007 Jul;102(7):1092–1101. doi: 10.1111/j.1360-0443.2007.01841.x.
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617–627. doi: 10.1001/archpsyc.62.6.617.
    1. Darian-Smith I, Johnson KO, Dykes R. "Cold" fiber population innervating palmar and digital skin of the monkey: Responses to cooling pulses. J Neurophysiol. 1973 Mar;36(2):325–346.
    1. Grossbard JR, Lehavot K, Hoerster KD, Jakupcak M, Seal KH, Simpson TL. Relationships among veteran status, gender, and key health indicators in a national young adult sample. Psychiatr Serv. 2013 Jun;64(6):547–553. doi: 10.1176/appi.ps.003002012.
    1. Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, Bertenthal D, Marmar CR. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010 Feb;23(1):5–16. doi: 10.1002/jts.20493.
    1. Bagalman E. Mental Disorders Among OEF/OIF Veterans Using VA Health Care: Facts and Figures 2013. Washington, DC: Congressional Research Service; 2013. [2015-05-22]. .
    1. Department of Veterans Affairs. Veterans Health Administration . Analysis of VA Health Care Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans: Cumulative from 1st Qtr FY 2002 through 1st Qtr FY 2013 (October 1, 2001 – December 31, 2012) Washington, DC: Department of Veterans Affairs; 2013. [2015-05-22]. .
    1. Alexa Internet . Alexa Top 500 Global Sites. San Francisco, CA: Alexa Internet; [2014-10-29]. .
    1. Facebook Facebook Statistics. 2014. [2014-10-29].
    1. Saleem M. By the Numbers: Facebook vs The United States. 2010. [2014-10-29].
    1. Edison Research The Infinite Dial. 2014. [2014-10-29]. .
    1. Website Monitoring Facebook Facts and Figures. 2010. [2014-10-29].
    1. Batterham PJ. Recruitment of mental health survey participants using Internet advertising: Content, characteristics and cost effectiveness. Int J Methods Psychiatr Res. 2014 Jun;23(2):184–191. doi: 10.1002/mpr.1421.
    1. Mychasiuk R, Benzies K. Facebook: An effective tool for participant retention in longitudinal research. Child Care Health Dev. 2012 Sep;38(5):753–756. doi: 10.1111/j.1365-2214.2011.01326.x.
    1. Jones L, Saksvig BI, Grieser M, Young DR. Recruiting adolescent girls into a follow-up study: Benefits of using a social networking website. Contemp Clin Trials. 2012 Mar;33(2):268–72. doi: 10.1016/j.cct.2011.10.011.
    1. Kaysen D, Cue DK, Kilmer JR. Use of social networking sites to sample lesbian and bisexual women. Addict Newsl Am Psychol Div 50. 2011;18(1):14–15.
    1. Brief DJ, Rubin A, Keane TM, Enggasser JL, Roy M, Helmuth E, Hermos J, Lachowicz M, Rybin D, Rosenbloom D. Web intervention for OEF/OIF veterans with problem drinking and PTSD symptoms: A randomized clinical trial. J Consult Clin Psychol. 2013 Oct;81(5):890–900. doi: 10.1037/a0033697.
    1. Ramo DE, Prochaska JJ. Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. J Med Internet Res. 2012;14(1):e28. doi: 10.2196/jmir.1878.
    1. Bauermeister JA, Zimmerman MA, Johns MM, Glowacki P, Stoddard S, Volz E. Innovative recruitment using online networks: Lessons learned from an online study of alcohol and other drug use utilizing a web-based, respondent-driven sampling (webRDS) strategy. J Stud Alcohol Drugs. 2012 Sep;73(5):834–838.
    1. Lord S, Brevard J, Budman S. Connecting to young adults: An online social network survey of beliefs and attitudes associated with prescription opioid misuse among college students. Subst Use Misuse. 2011;46(1):66–76. doi: 10.3109/10826084.2011.521371.
    1. Chu JL, Snider CE. Use of a social networking web site for recruiting Canadian youth for medical research. J Adolesc Health. 2013 Jun;52(6):792–794. doi: 10.1016/j.jadohealth.2012.12.002.
    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. Ahmed N, Jayasinghe Y, Wark JD, Fenner Y, Moore EE, Tabrizi SN, Fletcher A, Garland SM. Attitudes to Chlamydia screening elicited using the social networking site Facebook for subject recruitment. Sex Health. 2013 Jul;10(3):224–228. doi: 10.1071/SH12198.
    1. Visagie NJ, Sieling WL. Chloroquine-resistant Plasmodium falciparum malaria in South Africa. A case report. S Afr Med J. 1985 Oct 12;68(8):600–601.
    1. Battistella E, Kalyan S, Prior JC. Evaluation of methods and costs associated with recruiting healthy women volunteers to a study of ovulation. J Womens Health (Larchmt) 2010 Aug;19(8):1519–1524. doi: 10.1089/jwh.2009.1751.
    1. Fenner Y, Garland SM, Moore EE, Jayasinghe Y, Fletcher A, Tabrizi SN, Gunasekaran B, Wark JD. Web-based recruiting for health research using a social networking site: An exploratory study. J Med Internet Res. 2012;14(1):e20. doi: 10.2196/jmir.1978.
    1. Arcia A. Facebook advertisements for inexpensive participant recruitment among women in early pregnancy. Health Educ Behav. 2013 Sep 30;41(3):237–241. doi: 10.1177/1090198113504414.
    1. Ryan GS. Online social networks for patient involvement and recruitment in clinical research. Nurse Res. 2013;21(1):35–39. doi: 10.7748/nr2013.09.21.1.35.e302.
    1. Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, Thompson SG, Wallace P. Methodological challenges in online trials. J Med Internet Res. 2009;11(2):e9. doi: 10.2196/jmir.1052.
    1. Wright KB. Researching Internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput Mediat Commun. 2005;10(3):00. doi: 10.1111/j.1083-6101.2005.tb00259.x.
    1. Andrews C. Social media recruitment. Appl Clin Trials. 2012 Nov 1;21(11):32–42.
    1. Kramer J, Rubin A, Coster W, Helmuth E, Hermos J, Rosenbloom D, Moed R, Dooley M, Kao Y-C, Liljenquist K, Brief D, Enggasser J, Keane T, Roy M, Lachowicz M. Strategies to address participant misrepresentation for eligibility in web-based research. Int J Methods Psychiatr Res. 2014 Mar;23(1):120–129. doi: 10.1002/mpr.1415.
    1. Sadler AG, Mengeling MA, Torner JC, Smith JL, Franciscus CL, Erschens HJ, Booth BM. Feasibility and desirability of web-based mental health screening and individualized education for female OEF/OIF reserve and national guard war veterans. J Trauma Stress. 2013 Jun;26(3):401–404. doi: 10.1002/jts.21811.
    1. Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A, Murdoch M. Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Serv. 2010 Jun;61(6):589–597. doi: 10.1176/appi.ps.61.6.589.
    1. Westat . National Survey of Veterans, Active Duty Service Members, Demobilized National Guard and Reserve Members, Family Members, and Surviving Spouses: Final Report to the Department of Veterans Affairs. Rockville, MD: Westat; 2010. Oct 18, [2015-05-22]. .
    1. Ryan J. Traditional Vets Groups Turn to Social Media. 2010. Nov 19, [2014-10-29]. .
    1. Office of the Deputy Under Secretary of Defense Demographics: Profile of the Military Community, 2009-2013. 2012. [2014-10-29].
    1. Prins A, Ouimette P, Kimerling R, Cameron RP, Hugelshofer DS, Shaw-Hegwer J, Thrailkill A, Gusman FD, Sheikh JI. The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Prim Care Psychol. 2003;9(1):9–14.
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Spitzer RL, Kroenke Kurt, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Bliese PD, Wright KM, Adler AB, Cabrera O, Castro CA, Hoge CW. Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J Consult Clin Psychol. 2008 Apr;76(2):272–281. doi: 10.1037/0022-006X.76.2.272.
    1. Britton PC, Ouimette PC, Bossarte RM. The effect of depression on the association between military service and life satisfaction. Qual Life Res. 2012 Dec;21(10):1857–1862. doi: 10.1007/s11136-011-0104-4.
    1. Wells TS, Horton JL, LeardMann CA, Jacobson IG, Boyko EJ. A comparison of the PRIME-MD PHQ-9 and PHQ-8 in a large military prospective study, the Millennium Cohort Study. J Affect Disord. 2013 May 15;148(1):77–83. doi: 10.1016/j.jad.2012.11.052.
    1. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007 Nov 14;298(18):2141–2148. doi: 10.1001/jama.298.18.2141.
    1. Colice GL. Decision analysis, public health policy, and isoniazid chemoprophylaxis for young adult tuberculin skin reactors. Arch Intern Med. 1990 Dec;150(12):2517–2522.
    1. Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007 Mar 12;167(5):476–482. doi: 10.1001/archinte.167.5.476.
    1. Woodall A, Morgan C, Sloan C, Howard L. Barriers to participation in mental health research: Are there specific gender, ethnicity and age related barriers? BMC Psychiatry. 2010;10:103. doi: 10.1186/1471-244X-10-103.
    1. Bayley PJ, Kong JY, Helmer DA, Schneiderman A, Roselli LA, Rosse SM, Jackson JA, Baldwin J, Isaac L, Nolasco M, Blackman MR, Reinhard MJ, Ashford JW, Chapman JC. Challenges to be overcome using population-based sampling methods to recruit veterans for a study of post-traumatic stress disorder and traumatic brain injury. BMC Med Res Methodol. 2014;14:48. doi: 10.1186/1471-2288-14-48.
    1. Ryan MA, Smith TC, Smith B, Amoroso P, Boyko EJ, Gray GC, Gackstetter GD, Riddle JR, Wells TS, Gumbs G, Corbeil TE, Hooper TI. Millennium cohort: Enrollment begins a 21-year contribution to understanding the impact of military service. J Clin Epidemiol. 2007 Feb;60(2):181–191. doi: 10.1016/j.jclinepi.2006.05.009.
    1. Schonlau M, van Soest A, Kapteyn A, Couper M. Selection bias in web surveys and the use of propensity scores. Sociol Methods Res. 2009 Feb;37(3):291–318. doi: 10.1177/0049124108327128.
    1. Smith B, Smith TC, Gray GC, Ryan MA, Millennium Cohort Study Team When epidemiology meets the Internet: Web-based surveys in the Millennium Cohort Study. Am J Epidemiol. 2007 Dec 1;166(11):1345–1354. doi: 10.1093/aje/kwm212.
    1. Bjornson-Benson WM, Stibolt TB, Manske KA, Zavela KJ, Youtsey DJ, Buist AS. Monitoring recruitment effectiveness and cost in a clinical trial. Control Clin Trials. 1993 Apr;14(2 Suppl):52S–67S.
    1. Feild L, Pruchno RA, Bewley J, Lemay EP, Levinsky NG. Using probability vs. nonprobability sampling to identify hard-to-access participants for health-related research: Costs and contrasts. J Aging Health. 2006 Aug;18(4):565–583. doi: 10.1177/0898264306291420.
    1. Patrick JH, Pruchno RA, Rose MS. Recruiting research participants: A comparison of the costs and effectiveness of five recruitment strategies. Gerontologist. 1998 Jun;38(3):295–302.
    1. Brief DJ. VetChange: A web intervention for OEFOIF veterans engaging in problem drinking. 35th Annual Meeting of the Research Society on Alcoholism; Jun 23-27, 2012; San Francisco, CA. 2012. Jun 21,
    1. Griffiths KM, Farrer L, Christensen H. The efficacy of Internet interventions for depression and anxiety disorders: A review of randomised controlled trials. Med J Aust. 2010 Jun 07;192(11 Suppl):S4–S11.
    1. Ybarra ML, Eaton WW. Internet-based mental health interventions. Ment Health Serv Res. 2005 Jun;7(2):75–87.
    1. Pull CB. Self-help Internet interventions for mental disorders. Curr Opin Psychiatry. 2006 Jan;19(1):50–53. doi: 10.1097/01.yco.0000198103.31155.73.
    1. Tait RJ, Christensen H. Internet-based interventions for young people with problematic substance use: A systematic review. Med J Aust. 2010 Jun 07;192(11 Suppl):S15–S21.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj