Virtual Recruitment Strategies in Underserved Populations in Rural Pennsylvania (Preprint)

Abstract

Participant recruitment in rural and hard-to-reach/underserved populations can present unique challenges. These challenges are further exacerbated by the need for low-cost recruiting, which often leads to utilization of online recruitment methods (e.g., email, social media). Social media platforms are predominantly used by younger populations and require access to internet, which those with lower socioeconomic means and less education are less likely to have access to. The current study highlights how a recruitment strategy that utilizes email in combination with a follow-up phone call, produced high enrollment rates that included a diversity of participants from rural populations in older age brackets.

To examine whether a combination of email and telephonic recruitment strategies increased recruitment rates in various hard-to-reach populations, specifically in rural and elderly populations

We evaluated the overall enrollment rate of one recruitment arm of a larger study that aims to understand the relationship between genetics and substance use disorders. We evaluated the characteristics of the enrolled population to determine recruitment success of a combined email and follow-up telephonic recruitment strategy, as well as the rate of enrollment of hard-to-reach populations. These characteristics included, (1) enrollment rate before vs after follow-up phone call; (2) zip-code/county of enrollee to determine rural/urban and Appalachian status; (3) age to verify recruitment in all eligible age brackets; and (4) gender distribution among age brackets and rural/urban status.

The email and follow-up telephonic arm of the study had a 17.4% enrollment rate. Of those enrolled, 2297 (37.6%) of the participants enrolled before the follow-up phone call and 3809 (62.4%) enrolled after a follow-up phone call. A paired t-test with P= <.001 confirmed enrollment differences were significant. Of the enrolled participants, 76% lived in rural counties and 24% lived in urban counties in Pennsylvania. Of patients enrolled, 98.7% were from Appalachian counties and 1.3% were from non-Appalachian counties. Patients from rural Appalachia made up 76.2% of the total rural population. Enrolled patients represented all eligible age brackets from ages 20-75, with the 60-70 age bracket having the most enrollees. Females made up 72.5% of the enrolled population and males made 27.5% of the population.

Results indicate that combining an online recruitment method with a more traditional method, such as a phone call, yield higher enrollment rates than online methods alone. Adding a humanizing component, such as a live person phone call, may be a key element needed to establish trust and connection to encourage patients from underserved and rural areas to enroll in studies via virtual recruiting methods.