Evaluation of Web-Based and In-Person Methods to Recruit Adults with Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study

Abstract

BACKGROUND: Our clinical trial of a mobile exercise intervention for adults 18-65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic. OBJECTIVE: (1) evaluate the effectiveness and cost of using social media news feed advertisements, clinic-based approach, and web-based snowball sampling to reach inadequately active adults with T1D, and (2) compare characteristics of enrollees against normative data. METHODS: Participants were recruited between November 2019 and August 2020. Method #1: Facebook and Instagram news feed advertisements ran for five 1-8 day windows targeting adults (18-64yr) in the greater New Haven and Hartford, CT areas with ≥1 diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. Method #2: In-person approach of patients 18-24yr with T1D at clinical visits November-December 2019. Those interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. Method #3: Snowball sampling by physically active individuals with T1D contacting their peers on Facebook and emails for 48 days with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants similarly to snowball sampling. RESULTS: Method #1: Advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%), of whom 20 (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%, P < .001) but their responsiveness and eligibility rates did not differ. Method #2: We approached 40 patients of whom 32 (80%) inquired about the study, of whom 20 (63%) volunteered, of whom 2 (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. Method #3: Snowball sampling generated 13 inquirers, of whom 12 (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible and total costs averaged $20.59 per eligible volunteer. Other methods yielded 7 inquirers, of whom 5 (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible and total costs averaged $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (optimal glycemic control, obesity, low exercise), those recruited by news feed (obesity, older age), and snowball sampling (optimal glycemic control, low exercise). CONCLUSIONS: Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, costs comparing favorably to prior trials despite targeting an uncommon condition (i.e., T1D) and commitment to an intervention. They should be tailored in future studies to increase access to higher-risk participants.