Lessons From the Dot Contraceptive Efficacy Study: Analysis of the Use of Agile Development to Improve Recruitment and Enrollment for mHealth Research

Dominick Shattuck, Liya T Haile, Rebecca G Simmons, Dominick Shattuck, Liya T Haile, Rebecca G Simmons

Abstract

Background: Smartphone apps that provide women with information about their daily fertility status during their menstrual cycles can contribute to the contraceptive method mix. However, if these apps claim to help a user prevent pregnancy, they must undergo similar rigorous research required for other contraceptive methods. Georgetown University's Institute for Reproductive Health is conducting a prospective longitudinal efficacy trial on Dot (Dynamic Optimal Timing), an algorithm-based fertility app designed to help women prevent pregnancy.

Objective: The aim of this paper was to highlight decision points during the recruitment-enrollment process and the effect of modifications on enrollment numbers and demographics. Recruiting eligible research participants for a contraceptive efficacy study and enrolling an adequate number to statistically assess the effectiveness of Dot is critical. Recruiting and enrolling participants for the Dot study involved making decisions based on research and analytic data, constant process modification, and close monitoring and evaluation of the effect of these modifications.

Methods: Originally, the only option for women to enroll in the study was to do so over the phone with a study representative. On noticing low enrollment numbers, we examined the 7 steps from the time a woman received the recruitment message until she completed enrollment and made modifications accordingly. In modification 1, we added call-back and voicemail procedures to increase the number of completed calls. Modification 2 involved using a chat and instant message (IM) features to facilitate study enrollment. In modification 3, the process was fully automated to allow participants to enroll in the study without the aid of study representatives.

Results: After these modifications were implemented, 719 women were enrolled in the study over a 6-month period. The majority of participants (494/719, 68.7%) were enrolled during modification 3, in which they had the option to enroll via phone, chat, or the fully automated process. Overall, 29.2% (210/719) of the participants were enrolled via a phone call, 19.9% (143/719) via chat/IM, and 50.9% (366/719) directly through the fully automated process. With respect to the demographic profile of our study sample, we found a significant statistical difference in education level across all modifications (P<.05) but not in age or race or ethnicity (P>.05).

Conclusions: Our findings show that agile and consistent modifications to the recruitment and enrollment process were necessary to yield an appropriate sample size. An automated process resulted in significantly higher enrollment rates than one that required phone interaction with study representatives. Although there were some differences in demographic characteristics of enrollees as the process was modified, in general, our study population is diverse and reflects the overall United States population in terms of race/ethnicity, age, and education. Additional research is proposed to identify how differences in mode of enrollment and demographic characteristics may affect participants' performance in the study.

Trial registration: ClinicalTrials.gov NCT02833922; https://ichgcp.net/clinical-trials-registry/NCT02833922 (Archived by WebCite at http://www.webcitation.org/6yj5FHrBh).

Keywords: Dot; contraceptive; contraceptive efficacy; family planning; fertility awareness method; fertility tracker; higher mobile research; mHealth; mobile apps.

Conflict of interest statement

Conflicts of Interest: DS and LH are employed by the Institute for Reproductive Health (IRH), Georgetown University, which is recipient of a grant from the United States Agency for International Development that supports this study. The research tests an app for which a patent application has been filed by Cycle Technologies. Neither DS nor LH, or any other employee of Georgetown University, have any financial relationship to or receive any income or royalties from Cycle Technologies, a company that is owned by a family member of the director of the institute. Cycle Technologies is solely responsible for the app that is the subject of this research. All data from this research will be made available through the Open Data Act, as required by US law. RS, a former employee of IRH, also does not have any conflict of interest to declare.

©Dominick Shattuck, Liya T Haile, Rebecca G Simmons. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.04.2018.

Figures

Figure 1
Figure 1
Proofmode’s framework for data collection adapted from Dot study protocol.
Figure 2
Figure 2
Recruitment process with modification impact zones.
Figure 3
Figure 3
The pop-up screen after women were determined to be pre-eligible.
Figure 4
Figure 4
Dot study recruitment and enrollment process funnel.

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