Social media are useful recruitment tools but results vary, especially as to the quality of subjects. Examples from two recent Health Decisions trials illustrate. We utilized a variety of social media in both trials, including craigslist, Facebook, a social media recruitment vendor’s sites and investigators’ social media sites. In one study, social media accounted for more than 50% of the total study subjects and more than 50% of the completers for the study. In the other, social media recruited an adequate quantity of subjects but quality proved less than ideal.
Population Age and Communications Preferences
What made the difference? One of our observations is that social media recruitment generally works best when a study is targeting a young population. Although people across a wide age range use electronic communications to some degree, younger subjects make more extensive use of a greater variety of social media. An older population may be comfortable with email but less inclined to use text messages and very unlikely to use social media. A somewhat younger population may use email, text messages, web searches and sites like craigslist but be less comfortable with Facebook and Twitter. On the other hand, many young adults rely heavily on Facebook, Twitter and several other social networking media. A social media strategy must reflect an understanding of the communications preferences of the target age cohort.
Patients’ Ability to Assess Their Own Eligibility
Another observation from the two trials described above is making sure that recruitment advertisements are easy to understand. There is more to this than using simple and clear language. A key consideration is the nature of the health condition and whether subjects not only can comprehend the language in the advertisement but also have a reasonable likelihood of determining whether they have the health condition targeted in a study and meet key inclusion criteria. For example, a contraception or diabetes study will likely benefit more from a social media ad than a study for a complex infectious condition that requires microbiological diagnosis. Women will likely have a good understanding of their potential eligibility for a study of a novel contraceptive and may respond to ads placed in social media groups focused on issues of reproductive health. However, when multiple health conditions have the same or similar symptoms and there is a trial for one of those health conditions, patients with relevant symptoms but the wrong health condition can represent a strain on recruitment and screening resources. Online screening questionnaires can help, but not if determining eligibility requires a pathologist or clinical diagnosis by a board-certified specialist.
The Importance of the Investigator-Patient Relationship
Another consideration in evaluating the potential use of social media for subject recruitment is the importance of the investigator-patient relationship in the specific trial. Where successful recruitment is critically dependent on the investigator-patient relationship, the most effective strategy may be allocating most of the recruitment budget to the sites and letting them decide how best to identify and engage eligible subjects.
Timing also matters. The study that used social media more effectively started early. Social media were an integral part of recruitment strategy from the outset. Starting early requires discussing the potential use of social media outlets before start-up and understanding related budgetary requirements. Important factors in using social media early in a study include creating generic ads and having them reviewed and approved by an IRB at the beginning of a study. Even if the project team considers social media a backup strategy, it is important to be ready to move swiftly if recruitment by other means is less effective than expected.
Social Media Specialists: One Important Source Among Many
Lastly, there are third-party vendors that specialize in social media recruitment and have developed supporting services such as text messaging campaigns to drive both subject enrollment and subject retention. As with any recruitment service, it is important to verify familiarity with studies in the indication and the target patient populations. Such a third-party social-media recruitment specialist contributed to meeting recruitment goals for the more successful of the two studies referenced above. However, our own use of craigslist for the same study enrolled more subjects than the third-party vendor and at a lower cost. Both social media sources were worthwhile but craigslist was more cost-effective for the study in question.
Overall, we believe social media outlets can be effective recruitment tools and will evolve to increase enrollment in many types of clinical trials. But this is not to say that social media will supplant other recruitment methods across the board. Traditional recruitment methods are sometimes more effective than the latest technology. Many investigational sites are efficient at identifying eligible subjects within their patient populations. One of the two studies that utilized social media drew more than half of its patient population and study completers from social media. The other study drew more than half of its patient population from the efforts of investigational sites. In patient recruitment, the best strategy is to try different recruitment channels, track performance by channel and shift resources to the channel that performs best. Whatever works!
For an extensive discussion of potential recruitment strategies for female subjects, please see the Health Decisions white paper, Addressing the New Imperative to Include Females in Clinical Trials.
Jessica Kappes, MBA, CCRA is a clinical project manager at Health Decisions. Jessica has more than 7 years of project management experience on both the CRO and sponsor side. Her global experience includes trials in North America, Latin America, Asia-Pacific and the European Union. She has experience in both the neonatal and pediatric populations and therapeutic experience in IVDs, bacteremia, endocrinology and oncology. She holds an MBA from Indiana Wesleyan University and is a certified Clinical Research Associate through Association of Clinical Research Professionals.