Department of Medicine Recruiting Minority Adults through Electronic Technology Center of Aging in Diverse Communities Celia P. Kaplan, DrPH, MA
Outline Ø Background Ø Systematic Review 2
Background Ø There is need to increase the participation of older adults and underrepresented groups in research Ø Treatments are often based on studies including younger, healthier, higher functioning individuals Ø It is estimated that 20% of clinical trials need to be extended because of inadequate recruitment Ø Prior research has indicated underrepresentation of minorities and older adults in research 3
Example of recruitment of diverse groups: Registry African American (N=164) Asian American (n=126) Latino (n=206) Non-Latino White (n=359) 90 79 80 70 63.8 60 59.8 60 47.6 50 36.6 40 26.2 30 21.5 17 16.7 20 13.1 11.1 10 0 Participation in behavioral research Participation in clinical trials or other Willingness to participate health study Kaplan et al. (2015). "Knowledge and attitudes regarding clinical trials and willingness to participate among prostate cancer patients." Contemp Clin Trials 45 (Pt B): 443-448. 4
Example of recruitment of diverse groups: Health care setting 5
Recruitment: Sources of Participants Community Organizations Health Population Care at large Settings 6
El Electr troni nic rec ecru ruitmen ent methods Ø Methods that rely on the use of the Internet to identify or recruit participants into research studies Ø Potential benefits ü Increase recruitment ü Cost effectiveness ü Reach underrepresented groups ü Ethnic/racial minorities ü Rural populations ü Isolated elders ü Individuals affected by rare diseases 7
El Electr troni nic rec ecruitmen ment me method ods Internet ü General searches ü Social Media ( Facebook page, Twitter account) ü Study blogs ü Online newspapers, message boards, newsletters Email ü Listings from prior studies ü Listings from electronic health records ü Purchased listings ü Insurance listings ü Use of patient portals Paid Media ü Social Media ( Facebook Ads, Google AdWords) ü Web banner ads 8
What Wha t is is the the Ratio tionale nale? % OF US ADULTS WHO OWN THE FOLLOWING DEVICES White Black Hispanic 120% 98% 96% 96% 100% 82% 80% 79% 80% 60% 40% 17% 17% 14% 20% 0% Any Cellphone Smartphone Cellphone, but not smartphone Pew Research Center. Survey conducted Jan.8 to Feb.7, 2019. https://www.pewinternet.org/fact-sheet/mobile/ 9
Wh What is s the Rationale? % OF US ADULTS BY AGE GROUP 65-69 70-74 75-79 80+ 90% 82% 80% 75% 66% 70% 61% 60% 59% 60% 49% 50% 44% 41% 40% 31% 28% 30% 17% 20% 10% 0% use of Internet home broadband services own a smartphone https://www.pewinternet.org/ 2017 /05/17/tech-adoption-climbs-among-older-adults/ 10
11 https://sproutsocial.com/insights/new-social-media-demographics/ Use of Facebook- 2019
% OF FACEBOOK USERS, BY RACE/ETHNICITY Latino Black White All 74% 73% 73% 72% 71% 71% 71% 70% 69% 68% 67% 67% 66% 65% 64% Facebook https://www.pewresearch.org/fact-tank/2015/02/03/social-media-preferences-vary-by-race-and-ethnicity/ 12
Google Ads: How it works Researchers as advertisers Ø Determine the ad’s goal (e.g., drive people to the study website) Ø Decide where to advertise (e.g., geographical targeting) Ø Create a message to attract “clicks” (ie. Words) Ø Create key words Ø Set the budget cap (per day, monthly cap) Ø Ads appear on Google Searches based on bidding process 13
Example: Prostate Cancer Clinical Trials Ø Components: Ø Matching tool with trial summaries Ø Google Ads campaign Ø Implementation: October 2014 to April 2015 Ø Languages: English and Spanish Ø Targeted advertised campaign Ø Ad Time: 8 weeks Ø Non-Ad Time: 22 weeks Ø $ 4000 cost; 1.49 cost per click Ø 29 matched individuals who provided information Kaplan et al. (2018). A bilingual, Internet-based, targeted advertising campaign for prostate cancer clinical trials: Assessing the feasibility, acceptability, and efficacy of a novel recruitment strategy. Contemporary clinical trials communications, 12, 60-67 14
Kaplan CP,et al. A bilingual, Internet-based, targeted advertising campaign for prostate cancer clinical trials: Assessing the feasibility, acceptability, and efficacy of a novel recruitment strategy. Contemp Clin Trials Commun . 2018;12:60–67. Published 2018 Aug 15. doi:10.1016/j.conctc.2018.08.005
Example: Prostate Cancer Clinical Trials Survey Completion, Participants with Prostate Cancer, and Participants Who Left Information 25 20 Surveys Completed 15 Survey Takers 10 with Prostate Cancer 5 0 October 15, 2014 October 22, 2014 October 29, 2014 January 7, 2015 January 14, 2015 January 21, 2015 January 28, 2015 February 4, 2015 February 11, 2015 February 18, 2015 February 25, 2015 March 4, 2015 March 11, 2015 March 18, 2015 March 25, 2015 October 1, 2014 October 8, 2014 November 5, 2014 November 12, 2014 November 19, 2014 November 26, 2014 December 3, 2014 December 10, 2014 December 17, 2014 December 24, 2014 December 31, 2014 April 1, 2015 April 8, 2015 April 15, 2015 Kaplan CP, Siegel A, Leykin Y, et al. A bilingual, Internet-based, targeted advertising campaign for prostate cancer clinical trials: Assessing the feasibility, acceptability, and efficacy of a novel recruitment strategy. Contemp Clin Trials Commun . 2018;12:60–67. Published 2018 Aug 15. doi:10.1016/j.conctc.2018.08.005 16
Facebook ads Ø Ability to target by age, geography, income, eligibility and ineligibility criteria Ø Advertiser places monetary bid Ø Placement is based on: Ø Feedback from Facebook users Ø Facebook evaluation Ø The advertiser with the highest combination of all three elements gets that placed 17
Example: Elderly Clinical Trial Enrollment Ø Phase 1 clinical trial for Alzheimer's disease Ø Desired recruitment: 45 individuals 60 years and older Ø Traditional campaign: Ø Traditional methods (billboards, direct mailer, bus advertising, newspapers ads) Ø Yield: 6 enrolled subjects over 11 weeks Ø Social Media Campaign Ø Phase 1: Black and white campaign Ø Phase 2: Typical and Altruist campaigns 18
Example: Facebook example: Elderly Clinical Trial 1 ST CAMPAIGN ALTRUISTIC CAMPAING Cowie et.al. (2018) The Use of Facebook Advertising to Recruit Healthy Elderly People for a Clinical Trial: Baseline Metrics JMIR Research Protocols 19
Facebook example: Elderly Clinical Trial Parameter First Social Media Campaign Second Social Media Campaign: Altruistic Campaign Keywords Alzheimers’disease; medical research Neuroscience, Clinical trial, Alzheimer’s Alzheimer’s association ads disease research, Philanthropy, Mind games, Costco, Altruism, Medical research, Luminosity, or Lifelong learning Exclusions None reported National Cancer Survivors Day, Diabetes mellitus type 2 awareness, Hypertension Awareness, Allergy, Prehypertension, Cancer signs and symptoms, Diabetic diet Cowie et.al. (2018) The Use of Facebook Advertising to Recruit Healthy Elderly People for a Clinical Trial: Baseline Metrics JMIR Research Protocols 20
Evaluation of Electronic Technology Recruitment Strategies 21
Systematic review Ø Technology based recruitment studies Ø Study period 2008-2018 Ø Data bases Ø PubMed: EMBASE: PSYCInfo: Web of Science: Social Services Abstracts: Sociological Abstracts: Ø Studies included Ø Comparative analysis of methods Ø Primarily adults Ø Registries 22
Why Registries? Ø Useful tools to improve recruitment into health research Ø Voluntary: Includes indicate interest or agree to be contacted for future research Ø Type of registries ü Rare diseases ü Minority populations ü Local or international Ø Examples Ø Research 23
Systematic Review- PRISMA Social Services Sociological PubMed : 1209 EMBASE : 1613 PSYCInfo : 383 Web of Abstracts : 2061 Abstracts: 1510 references references references Science : 914 references references references 5811 references after 5312 excluded by title deleting duplicates 499 included by title 205 excluded by abstract Registries: 34 Surveys: 40 Interventions: 220
Comparative studies Ø Alzheimer’s disease Ø Grill et al. Constructing a local potential participant registry to improve Alzheimer’s disease clinical research recruitment (2018 ) Ø African American Ø Green et al. Connecting communities to health research: Development of Project CONNECT minority research registry (2013) Ø Rare Disease Ø Johnson et al. Evaluation of Participant recruitment methods to a rare disease online registry (2014) 25
Evaluation Ø Reach (i.e. numbers of participants) Ø Are electronic methods (EM) more effective at research participant recruitment than traditional methods Ø Representation Ø Do EM recruit a sample comparable to traditional methods Ø Do EM recruit a more diverse sample than traditional methods Ø Cost Ø Are EM more cost effective at research participant recruitment than traditional methods 26
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