research study recruitment video

How To Successfully Recruit Participants for A Study (2023 Edition)

Whether you’re recruiting participants for a B2B or a B2C research study, here the steps you need and the best recruiting methods for a successful project.

At its very core, successful, informative, useful research is dependent on the participants that are recruited for a study. Recruiting is not about finding a certain number of people, but about identifying the exact “right” people specific to the study and that study’s objectives.  

5 STEPS TO A SUCCESSFUL RECRUITMENT STRATEGY FOR PARTICIPANTS

To do this involves several steps. When you take the time to meticulously go through these steps, the results will be a successful recruit and a successful recruit will mean a successful project and that means a happy client or team and research results that can make a positive impact on your business or initiative.  

STEP 1. DEFINE YOUR IDEAL PARTICIPANT PROFILE

If you don’t take the time to specifically define your participant profile you might as well not conduct the research because without the “right” participants your results will be skewed or invalid and could lead you down the wrong path.  

The first step to figuring out who the study participants should be is to determine the objectives of your project. To do this bring your team and your client team together to discuss and answer these questions:  

• What do you want to learn from doing this research that you don’t already know?
• What do you already know, or think you already know in terms of what you want to learn?
• Why do you want to learn this? What business decisions do you want to be able to make, or actions do you want to take, when this research is complete?  In other words, what do you want to DO with the insights and learnings after you have them?

Be very specific in your answers and your final objectives. Too broad an objective or too many objectives and you won’t learn enough about any one thing to be valuable.  

Now that you’ve determined the objective of your research you are ready to create a profile based on who has the knowledge, background, education and experience to answer the questions you’ll need answered.  

Whether your research is B2B or B2C, along with the specific objectives of your research will determine how extensive the requirements are for your participants.

For example, if you’re doing a B2C study exploring new candy flavors for children, age 6-12, the participant profile might be as simple as:

• Must eat and like candy
• Must have no food allergies
• Must be open to trying new foods and flavors  
• Must be articulate and enthusiastic.

You might also recruit for a mix of ethnicities, an even gender split and household income requirements.

If you’re doing a B2B study about software use, the participant requirements might include:

• Which industry they’re in
• What professional level they’re at
• Have X+ years in their position  
• Use of specific software  
• Reached a certain educational level
• Not having worked at certain companies or in certain industries
• Not having used certain technologies
• Are articulate and enthusiastic

And you will likely need to have some of the same demographic screens from above as well.  

Keep in mind that the more extensive and specific the qualifiers, the lower the incidence (or pool) of potential qualified participants. This means the more difficult and costly it will be to recruit your study.  

STEP 2. CREATE SCREENERS TO WEED OUT THE UNQUALIFIED AND WANNABES AND QUALIFY THE “RIGHT” PARTICIPANTS

No matter the number of screens required for your participant, you still want to screen for articulateness and willingness to participate. Even if a candidate has all the “right” qualifications, if they’re unwilling to or can’t share their experiences, opinions and feelings they are simply unqualified to participate.

Today screening surveys are often used to cast a wide net and quickly weed out participants that don’t qualify at the lowest level. These surveys can be sent via an email or link to thousands of candidates. But time, trouble and costs can be saved up front if the screening survey is sent out to a more targeted and potentially qualified audience.  

A survey should always be followed by screening those who pass the survey “test” by having a screening conversation with the candidate using a pre-written screener that asks additional, deeper qualifying questions.

Creating a carefully and well-designed screener that is easily understandable by first the recruiter and their call center staff and then by the needed audience is imperative to the success of the recruit. To achieve this, carefully review the screener with the recruiter to make sure each question and the responses that qualify or terminate a candidate are well understood.

As recruiting for research projects has moved from professional recruiters using lists more-and-more to leveraging social media and other Internet platforms for recruiting, a blight of professional researchers AKA research imposters has popped up. Because of these posers, leading questions with obvious choices for response should be avoided in screeners and screening surveys. This can be achieved by offering some multiple-choice responses that will mis-direct unqualified candidates and asking questions where only truly qualified candidates would choose a qualifying response.  

For the highest response rates, screeners should be as short and succinct as possible while still posing all the questions needed to identify qualified participants. Along the same lines be honest about how long the survey and conversation will take. Nothing will turn a potential participant off faster than telling them, “This will take five minutes,” and taking fifteen.  

STEP 3. RECRUITING METHODS: WHAT WOULD BE THE MOST SUCCESSFUL RECRITING METHOD BASED ON THE PARTICIPANT PROFILE

Choosing how you’ll recruit and who is your recruiting partner is key to recruit success. Your recruiting resource needs two things, understanding of who your participant profile is and depth of the candidates that fit the profile you’re looking for.  

For example: recruiting from something like Craig’s List, while admittedly used by many recruiters, is too un-focused and reaches too broad and disparate a crowd to truly be helpful. While it offers depth it has no mechanism for the understanding or context of the participants you need.

Not all recruiting methods will work well for all recruits. Much like the story of The Three Bears, it’s important to find the recruiting method that fits “just right” for the audience you need to recruit. Let’s take a look at some of the recruiting method options.

B2C recruiting: Most (but not all) consumer recruiting is easier than most B2B recruits. This is because for most consumer studies there is a higher incidence of potential participants and require far less qualifiers overall as well as far less stringent ones. Like the example of the candy study above, it’s pretty darn easy to find kids who like candy.  

Because of this, a wide variety of recruiting methods will, generally, work for B2C recruits. These include:

• Traditional methods : Focus Group Facilities that recruit, other large recruiting firms, boutique and independent recruiters all use existing lists and can supplement with placing ads (Broadcasting) when needed.
• Client databases of their consumers : This works when participants need to be customers of the client. It can be used in conjunction with other recruiting methods when a study calls for both customers and non-customers.
• Word-of-Mouth and Snowballing : Word-of-Mouth is an extremely cost-effective way to recruit and works well when very few screens or qualifiers are needed or when “word-of-mouth” is spread through a specific demographic or professional community. Similarly, Snowballing is when you ask recruited participants to invite a friend or friends that might qualify.
• Non-Professional Social Media platforms like Facebook and Twitter: Putting the word out randomly on a social media platform can be a cost-effective method to recruit when a generic profile of participants is needed. If a more specific profile is required targeting specific groups or communities within a social media platform can be effective.

B2B recruiting: Most B2B projects require a more focused and intense recruit. As we discussed above, B2B participants likely will have many more and more specific requirements to qualify. This calls for a more specialized or unique recruiting method. These include:  

• Specialized Recruiters : Recruiters who specialize in certain demographics or professions like tech, financial, medical, etc. can be the solution when your participants all must belong to the same profession. Specialized Recruiters can be especially key to finding and booking C or VP-level professionals—possibly the most difficult recruit to accomplish.
• Recruiting platforms : Some recruiting platforms, like Respondent have, literally millions of professionals pre-qualified for their willingness to participate in research as well as to their professional credentials. Respondent also offers additional features that make recruiting and participant management turnkey, Recruiting Platforms, including Respondent can come to the rescue when you need a fast, yet high-quality recruit.  
• Broadcasting/Running ads : Placing ads or announcements where your qualified participants would likely see them, including websites, trade journals, association platforms and media. This is often used to boost the pool of potential participants for the primary recruiting method being used.
• Purchased lists from associations or company directories : For truly difficult recruits sometimes you just have to spend the money and get a totally targeted list. Before purchasing a list, check association websites, some might list members with contact information.
• Professional Social Media Platforms like Linkedin.com. With one of the more robust (and expensive) memberships you can search by specific professions, view member profiles where you can check their credentials, background and title.
• Relationship Recruiting : This is a great solution if you need to continually conduct research with a specific audience. Build and leverage relationships with the people, companies and associations that are relevant to your target industries for recruiting.

As you might have guessed, recruiting can get expensive but given the importance of the “right” participants to the outcome of your study, recruiting is not the place you want to cut costs.  

STEP 4: DETERMINE HOW MANY PARTICIPANTS YOU NEED  

Deciding how many participants you need for your project is a delicate balance between budget, time and research needs.  

The minimum number needed is dependent on several factors:

• What is the subject of your research? Example: the optimum number for straight forward UX research is 5-10. As you’ll see, that number is much smaller than for most types of research.  
• How many markets do you need to cover for your research or could remote research, where you include participants from multiple markets work?
• Do you need to conduct the research with different audiences, if so, how many?
• Do you need to segment your groups by gender?
• If you are conducting research with kids, you’ll need to segment the groups by age range and possibly by gender.  

These scenarios will add significantly to the number of participants you need to sufficiently represent each market and each audience. This number becomes even greater when you have multiple audiences, genders or kids’ ages across multiple markets.  

How Many Participants for A Focus Groups

Now that we’ve complicated matters, let’s simplify them. Generally speaking, across a wide variety of research subjects, a good rule of thumb for the minimum number of focus groups and participants in one market would be four groups with eight participants per group so 32 participants (and researchers will disagree on this). You would not need to multiple by the number of markets or audiences. Adding a couple of groups total per audience/age/location will allow you to see if there are differences by segments.

You can do this across markets by “flip-flopping” groups. Here’s an example of how this might look for nine groups with three audiences, 10-12-year-olds, 13, 14-year-olds and moms across two markets:

As you can see, each audience is represented in each market but without having to double the number of participants overall.  

How Many Participants For I-D-Is?

Researchers differ as to the optimum number of one-one-one-in-depth interviews needed to be conducted for a study. Some suggest 8-12, while others feel that no less than 25 are needed. Our recommendation—certainly no less than 8 assuming you’re looking at one audience, but as many as reasonable that your budget will allow for.  

Over Recruiting, A Must

A reality of research recruiting is the no-show participants. To account for this you should always over recruit. If you want to seat 8 for a focus group, recruit 10. If you want to conduct 20 I-D-Is you would want to recruit 3-4 additional participants.  

STEP 5: DECIDE ON INCENTIVES

Incentives are a must. Why? Of course, to motivate participants to sign on, to insure they’ll show up and to inspire high, enthusiastic participation and truthful responses. More importantly, incentives show you respect and value participant’s time, expertise, opinions and emotions.  

There is not a one-incentive-fits-all. Incentives must be figured out based on different rates for different types of research, length of sessions and even industries and titles of participants. Some factors include:

• The longer the session, the higher the incentive.
• In-person sessions will require a higher incentive than remote.
• Focus groups vs. IDI’s vs. ethnographies (such as dine-alongs, shop-alongs and home visits) vs. diary studies each require a different level of incentive. The more “skin-in-the-game” for participants, the higher the incentive.
• Professionals who participate who are at higher income levels such as doctors, C-levels and VPs will require substantially higher incentives to motivate them to participate at all.  

RECRUTING IT’S A LOT, BUT WORTH IT

There is no doubt that recruiting takes a lot of time, diligence and money. But there’s also no doubt that the success of your project is worth every minute and dollar spent on recruiting. For additional tips on recruiting go to Respondent.

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Recruiting Participants for Research 101: The Ultimate Guide

In this blog post you will find:

1. The Importance of Recruiting the Right Participants for a Research Study 2. Main Challenges When Recruiting Participants for Research 3. Effective Approaches to Recruit Participants 4. The Key Methods to Recruit Eligible Participants for Research 5. Conclusion – Recruiting Participants

Today, innovation and creativity reign supreme, and understanding your users is the key to building valuable products. However, you can’t always know what your users need, want, or expect.

To craft digital experiences that truly resonate with your audience, you need to dive deep into the minds of your users. Enter UX research participants, those who actively engage in the research process to provide insights and feedback on a product or service.

But finding participants for UX research studies can be a difficult task. So, in this blog post, we go over how to recruit the perfect participants for your UX research projects. 

The Importance of Recruiting the Right Participants for a Research Study

Recruiting the right participants for a user research study is of paramount importance for several reasons.

Representative data

The quality and reliability of research findings depend on having a sample that accurately reflects the target population.

Selecting the right participants ensures that your data is representative and can be generalized to a broader group.

 If the participants are not representative, your findings may not be applicable to the wider context.

Accurate insights

The right participants are more likely to provide accurate and insightful information. They have a vested interest in the research topic, which can lead to more honest and relevant responses. 

This, in turn, results in a higher quality of data and more meaningful conclusions.

User-centered design

In fields like user experience (UX) research, the right participants are crucial for designing products or services that genuinely meet users’ needs.

Selecting individuals who represent the actual user base ensures that your design decisions are in sync with their preferences and behaviors.

Recruiting the right participants saves time and resources. If you target the wrong group, you may end up with data that doesn’t answer your research questions, necessitating additional rounds of research and recruitment. 

This is not only costly but can also lead to delays in your project.

Ethical considerations

Selecting appropriate participants is an ethical responsibility. Informed consent and a clear understanding of the research’s purpose and potential impacts are essential.

Recruiting the right participants means you’re involving individuals who can make informed decisions about their participation.

Minimizing Bias

Proper participant recruitment helps reduce bias in your data. Selecting participants who have no inherent bias or conflict of interest related to your research topic ensures that your findings are not skewed in a particular direction.

Improved validity

The right participants enhance the internal and external validity of your study. Internal validity relates to the accuracy of your findings within your research context, while external validity concerns the generalizability of those findings to a broader population. 

Recruiting the right participants enhances both aspects of validity.

Enhanced engagement

Participants who are a good fit for the research are more likely to engage actively in the study. They can provide valuable feedback, insights, and details that may be missed with less suitable participants.

The importance of recruiting the right participants for a research study cannot be overstated. It impacts the validity, quality, and relevance of your findings, and it can ultimately determine the success and impact of your research project.

Careful participant selection is the foundation upon which valuable and meaningful research is built.

Main Challenges When Recruiting Participants for Research

Participant recruitment for user research can be a pain.

Participant Availability

Finding potential participants who match your criteria and are available during the time frame of your user testing project can be difficult. People have busy schedules, and aligning their availability with your research schedule can be a significant hurdle.

Representativeness

Ensuring that your participant pool is representative of your target user group can be challenging. You want to avoid bias in your findings, so recruiting a diverse set of participants is crucial. However, this can be difficult, especially for niche or hard-to-reach user groups.

Recruitment Bias

The methods you use to recruit participants can introduce bias. For example, if you primarily rely on online advertising or social media, you may inadvertently exclude individuals who are not active in those spaces. Finding participants hence become a challenge.

Even when participants express interest and agree to participate, there is no guarantee that they will actually show up for the research sessions. This can be frustrating and impact the study’s schedule and budget.

Participant Motivation

Some participants may not be genuinely motivated to provide useful feedback. They may participate for compensation or other incentives without a genuine interest in the research topic, leading to low-quality data.

Privacy and Confidentiality Concerns

Participants may have concerns about their privacy or the confidentiality of the information they provide during the research. Addressing these concerns is essential to recruit and retain participants.

Participant Fatigue

In cases where you need to repeatedly engage the same participants, such as in longitudinal studies, participant fatigue can set in. This can affect the quality of their feedback and the overall success of the study.

Geographic and Cultural Barriers

If your research involves participants from different geographical locations or cultural backgrounds, you may face challenges related to language barriers, time zone differences, and varying cultural norms and expectations.

Recruitment Costs

Recruiting participants, especially in niche markets, can be costly. Incentives, compensation, and other expenses can strain the research budget.

Overcoming Incentive Mismatch

Finding the right balance in incentives to motivate participants without inducing participation solely for the rewards can be tricky. Offering too much can attract those who are less interested in the research itself.

Legal and Ethical Considerations

Complying with legal and ethical guidelines, such as obtaining informed consent and protecting participant data, can be complex and time-consuming.

Scheduling and Coordination

Coordinating schedules between researchers, participants, and any stakeholders involved can be a logistical challenge, especially in larger research projects.

Recruitment Source Diversity

Relying on a limited number of sources for recruitment can restrict the diversity of your participant pool. Diversifying your recruitment channels can help address this challenge.

Effective Approaches to Recruit Participants

When recruiting research participants for a research study, there are several best practices you should follow to meet success.

Clearly Define Your Research Goals

Before you start recruiting, have a clear understanding of your research objectives, the type of participants you need, and the specific criteria they should meet.

Defining your research goals helps ensure that the participants you recruit are relevant to your study. Without clear goals, you may end up with participants who don’t match the target audience, making your research less useful.

Honed Screening Process

Use screening questions to filter out participants who do not meet your specific criteria. This can save both your time and the participants’ time.

A thorough screening process can save time and resources by eliminating participants who don’t meet your criteria. This prevents you from conducting interviews or observations with individuals who won’t provide valuable insights.

Create Detailed Personas

Detailed personas provide a clear picture of your ideal users, including their demographics, behaviors, and needs. This helps in precisely targeting and recruiting participants who closely match these personas, ensuring that your research is relevant and representative of your user base.

Recruiting participants who closely resemble your personas ensures that the data collected during user research is directly applicable to your target audience. This leads to insights that are more likely to drive design and development decisions. You can also work with your existing customers.

Diversify Recruitment Channels

Using multiple recruitment channels allows you to reach a more diverse and representative pool of participants. 

Different channels may attract individuals with varying backgrounds, experiences, and perspectives, ensuring a richer and more comprehensive dataset.

Relying on a single recruitment channel can introduce bias into your participant pool. By diversifying recruitment sources, you reduce the risk of selecting participants who share similar characteristics, behaviors, or opinions, which can lead to a more balanced and unbiased sample.

Leverage Existing User Base

Your existing users are already familiar with your product or service, making them well-suited for certain types of research, such as usability testing or feedback on new features.

This familiarity can expedite the research process as participants require less time to get acquainted with the product.

Recruiting from your existing user base can be more cost-effective than sourcing participants from scratch.

You can save resources on advertising, incentives, and initial outreach because you already have a contact point.

Incentives provide a motivation for individuals to participate in your research. It compensates them for their time and effort, making them more willing to engage in your study.

Further, incentives can attract a more diverse group of participants. Without incentives, you may primarily get individuals who have a strong interest or a personal stake in your research, whereas incentives can help you reach a broader audience.

Pilot Testing

Pilot testing allows you to refine and improve your research materials, such as interview scripts, questionnaires, surveys, or usability test scenarios, before using them with the actual participants.

This can help ensure that your materials are clear, relevant, and effective in gathering the information you need.

The Key Methods to Recruit Eligible Participants for Research

Use your existing user base.

If you have an established user base, you can leverage your current customers or users as potential research participants. They are already familiar with your product or service, and this familiarity can lead to more in-depth and contextually relevant feedback.

Current users often have a vested interest in your product or service’s success. They are more likely to be engaged and motivated to participate in research activities, making it easier to gather valuable insights.

Focus on Email Lists

Use email marketing lists to reach out to your subscribers or customers who have expressed interest in research participation.

With email lists, you have direct access to the contact information of potential participants. This makes it easy to send invitations and reminders, streamlining the recruitment process. Further, sending emails is a cost-effective way to recruit participants. 

You can eliminate the need for third-party recruitment services, saving both time and money.

Turn to Social Media

Promote your research opportunities on social media platforms such as Facebook, Twitter, LinkedIn, or Instagram. You can use both organic posts and paid advertising to expand your reach.

Social media platforms have extensive user bases, allowing you to access a wide and diverse pool of potential participants. This is especially beneficial if you need participants from various demographics or locations.

Take Part in Online Communities and User Groups

Participate in or partner with relevant online communities, forums, and discussion groups where your target audience congregates. Engage with the community and request participation.

Also, many products or industries have user groups or associations. These groups can be a valuable resource for recruiting participants with a specific interest or expertise.

Leverage Professional Networks

Reach out to professional networks or associations related to your research domain. This is particularly useful for B2B research.

Professional networks are populated by individuals who are often well-qualified and experienced in specific industries or fields. This allows you to access a niche and knowledgeable pool of potential participants.

Participate in In-Person Events

Attend conferences, trade shows, or local meetups to recruit participants who are already engaged in your field.

In-person events allow you to meet potential participants face-to-face, establishing a personal connection that can lead to greater trust and willingness to participate in your research.

You can engage with event attendees in real time, providing an opportunity to explain the research process, answer questions, and address concerns immediately.

Reach Out to Customer Support Channels

Collaborate with customer support teams to identify users who have expressed an interest in providing feedback or participating in research.

Customer support channels typically have direct access to your existing customers, who are often willing to provide feedback and insights, making them valuable potential participants.

Users may already have a level of trust and familiarity with your customer support team. When these teams recommend your research, it can boost participants’ confidence in the legitimacy of your research efforts.

Conclusion – Recruiting Participants

The process of recruiting participants for research is a critical and often complex component of any study. Whether you’re conducting user research, academic research, or market research, finding the right participants is key to the success of your project.

Recruitment is not just about numbers; it’s about finding the right individuals whose insights and experiences will drive your research forward. It’s about building trust, respecting participants’ time, and ensuring ethical conduct throughout the process.

As you embark on your research journey, remember that each study may present unique challenges and opportunities. Flexibility, adaptability, and a commitment to continuous improvement are essential.

Your participants are the cornerstone of your research, and by following the guidelines in this guide, you’ll be better equipped to recruit the right individuals, gather valuable insights, and make informed decisions to drive your research projects to success.

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Recruiting Participants through Social Media

Social media provides a wide variety of mediums for researchers to connect with a broad pool of potential participants. this article contains a few tips to keep in mind about social media recruitment..

Participant recruitment includes any documents, media posts, or contact made with potential participants (or the legal guardian of potential participants) to inform them about a research study. Participant recruitment materials may include, but are not limited to, emails to listservs, social media posts and images, physical or digital flyers ,  presentations, and person-to-person contact. Participant recruitment materials should include at minimum: 

• the PI’s name and contact, 
• the institution’s name, 
• the IRB protocol number, 
• the purpose of the research and eligibility criteria, 
• a description of risks and benefits, 
• the time commitment and activities, 
• the amount of compensation, and criteria for earning the compensation.

For more information on required elements of participant recruitment materials, please review our Notes on Recruitment . All materials must be submitted to TC IRB for review prior to being used for participant recruitment. 

Revising Elements of Recruitment

TC IRB understands that some recruitment mediums may be limited by word or character count (e.g., Twitter posts). In these cases, the primary investigator (PI) or lab name, and the IRB protocol number must be included in the recruitment. Other information should be included as necessary. For example, “Education Research Lab is recruiting college students for a study (e.g., 22-123) on sleep and academic performance. DM us for more info (OR) click the link in bio for more info!” 

In other cases, researchers may wish to use multi-media for recruitment purposes, such as videos or images. For short form videos (e.g., TikTok) or images with limited text (e.g., Instagram post), researchers should follow a similar rule of thumb to Twitter, in that the PI name and IRB protocol number should be included in the media itself. Further information about the study should be included in the caption. Long form videos or flyers with texts must adhere to the minimum participant recruitment criteria. In order to allow the IRB to review recruitment videos, researchers can upload the video script or share a link to the video. Please alert the IRB reviewer if the video link will be deactivated after the study. Images or flyers should be uploaded directly to Mentor IRB.

Recruiting on Private Groups or Spaces 

Some online spaces (e.g., forums) may be visible to the public, but participation requires the user to meet certain criteria or have a specific role. These spaces are considered private spaces. This includes Facebook groups, subreddit, or forums in which an administrator confirms you meet inclusion criteria that allows you to be part of the group once terms of use are agreed to (e.g. “You must be a resident of Morningside Heights to be a part of this group”). If you are a part of a private group under a role separate from your researcher role (e.g., Morningside Heights resident), you may not be able to post your recruitment materials for research purposes unless you disclose your researcher status to the moderators and the group prior to posting. For private groups, it is always best to ensure you have full permission from the moderators to post as a researcher. In general, TC IRB recommends these three steps when looking to recruit in private digital spaces:

• Review the space's Terms of Use (TOU). If the TOU explicitly prohibit recruitment or research-related posts, you may not post.
• If the TOU do not explicitly prohibit recruitment, contact the moderators/administrators of the space and ask for permission to post or engage with the group as a researcher.
• When posting your research, announce yourself as a researcher to be clear of your role in the group.

Recruitment materials must be reviewed by the IRB during the initial protocol review. Researchers working with human subjects may not begin recruitment or research until they receive a final IRB approval letter. If you have questions about data security, please contact  TC Information Technologies.

— Kailee Kodama Muscente, Ed.M., M.A.

Published Tuesday, Aug 30, 2022

Institutional Review Board

Address: Russell Hall, Room 13

* Phone: 212-678-4105 * Email:   [email protected]

Appointments are available by request . Make sure to have your IRB protocol number (e.g., 19-011) available.  If you are unable to access any of the downloadable resources, please contact  OASID via email [email protected] .

Clinical Researcher

Getting Started with Using Social Media to Recruit Research Participants

Clinical Researcher April 14, 2020

Clinical Researcher—April 2020 (Volume 34, Issue 4)

SPECIAL FEATURE

Deaven A. Hough, MA; Elizabeth Flood-Grady, PhD, MS

Recruiting participants into research studies is one of the most difficult challenges we face as research professionals. The development of online tools, such as ResearchMatch and other participant-facing recruitment websites,{1} has enhanced research recruitment efforts. Study teams are also increasingly interested in using social media channels to bolster recruitment.{2}

At the University of Florida (UF), we’ve developed guidelines for recruitment on social media and launched a Facebook page, UF Studies , as a central channel for recruitment advertising and general information about study participation. We’ll give you a glimpse of these initiatives here, and we plan to present on this topic live through ACRP in the near future.

Creating Guidelines for UF Research-Study Teams

Despite the expansive reach of social media, there are generally limited directives regarding their use for study recruitment. In 2016, our institution identified the need for a coordinated approach to address privacy, information security, and other questions pertaining to institutional review board (IRB) submissions to enable researchers to use social media in an ethical and compliant way to recruit research participants.

Social media have generated a great deal of enthusiasm as recruitment tools, but simply planning to “post on social media” isn’t enough to effectively and ethically recruit participants. To harness the power of social media for study recruitment, UF’s Clinical and Translational Science Institute (CTSI) facilitated a committee and workgroup that endeavored to establish guidelines on how teams and institutions can ethically and effectively use social media channels for recruitment. Because multiple stakeholder groups are involved in the ethical recruitment of research participants and affected by social media recruitment decision-making, key stakeholders at the institution were involved in the development of guidelines from the beginning.

Dr. Elizabeth Flood-Grady presented a webinar featuring our process for identifying and engaging these stakeholders as part of the Trial Innovation Network (TIN) webinar series. You can watch the webinar here and download the slides here if desired.

Our guidelines emphasize:

• compliance with social media site terms of use;
• participant privacy, confidentiality, and data security; and
• procedures and considerations for using social media to recruit participants.

The guidelines focus on Facebook as the primary social media platform to recruit participants, due to the platform’s expansive reach and large base of users. Facebook, the leading social networking site worldwide, offers billions of users the unique opportunity to access and exchange health information,{3,4} including information about recruitment and participation in health research studies. Other social media channels are reviewed on a case-by-case basis.

We invite you to click here to read the full guidelines available on our website .

Facebook Advertising Through UF Studies

The UF CTSI’s Recruitment Center is funded by a Clinical and Translational Science Award from the National Center for Advancing Translational Sciences (NCATS) , and serves as a central resource for study teams interested in recruitment assistance. The UF guidelines incorporate the establishment of a central UF Studies Facebook page, which the CTSI Recruitment Center manages and uses to advertise studies at the request of UF researchers and to disseminate other relevant information about research and research participation.

The CTSI Recruitment Center provides no-cost consultations for research teams identifying and evaluating study recruitment methods, including Facebook, and creating comprehensive recruitment strategies for individual studies and grants. We conduct a feasibility assessment for teams interested in recruiting through Facebook paid advertising or Facebook groups and pages. The vast majority of our Facebook recruiting efforts use paid advertising campaigns. We create Facebook recruitment plans for IRB approval, launch IRB-approved plans, monitor campaign progress, and track metrics on recruitment. Here, we’ll use a case study on recruiting adults for a Type 2 diabetes study to demonstrate this process.

Case Study: Diabetes

This randomized study’s population is age 21–75 with Type 2 diabetes in the Gainesville, Fla. area. Exclusionary criteria include a diagnosis of Type 1 diabetes, drinking three or more alcoholic beverages a day, or diagnosis of Hepatitis B or C.

To see if Facebook would be a good fit for this study, we conduct a feasibility analysis in the ads manager function on Facebook. The ads manager is also where we eventually launch and monitor the campaigns. First, we select the target audience that we want to see the ads. Target audience is determined by selecting the targeting criteria, including location, age, gender, demographics, and any potential interests that are relevant to the population who will see study advertisements.

Click here to see Facebook’s infographic of all the areas teams can use to target participants . When we conduct a feasibility analysis, the goal is to have Facebook evaluate the audience as “defined,” and within the green section of the meter (as shown above).

Study teams cannot target prospective participants by health conditions. Instead, they can identify and target prospective participants by health condition–related interests.

For example, we cannot target individuals with Type 2 diabetes, but we can target by interests related to the “Diabetes Daily” or “Diabetes mellitus type 2 awareness” (as depicted below). We recommend turning to the Facebook Audience Insights tool to identify additional interests for your target audience.

With general interests about diabetes, it is likely that individuals with Type 1 diabetes, an exclusion criterium for this study, may also see the ads. That is why developing targeted ad content, which is explained in detail below, is incredibly important.

The CTSI Recruitment Center creates a recruitment plan for the study team which contains:

• the list of targeting criteria (i.e., location, age, gender, demographics, and any potential interests);
• ad content, including a variety of post text, headlines, and images; and
• a description and link for where the ads will direct users.

The above considerations combine to make up a Facebook ad (see below).

We create post text and headlines that are theoretically informed and based on previous successful Facebook advertising campaigns.

You can see in the ad we mention Type 2 diabetes in both the post text and the headline. Although adults with Type 1 diabetes may still see the ads, being as specific and targeted as possible in our ad content is an effective strategy for highlighting the relevance of the study to intended participants.

Images are selected from Shutterstock , as every Facebook ad manager has no-cost access to Shutterstock images.

The ad link should lead potential participants to more information about the study. Our Type 2 diabetes ad shown above links to a webpage with more information about the study. This webpage is what we refer to as a “study listing” that lives on our hospital’s website. The “study listing” is created by our CTSI Recruitment Center along with the Facebook plan with optimized content such as clear headlines and bulleted lists.

Linking the ads to study webpages with additional inclusion/exclusion criteria ensures the study team is not overwhelmed with requests from potential participants who would not qualify for study participation. In addition, by linking to a study listing on our hospital website, prospective participants see our health system logo and website URL and the study legitimacy is verified.{5,6}

Launching, Monitoring, and Tracking Campaigns

If the study team wishes to move forward with advertising its research on Facebook, we discuss the fees associated with using UF Studies and the CTSI Recruitment Center. Study teams are responsible for the cost of the campaign advertising and for CTSI Recruitment Center service fees associated with creating, launching, and monitoring the advertising campaign. The study team is also responsible for submitting all recruitment materials to the IRB for approval prior to launching a campaign on Facebook.

Once the study team has an IRB-approved plan, the CTSI Recruitment Center launches the advertising campaigns on the UF Studies Facebook page. Each campaign we launch on UF Studies allows us to learn more about recruiting participants using social platforms.

We won’t go into detail about the technicalities of launching the ads, but we do want to discuss monitoring Facebook ads. Let’s just say launching is the easy part.

Our guidelines address how to handle comments that reveal protected health information (PHI). For example, we had a Facebook user comment, “I am interested in the study, please call me at [phone number redacted]” and we hid the comment due to the reveal of the private information, even if it was self-disclosed.

The possibility of getting comments of this sort is very real, which is why having a plan in place to monitor, evaluate, and respond to comments is critical. Here at UF, we have a team that is available to help respond to or suggest deletion of comments.

In addition to monitoring comments, we track campaign metrics through Facebook’s ad manager function. This allows us to see how many clicks, people reached, and impressions the ad campaigns are receiving. We provide study teams with a weekly update on their campaign metrics and request data from them in return, including how many individuals contacted them because of the Facebook ads and how many participants they enrolled as a result.

Facebook Groups and Pages

Utilizing existing Facebook groups and pages is a good option for teams with a limited budget (it’s free) and if there is a specific disease condition where pages and support groups exist.

Although posting in groups and pages is free, there is no guarantee that the Facebook algorithm will display the post to the intended audience. Paid advertising allows us to track metrics such as clicks, reach, impressions, and budget. Posting to groups and pages does not allow for those analytics unless specifically requested from the group or page moderator.

For our Type 2 diabetes study, we searched for groups and pages that are relevant to the study population in the local area.

When searching for groups, we want to make sure we are being as specific as possible. Posting to bigger groups might at first seem like a good way to reach large numbers of people, but can result in queries and questions that are difficult to manage due to the sheer volume of the audience you are reaching. Study teams must submit a social media management plan for these posts to the IRB for approval; these plans must address not only how inquiries will be handled, but also how PHI posting will be addressed.

We do not recommend study teams join private groups. Instead, we suggest that the study team asks the Facebook page administrator to post on behalf of the study team. This not only protects the potential participants, but also relieves study teams from having to monitor comments and questions.

Results and Lessons Learned

So, does Facebook advertising work? We think so; since launching our UF Studies page in 2017, we have seen incredible growth in our page and paid advertising results (as of March 2020):

• 39 campaigns launched
• 39,000+ link clicks
• 868,000+ people reached
• 2,000,000+ impressions

Most importantly, nearly 1,800 participants have enrolled into studies at UF directly from paid UF Studies Facebook campaigns. Behavioral studies, particularly those requiring completion of an online survey, make up a large proportion of studies at UF. While some of our clinical trials are tough to recruit for and may not have any enrollments from Facebook, we still see a lot of engagement such as comments, likes, and shares from our ads.

As we move into 2020, we hope to understand a bit more about engagement on Facebook and just what sort of role it plays in recruitment. To date, our results demonstrate that Facebook advertising has incredible potential to enroll research participants, though a common concern is the ethics of this recruitment method.

When someone signs up for a social media platform, such as Facebook, they agree to the terms of use, but it is our responsibility to ensure that any use we make of the platform takes the rights and welfare of potential participants into full consideration. This is why we highly recommend institutions that are interested in using social media to recruit research participants take the time to understand the roles and responsibilities of different institutional offices (e.g., the IRB will review social media content) and research teams (e.g., teams must adhere to existing social media policies enforced at the site). This also includes the permissible channels, strategies, and mandatory information to include in a social media management plan.

Perhaps one of the biggest lessons we have learned is that there isn’t just one way to use social media—or even Facebook specifically—to recruit research participants. While other platforms have generated enthusiasm, we are continuing to evaluate our progress with Facebook groups, pages, and (of course) paid advertising. Having established relationships with your IRB, site communications team, and overall leadership is essential, as Dr. Flood-Grady describes in her TIN webinar .

While Facebook shows promise, running paid ads or posting in groups and pages is not an automatic “win” for recruitment. When a study team comes to the UF CTSI Recruitment Center and expresses interest in using Facebook, we recommend a wide variety of services through our consultations and feasibility analysis. Indeed, we often suggest that study teams combine Facebook advertising with other services, such as ResearchMatch, our hospital’s research registry, and our community engagement program, HealthStreet .

The UF CTSI offers a wide variety of resources to study teams across the university, specifically research services like our CTSI Recruitment Center . To strengthen our services, we work closely with the STEM Center for Translational Communication at the UF College of Journalism and Communications. Researchers and communications professionals from both groups work together to improve human health by incubating health communication research across disciplines and making scientific research more accessible, understandable, and usable.

As we continue to launch, monitor, and evaluate Facebook as a recruitment tool for research studies, we invite you to share your own social media recruitment experiences with us. We would love to collaborate with you and exchange information to ensure that study teams across the nation are using effective recruitment tools that are tailored to research participants.

• Flood-Grady E, Paige SR, Karimipour N, Harris PA, Cottler LB, Krieger JL. 2017. A content analysis of Clinical and Translational Science Award (CTSA) strategies for communicating about clinical research participation online. J Clin Transl Sci 1(6):340–51. doi:10.1017/cts.2018.2
• Topolovec-Vranic J, Natarajan K. 2016. The use of social media in recruitment for medical research studies: a scoping review. J Med Internet Res 18(11). doi:10.2196/jmir.5698
• Strekalova YA, Krieger JL. 2017. A picture really is worth a thousand words: public engagement with the National Cancer Institute on social media. J Cancer Ed 32(1):155–7. doi:10.1007/s13187-015-0901-5
• Strekalova YA, Krieger JL. 2017. Beyond words: amplification of cancer risk communication on social media. J Health Comm 22(10):849–57. doi:10.1080/10810730.2017.1367336
• Gulliver A, Griffiths KM, Christensen H. 2010. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10(1):113. doi:10.1186/1471-244X-10-113
• Sawyer DC, Lambert D. 2006. Rural and frontier mental and behavioral health care: barriers, effective policy strategies, best practices. National Association of Rural Mental Health (Waite Park, Minn.). doi:10.1037/e546002013-001

Deaven A. Hough, MA, is a Recruitment Specialist with the University of Florida Clinical and Translational Science Institute.

Elizabeth Flood-Grady, PhD, MS, is a Postdoctoral Associate at the University of Florida specializing in translational health communication, mixed methods, and dissemination.

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Barriers to Clinical Trial Enrollment: Focus on Underrepresented Populations

Using Simulation to Teach Research

An Approach to a Benefit-Risk Framework

• Open access
• Published: 15 October 2020

Does a video clip enhance recruitment into a parenting trial? Learnings from a study within a trial

• Holly C. Mattock 1   na1 ,
• Rachael Ryan 1   na1 ,
• Christine O’Farrelly 1 , 2 ,
• Daphne Babalis 3 &
• Paul G. Ramchandani 1 , 2 , 4  

Trials volume  21 , Article number:  856 ( 2020 ) Cite this article

1788 Accesses

5 Citations

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Metrics details

Reaching recruitment targets in randomised controlled trials is a challenge. Media tools are increasingly used to engage participants, yet there is a paucity of research into the use of video to optimise recruitment. We therefore tested whether adding a participant information video clip to a standard participant information sheet improved recruitment into a parenting trial.

One hundred seven participants were randomised to receive either a participant information sheet ( n  = 51) or an informational video clip ( n  = 56) as part of an email contact following a screening phase. All participants went on to receive the information sheet as part of the existing consent procedure.

The video condition did not increase the odds of recruitment into the trial, such that those in the video condition were significantly less likely to participate in the main trial (OR = 0.253, CI = 0.104–0.618, p  = 0.003).

The introduction of a video clip into the recruitment stages of a parenting trial did not lead to an improvement in recruitment; however, the small sample size precludes definitive inferences. We offer reflections on challenges encountered in implementing the SWAT and suggestions for other researchers seeking to embed recruitment SWATs into similar trials.

Trial registration

Current controlled trials ISRCTN 58327365 . Registered on 19 March 2015.

SWAT registration

SWAT 106; Effects of a video clip on recruitment into a randomised trial. Registered on 20 December 2016.

Peer Review reports

Randomised controlled trials (RCTs) are considered the gold standard in research design for evaluating interventions [ 1 , 2 ]. However, issues surrounding recruitment and retention are common, which often lead to delays, extra costs, protocol changes or the altogether abandonment of trials [ 3 ]. Poor or slow recruitment, whereby the target sample number is not reached within the anticipated timeframe, can lead to smaller sample sizes, which can give rise to sampling bias, limiting statistical power, and may increase the possibility of a type 2 error [ 4 , 5 ]. For example, within the UK, the National Institute for Health Research (NIHR) invests substantial funding in health intervention research; in 2014 and 2015, this amounted to £237.6 million, with a considerable proportion allocated to RCTs [ 6 ]. Yet in Raftery et al.’s [ 3 ] review of 125 NIHR-funded RCTs, the authors found that 43.1% of studies submitted a time extension request citing recruitment issues. Walters et al. [ 6 ] reported that only 56% of 151 studies conducted under NIHR funding in the UK between 2004 and 2016 reached their recruitment target. Due to the time, cost, and resource implications of recruitment issues, the identification of more effective recruitment methods has become a priority [ 7 , 8 ].

Study within a trial

A developing area of trial methodology, which can be used to investigate recruitment strategies, involves embedding a study within a trial (SWAT). SWATs are a means of evaluating methodology and formally assessing how effectively a study is running. Treweek and colleagues [ 9 ] defined a SWAT as a ‘self-contained study that has been embedded within a host trial with the aim of evaluating or exploring alternative ways of delivery or organising a particular trial process’ (p. 143). The experimental design of SWATs means they are valuable for testing hypotheses and investigating whether traditional approaches adopted historically can be refined or adapted as research practices evolve. As Shah points out in the paper by Gheorghiade et al. [ 10 ], it is ironic that we use trials to generate evidence-based treatments, whereas we rely largely on anecdotal approaches as to what we think works to inform their conduct, rather than developing empirical evidence to identify best practice.

The value of SWATs is increasingly being recognised, with several developments moving to raise their profile and encourage their routine use in RCTs [ 11 ]. These include online research platforms specifically designed to address recruitment and retention challenges within RCTs, such as Trials Forge [ 12 ] and Clinical triAls [ 13 ]. These online resources primarily aim to share knowledge from existing studies and build a platform to collate the findings and inform new hypotheses. Another initiative, the Prioritising Recruitment in Randomised Trials [PRioRiTy; 14 ] study has identified leading priorities concerning recruitment and retention into RCTs, using a priority setting partnership approach involving the public, carers and healthcare professionals. Amongst the ten leading questions identified were the need to identify how best to design and deliver information on RCTs to the public and the advantages and disadvantages of using technology during recruitment. This focus is timely as the dramatic influx of technology into everyday life provides opportunities to enhance practice using alternative media to present trial information in an efficient, interactive, and potentially low-cost way, for example through video clips, social media and/or informational websites.

Currently sharing an information sheet or form is the conventional format for providing study information to potential participants. Traditionally, this information sheet or participant information sheet (PIS) is a printed text document that aims to provide potential participants with comprehensive details of the study. These often become long and complex to ensure accordance with ethical guidance [ 15 ] and may not be visually appealing [ 16 ]. Previous research has shown that after receiving a PIS, participants may still not be fully informed, often failing to understand key aspects of the study, such as the right to withdraw [ 17 ] and potential side effects [ 18 ]. Thus, it is likely that the traditional PIS could be a barrier to study participation for certain demographic groups. In light of these potential limitations of the PIS, the Health Research Authority in the UK has advocated for the investigation of alternative media for participant material [ 19 ].

Indeed, there has been an increase in the use of multimedia implemented within trial design (e.g. websites, social media, audio and video clips). It has been suggested that video clips may be an acceptable means of promoting understanding of participation in RCTs with a small but growing number of studies assessing their utility. Meropol et al. [ 20 ] looked at the use of a web-based platform to explain key features of a cancer RCT and found that video clips (when compared to text) increased patient knowledge and decreased attitudinal barriers. However, a recent Cochrane review investigating recruitment strategies, which included the effects of video clips versus standard information in three oncology trials, found that there was insufficient evidence to draw conclusions about the effects of clips [ 21 ].

More recently, Jolly et al. [ 22 ] conducted a recruitment SWAT in a RCT for people with mild symptoms of chronic obstructive pulmonary disease to compare the use of a multimedia resource and standard PIS materials. The multimedia resource shared information about the RCT and included video clips of patients discussing their experiences of participation. No group differences in enrolment were found, although the authors suggested that the multimedia format may not have been best matched to the information preferences of the participants (largely men over 70 years) and may be better suited to populations with higher general consumption of multimedia. Related to this, the TRECA study (Trials Engagement in Children and Adolescents) [ 23 ] has conducted user testing to explore the use of a multimedia platform in healthcare trials with children, adolescents and their parents [ 24 ]. Participants commented positively about the interactive resource, with varied preferences of information medium; some preferred animations and video clips whereas others preferred text. These resources are due to be embedded and tested in six healthcare trials.

Research using SWATs to investigate the use of multimedia in recruitment processes could identify more effective and efficient recruitment methods in RCTs. As the utility of multimedia may differ depending on the target group, there is a need to investigate its inclusion during recruitment of diverse patient and public populations. SWATs themselves create a vital opportunity to evaluate methodology in real world trials; however, reporting of SWATs remains limited. Through sharing the challenges faced and the key learning points from the present study, we hope to provide information to help support the routine inclusion of SWATs in RCTs.

This study aimed to use a SWAT to explore whether the inclusion of a video clip alongside a standard PIS improved the rate of recruitment, compared to a standard PIS alone. We further aimed to report our experience of embedding a SWAT during an active RCT and the challenges encountered, and offer reflections for consideration by other researchers.

The host trial—Healthy Start, Happy Start

The present SWAT is hosted by the Healthy Start, Happy Start (HS,HS) study. The HS,HS study is a UK-based RCT funded by the NIHR. HS,HS aims to assess the effectiveness and cost-effectiveness of a Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in preventing enduring behavioural problems in young children aged 12–36 months (see Ramchandani et al. [ 25 ] for further details of the protocol).

Eligibility for HS,HS

Participants for HS,HS were recruited predominantly through health visiting services in 6 National Health Service (NHS) trusts, via face to face contact and mailshots. The eligibility criteria for HS,HS included parents aged ≥ 18 years, child aged between approximately 12 and 36 months, a score in the top 20% on population norms for child behaviour problems using the Strengths and Difficulties Questionnaire (SDQ; Goodman [ 26 ]) and written informed consent. Exclusion criteria included if the child or parent had a severe sensory impairment, learning disability or language limitation which is sufficient to preclude participation in the trial; were actively participating in family court proceedings; if the parent was participating in a closely related research trial; and/or if the families were concurrently receiving an individual video-feedback intervention.

Study within a trial rationale

As is the case in many RCTs, recruitment for the HS,HS trial was initially slow, and therefore, an extension was granted for 9 months to enable the target sample size to be met. The HS,HS trial encountered challenges to recruitment in part due to changes to local health visiting services and NHS service provision which impeded the availability of staff time to support face-to-face recruitment. Consequently, the trial increasingly utilised mailshots to reach potential participants. These challenges also stimulated a dialogue surrounding alternative methods to optimise families’ initial engagement in the study and the recruitment process. We had previously revised the PIS to improve its readability and added a randomisation schematic to aid understanding. However, we were constrained by the PIS’s traditional text-based format, ethical requirements concerning the level of detail and topics requiring standardised institutional wording. Thus, we were interested in determining whether adding a short video clip to the PIS could be more appealing, help to personalise the research by introducing the research team and provide sufficient initial information to increase families’ engagement with the recruitment process. Also, as the intervention under study in the HS,HS trial used video clips of parents’ behaviour to enhance parenting, the clip could help to normalise the experience of being on camera. To explore this idea further the team decided to implement a SWAT 8 months into recruitment, after approval was sought through a substantial amendment. The SWAT sought to compare the effect of a video clip and PIS, to the PIS alone, on recruitment and to learn from both participant and researcher feedback, as well as reflecting on the process of embedding a SWAT in an active RCT.

Video development

The HS,HS study had an active patient and public involvement (PPI) group that were involved in all aspects of the trial and were also consulted during video clip development. An indicative draft of the video was made by the research team and a dedicated PPI meeting was held to discuss the video. The group’s suggestions shaped the contents and design of the clip, which included adding an explanation of why the study is relevant for the population, highlighting the importance of research within the NHS, timing visual animation effects to match the voice over, what actors should demonstrate in terms of family participation and the inclusion of both senior (e.g. chief investigator) and junior staff (e.g. research assistants completing the research visits) in the video. Following these suggestions, a final version of the video was designed. A member of the PPI group and their family featured in the video to help explain what would be involved in the research visits. The video included a welcome by the chief investigator, outlined what would be involved in each trial arm and introduced the research assistants who would be conducting the home-based research visits. The duration of the video totalled 302 s (5 min).

The development of the video required approximately 60 h of research assistant time. Video props and technological equipment were purchased for £250 and the actor family in the video was given a £50 honorarium for taking part. Both the video producer and graphic designer worked at a significantly reduced rate due to the nature of the research and were each given a £200 honorarium. An alternate quote for video production was £750. Costs for the PPI group consultation were approximately £350. The six attendees were provided with £50 vouchers as compensation for their meeting attendance, email contact and feedback about the design and content of the video, and approximately £50 spent on refreshments at the meeting. The total estimated costs for the development of the video are £1000 (not including researcher time).

PIS development

The PIS comprised of a 4-page word document structured in headed paragraphs describing the HS,HS study. The PIS included information on why participants had been asked to take part, the possible benefits and disadvantages of participation, confidentiality, information security, information about the funders and contact details of the principal investigator and trial manager. The PIS was amended during the trial phase of HS,HS to enhance understanding and readability following informal feedback from trial participants. Two schematics were included to illustrate the possible randomisation allocations to improve understanding of group allocation.

SWAT eligibility and implementation

The SWAT ran for 15 weeks between March and July 2017 until recruitment to the trial ended. Once eligibility for the trial phase of HS,HS was confirmed, participants were assessed for inclusion into the SWAT sample. The additional eligibility criteria required for SWAT inclusion was that participants needed to provide a valid email address. For example, those participants who only provided a telephone number as contact details were excluded. All participants who were invited into the trial during this time period were assessed for eligibility for the SWAT. Participants who were already participating in the HS,HS trial could not be included in the SWAT. See Fig.  1 for information about how participants were contacted.

SWAT participant contacts

Participants were randomly allocated to receive one of two initial contacts from the research team: video and PIS or PIS alone. For ease of understanding the video and PIS group will be referred to as the ‘video group’ and the PIS only group will be referred to as the ‘PIS group’ hereafter. A randomisation list for the initial contact was prepared by the trial statistician, and allocation was released weekly to the research team. Each participant was allocated to their condition based on the week they returned their screening questionnaire. The research team were not blinded to group allocation.

The initial randomised contact took place after participants completed the screening phase. Participants were sent an initial email thanking them for completing screening and informing them that a member of the research team would be in touch by phone within a couple of days. The email sent to both groups was identical except that the video group’s message included a link to the video clip, whereas the PIS group only had the trial’s standard PIS attached. Once a minimum of 24 h had passed, the research team called participants to ascertain their interest in participating in the full trial. Follow-up involved telephone call(s) and/or email(s) until contact was made.

The contacts were spread over approximately 4–6 weeks, and there was a mean of 2.7 contacts per participant during this time frame (range 0–15). If contact was established with the participant, the study was explained by a member of the research team and they were then sent an email with the PIS attached, irrespective of group allocation, to ensure this did not affect the provision of the standard PIS to all participants at the time of booking a first research visit.

Participants who were randomised into HS,HS during the SWAT period were then asked a few questions at the end of their first research visit. The aim of these questions was to ascertain feedback about their experience of receiving either the PIS or video clip, whether it affected their decision to take part in the study and how useful they found it (Additional file  1 : Appendix 1). Two members of the research team who were responsible for contacting prospective participants during recruitment were also asked about their experience at the end of the SWAT including the ease of implementing the SWAT and their perception of how it influenced participant understanding (Additional file 1 : Appendix 2).

Analysis strategy

The primary outcome of interest was the proportion of participants who consented to take part in the main trial based upon their SWAT allocation. Therefore, a binary logistic regression was used to examine the main effect of SWAT allocation (video vs PIS) on the number of participants recruited into the trial (randomised vs not randomised). Despite randomisation, more participants in the PIS group (63%) were screened in person in comparison to other methods whereas only 40% of participants in the video clip condition were screened in person. Differences were identified between the groups in regard to baseline characteristics in education and number of contacts made by the team. Therefore, the regression was repeated to adjust for number of contacts made and education status. Educational status was defined in two levels (university and pre-university qualifications) and number of contacts made by the team was continuous. Findings were presented using odds ratios (OR), and 95% confidence intervals (CI) were calculated to compare intervention strategy on recruitment.

A secondary outcome of interest was participant and researcher attitudes towards method of recruitment via brief structured interviews. Our goal was to invite all SWAT participants to participate in an interview; therefore, data saturation was not used to inform data collection. However, due to time demands in research assessments, it was not possible to interview all SWAT participants. Where interview data were available, content analysis was used to analyse the text [ 27 ]. However, formal comparisons between the groups were not conducted on frequency of categories, due to the small sample size and differences in group sizes, video ( n  = 5) and PIS ( n  = 12), which increased the risk of bias.

Participants

During the SWAT period, 317 potential HS,HS participants were screened, of whom 121 were eligible for the HS,HS trial, and of these, 107 were eligible to be included in the SWAT sample. Fourteen participants were excluded as they had not provided an email address. Of the 107 participants, most were identified as ‘White’ (79%), biological mothers (93%) and educated to postgraduate level (47%). The mean parent age was 33.59 years ( N  = 105, SD  = 5.4), and the mean child age was 21.9 months ( SD  = 0.5); slightly more male than female children participated (58% vs. 41%). Table  1 displays the participants’ demographic characteristics.

The final sample consisted of 101 participants (50 randomised to video and 51 randomised to PIS condition). There were initially 56 participants allocated to the video condition; however, 6 were then excluded from analysis as they were inadvertently allocated to the wrong group. Figure  2 shows the flow of participants through the study.

Participant flow through the study within a trial. a Due to researcher error in the context of the busy trial, 6 families were contacted using the incorrect allocation. These participants were excluded from formal analyses

Primary outcome

Of the 50 participants given the video clip, 10 (20%) consented to take part in the trial, compared with 26 (51%) of 51 participants given information only via the traditional PIS. The difference was 26%. Table  2 shows that the odds of consenting to the trial were 76% less in video group than in the traditional PIS group (OR 0.240, 95% CI 0.099–0.582). The OR was not significantly influenced by frequency of contact or by educational attainment (OR 0.253, CI: 0.104–0.618, p  = 0.003). Thus, the odds of consenting to the trial were statistically lower in the video group compared to the standard PIS group.

Video clip engagement data

The video was emailed to 50 prospective participant email accounts. Access to online metadata from the host website revealed that the link was accessed 38 times, and of these, 16 watched the entirety of the video clip. The average length of play was 190 s (of a possible 302 s).

Qualitative feedback

Whilst the initial aim was to gain feedback from all SWAT participants who were randomised ( n  = 36), for practical reasons (e.g. time demands of the assessment) and the importance of not overburdening participants, 17 participants were invited to interview. All 17 participants who were approached agreed to interview (5 video, 12 PIS). Baseline demographics of interviewed participants are displayed in Table 1 .

Irrespective of condition, all participants commented positively on how useful they found the introductory information. Participants from both groups commented that the information was easy to understand and that it was informative:

“I did find it helpful to watch it and thought that it gave quite a lot of information”. (video clip)

“it was well explained”. (PIS)

However, participants within both groups stated that they had further questions that needed discussing over the phone.

One PIS participant commented: “I think I needed a few things explained”.

And one video clip participant indicated “I think I got more from actually chatting and asking questions that the actual video clip itself”.

The participants in the video group tended to frame the material as introductory, whilst those in the PIS described the material as comprehensive.

The key finding from both researcher interviews was the shared perception that the initial email contact increased participants’ receptivity to the study team and engagement in the trial. Prior to the SWAT being implemented, participants were first contacted by telephone after completing the screening questionnaire. Notably, both researchers reported that participants, regardless of condition, were more open to phone calls after receiving an initial email.

“I noticed a difference in how receptive they were just to our phone call [erm] because they’d had a chance -whatever they’d received they’d had the chance to consider the study a bit more”.

Both researchers found that participants had often not watched the video clip or only viewed a portion of it, although those who had viewed it were reported as having a better understanding of randomisation:

“they all commented on the understanding of the two groups”.

“that was the hardest thing to explain to participants without a visual aid, over the phone I think it was helpful that they had seen those two groups”.

The researchers also highlighted the advantage of participants seeing images of the research team and activities in the video clip:

“I think for the families who had seen it I think that was really reassuring that it’s like ‘look we’re these harmless people who are coming to play with some toys and ask some simple questions’ it’s not this weird abstract visit that has no context”.

Contrary to our expectations, the inclusion of a video during recruitment did not result in an improvement in recruitment rates in this RCT of a parenting intervention. However, the interpretation of the results should be made cautiously given the small sample size and the exploratory nature of the study. This finding is consistent with both the findings of Jolly et al. [ 22 ] and Campbell et al. [ 28 ]. Campbell et al. [ 28 ] simulated recruitment of parents from low-income backgrounds and found no difference in rates of agreement to enrol when comparing various formats of consent including text, narrated video clips and PowerPoint presentations. Participants reported no greater preference for video clip over text, although when accounting for educational attainment, those who read at an 8th grade level or below did show improved comprehension for an enhanced text version of the information sheet. However, interestingly even though the preference was specified, there were no differences seen in rates of enrolment. Thus, it is possible that media such as a video may be beneficial in enhancing understanding of research participation, without that understanding necessarily translating into increased recruitment. Indeed, it is conceivable that enhanced understanding of what research participation involves may lead fewer participants to enrol, if, for example, the demands of participation exceed the time participants may be able to commit to the study.

Moreover, participants included in this SWAT were generally highly educated, particularly in those interviewed, and so have an assumed higher reading level. Therefore, it would be plausible that the enhanced PIS used was accessible and understandable. By extension, the video may not have had as much impact on understanding within this population, compared to a potential participant population who have a lower reading ability or based on previous research [ 28 ]. Equally this may have been a matter of preference, which may explain the low number of views of the video. One parent specified they were unable to watch the video without headphones in case of waking their child and would have therefore preferred a PIS.

Another possible explanation for these findings may be linked to the format and use of the video clip. The metadata indicated that only one third watched the clip in full, assuming no participant watched it twice. Although studies on patient engagement with clips do not typically report metadata, research on the use of educational videos in the context of distance learning has found that the rate of in-video dropout is positively correlated with video duration, with a predicted drop-out rate of 53% for a 5-min video [ 29 ]. Thus, it may be instructive to examine whether a shorter clip is more beneficial. It is also possible that tailored videos that provide content that can be selected based on participants’ questions such as in Meropol et al.’s [ 20 ] study may be more effective than general videos. Additionally, it is possible that video is least accessible to those who stand to benefit most, if socioeconomic factors linked to literacy are also associated with more limited access to smartphone models, data plans, and/or availability of a computer in the home.

An unexpected, but notable finding came from the researcher experience which suggested that email contact prior to the recruitment phone call, regardless of group allocation, helped promote participants’ engagement with the study. This finding is contrary to the Cochrane Review by Mapstone et al. [ 30 ] who reported that pre-warning participants was not beneficial to enrolment, examining methods including sending a letter a week before [ 31 ], a postcard prior to sending a questionnaire [ 32 ] and leaving a voicemail [ 33 ]. However, none of these studies investigated the use of email to pre-warn participants, and our finding may be attributed to a shift in type of contact preference towards email. Specifically, as Samuels et al. [ 34 ] found that when asking subjects how they would like to be contacted for future research studies 58% opted for an email whereas only 16% opted for a phone call.

Challenges, limitations and reflections on SWAT

We encountered a number of challenges in implementing the SWAT during an active RCT.

Whilst it is an advantage that the SWAT was responsive to recruitment challenges as they arose, the timeframe to implement the study significantly undermined the amount of data that could be collected. From initial idea to implementing the SWAT, the entire process took 13 months leaving just 4 months of data collection. This involved collaboration with the PPI group, submitting a substantial ethics amendment, creating the video clip and gaining local approvals from each of the trial sites. Thus, the sample size was small and this limited inferences that could be gleaned from the study. Future research would benefit from including SWAT procedure in the original ethics application and holding PPI consultations in the first instance to avoid delays. Indeed, in the UK, the NIHR Health Technology Assessment (HTA) programme now encourages the inclusion of SWAT protocols in funding proposals for host trials. To this end, the SWAT template provided by Smith et al. [ 35 ] may provide a helpful template that can be referenced as part of the host trial’s protocol. This would allow the opportunity to monitor the effectiveness of recruitment strategies from the start and for trials to determine the relative benefits of different strategies. However, there are also likely to be cases when SWATs will provide opportunities to test innovations that respond to unexpected challenges as they arise. Thus, efforts to increase the efficiency of ethical review and local approvals may be crucial to realising the benefit of SWATs.

The SWAT also added time into the recruitment process and an additional step, an email contact, that had not been completed previously. This had the effect of a cumulative increase in workloads in the context of demanding recruitment targets and deadlines. Combined with the randomisation allocation which changed weekly, this may have increased the likelihood of human error. This can be seen in the randomisation phase where six participants were contacted with the incorrect study allocation. Embedding the SWAT at the beginning of the trial could provide further time for training; alternatively, automating aspects of the recruitment process could also minimise the scope for human error.

It was difficult to control for a number of extraneous factors. For example, the number of contacts was conflated by the temporal factor of recruitment deadlines, such that the frequency of contacts increased in line with monthly deadlines. Ideally, the number of times the study team contacted participants would be standardised; however, this is not practical in the context of target-driven recruitment. Similarly, it was difficult to prioritise the interviews with participants about their SWAT experience at the risk of overburdening participants and without undermining the time allocated to outcome assessment. Thus, less interview data were collected than expected, particularly in the video condition, and this may have limited insight. Moreover, whilst participants were generally positive about the information they received through the SWAT, it would have been helpful to find out why they may not have watched the full duration of the video. Due to the limited sample size, we were unable to control for the initial contact type participants received during screening. For example, potential participants either completed screening in person with a member of the wider team or received questionnaires in the post. Whilst these were not notably different between groups, further research may benefit from controlling for extraneous factors of this nature. Moreover, participants were highly educated and often women; it is difficult to generalise these findings to other types of participants who may have different experiences which would influence their engagement with written material or video content.

The optimal design would be to test the video clip in isolation against the PIS to identify effects on recruitment. However, due to ethics requirements, participants had to receive the PIS prior to the baseline visit limiting our ability to formally test the video on recruitment. In a time of increased use of multimedia, it would be instructive to formally test whether there are complete alternatives to standard PIS that may be more acceptable and effective whilst being ethically robust. We were also unable to gain feedback from families that may have viewed the initial information but not enrolled in the study, which limits our understanding of participants’ reasons for not engaging with the study.

Implications for recruitment practice

Although somewhat contrary to our expectations, it was encouraging that the PIS appeared to be effective for this sample. Moreover, participants and researchers perceived an initial email contact, regardless of whether it included the PIS or video, as being helpful. This suggests that initial contacts of this kind may be helpful in facilitating initial conversations about research as well as decision making about taking part. It would be helpful to test this formally using a SWAT design in future studies.

Future research may be focused on testing the effectiveness of a video clip as an initial recruitment contact rather than following a screening phase. Moreover, it would add value to evaluate this recruitment method in different demographic populations (e.g. those with lower literacy, children and young people, those with intellectual disabilities) in order to better ascertain utility. The inclusion of data regarding participants’ engagement with a PIS would also be helpful to identify potential areas for improvement and general levels of engagement.

We found involvement with our PPI group extremely helpful in developing the video and SWAT study. We strongly recommend that other researchers involve PPI groups when developing patient facing materials and designing trial procedures. The video may have benefited from several rounds of user testing to optimise its potential; however, due to timeframes and potential burden on the PPI group, this was not possible on this occasion.

Future research could consider whether videos may be particularly helpful for specific groups, better utilised in shorter (e.g. 30 s) formats addressing specific topics (e.g. randomisation), or as a supplementary material after participants have read the PIS. It would also be of interest to examine the impact of either formats on participant retention.

Conclusions

The inclusion of a video clip explaining the trial did not result in an increase in recruitment to the host trial of a parenting intervention. Future research could consider a shorter video clip and explore its effectiveness in different populations alongside collaboration with a PPI group.

Availability of data and materials

The de-identified data included in the paper will be available 12 months following publication and for 5 years after the date of publication. Data will be made available to researchers who provide a methodologically sound and hypothesis-driven proposal and have the required institutional approvals in place to achieve the aims in the approved proposal. To gain access to the data, proposals should be directed to Professor Paul Ramchandani for approval by the investigator group. Requestors will be asked to sign a data access agreement. The study protocol and consent form will also be made available.

Abbreviations

Healthy Start, Happy Start

National Institute for Health Research

National Health Service

Patient and public involvement

Participant information sheet

Randomised controlled trial

Video-feedback intervention to promote Positive Parenting and Sensitive Discipline

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Acknowledgements

We would like to thank the Healthy Start, Happy Start Patient and Public Involvement Group, Christopher Moores, and Jonas Grimås for their contributions to the design and production of the Participant Information Clip. We are grateful to the families who took part in the study and the study’s funders. We are thankful to Hilary Watt for her help in generating the randomisation list and to the Healthy Start, Happy Start research team, with special mention to Beth Barker and Ellen Grimås for their contributions to the study and data collection.

This study was supported by the National Institute for Health Research Imperial Biomedical Research Centre and Imperial Clinical Trials Unit based at Imperial College Healthcare NHS Trust and Imperial College London. The Healthy Start, Happy Start study is funded by the National Institute for Health Research Health Technology Assessment Programme (Grant Reference Number 13/04/33). The views expressed are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

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Holly C. Mattock and Rachael Ryan contributed equally to this work.

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Centre for Psychiatry, Imperial College London, London, UK

Holly C. Mattock, Rachael Ryan, Christine O’Farrelly & Paul G. Ramchandani

PEDAL Research Centre, Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, UK

Christine O’Farrelly & Paul G. Ramchandani

Imperial Clinical Trials Unit, Imperial College London, London, UK

Daphne Babalis

Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK

Paul G. Ramchandani

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RR, COF, DB and PR designed the embedded study and were involved in the delivery of the intervention. HM, COF and RR were major contributors for writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Paul G. Ramchandani .

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This study was embedded within the Healthy Start, Happy Start trial which was pre-registered ISRCTN58327365 and received ethical approval from the NHS London - Riverside Research Ethics Committee (Ref no: 14/LO/2071). The embedded study received ethical approval as a substantial amendment (dated 13 January 2017) to the trial.

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Additional file 1: appendix 1..

Interview schedule for participants. Appendix 2. Interview schedule for researchers.

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Mattock, H.C., Ryan, R., O’Farrelly, C. et al. Does a video clip enhance recruitment into a parenting trial? Learnings from a study within a trial. Trials 21 , 856 (2020). https://doi.org/10.1186/s13063-020-04779-0

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YouTube as a Recruitment Tool? A Reflection on Using Video to Recruit Research Participants

Profiling emerging research innovations.

This article presents an innovative, video-based approach to the recruitment of research participants. A YouTube video was created and uploaded as part of a doctoral study exploring what it means to be struggling as a teacher. Following a review of the recruitment literature, which highlights a general lack of attention paid to the challenges of recruitment, the author explores the approach she took in planning the video. The video was the main promotional tool for the study and was communicated via Twitter and email. She also presents online survey findings on the perceived impact and influence of the video; the visual format, informal tone and the ability to see the researcher in person were rated very positively. A reflective analysis of the video transcript follows drawing on the literature as well as the survey findings. She concludes that video-based recruitment can be an inexpensive but powerful tool which allows a human connection with the researcher early on in the research process.

Suzanne Culshaw’s article comprises a video, which can be viewed here (and here ).

Citation: Video Journal of Education and Pedagogy 5, 1 (2020) ; 10.1163/23644583-00501004

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This article is part of the special topic ‘Profiling Emerging Research Innovations’, edited by Elaine Khoo.

• 1 Introduction

This article presents an innovative recruitment strategy used in a doctoral study. I wanted to recruit educators working in the English secondary school system to participate in research interviews and who would be prepared to share with me their experiences of struggling as a teacher. The research question – what it feels like to be struggling as a teacher – required a particularly sensitive research design. I was keen to come across to potential participants as both approachable and compassionate and felt that a more personal approach to recruitment was required. I wanted to establish a personal connection with potential participants early on in the research process. To this end, I created and uploaded a short YouTube video.

My research found that struggling – as a teacher – is experienced as a temporary, fractured state. Dimensions of struggling include heightened bodily symptoms and it is associated with negative moods and emotions. Struggling can also involve a damaged self-view, a reduced sense of controllability and may lead to impaired performance ( Culshaw, 2019a ). I adopted an innovative approach, not just for the recruitment of participants, but in terms of the research methodology generally. I used an arts-based method, collage, to explore what it means to be struggling and participants expressed their experience of struggling by placing and moving a range of arts and crafts materials as their thinking developed. I have written elsewhere about the power of collage as a research method ( Culshaw, 2019b ).

In this article I present first a short review of a specific section of the recruitment literature, which I position within the context of the research design for this study. Then I outline the recruitment approach I adopted. I provide a forensic exploration of the specific method I used – a YouTube video – and reflect on its merits as a recruitment tool drawing on survey feedback. I close with an outline of the possible limitations of using this method and suggestions for further research.

• 2 Recruitment of Participants: the Literature

I undertook a search of the recruitment of research participants literature in Google scholar, with a specific focus on the use of video, the internet and social media in the recruitment of participants. Search terms included:

promoting research participation online participant recruitment challenges (teachers) recruiting participants online YouTube recruiting participants video

A review of abstracts led me to rejecting several publications from the review process, as their focus was more on the use of social media for data collection purposes rather than the recruitment of participants. The search yielded 15 results for review, from a range of disciplines including medical education, psychiatry, social research methodology and occupational rehabilitation. The recruitment literature reviewed here included four systematic reviews. This article adds to that literature and makes a contribution to recruitment methodology generally, and in educational research more specifically. A list of the 15 reviewed publications is included in the Appendix.

Recruitment in research is defined as the dialogue which takes place between an investigator and a potential participant, prior to the initiation of the consent process ( Kaba & Beran, 2014 ; Patel, Doku & Tennakoon, 2003 ). It is essential to consider a recruitment methodology when designing a research project as the methods used influence the success of the research (Derrick, Elsieo-Jaye, Hanny, Britton & Haddad, 2017). In many cases, multiple – rather than single – recruitment strategies are used (e.g. Ibrahim & Sidani, 2014 ; Luck, Chok & Wilkes, 2017 ). Some suggest (e.g. Kaba & Beran, 2014 ; Patel et al., 2003 ) that recruitment is the most challenging aspect of any study and yet it is a key determinant of the results ( Kaba & Beran, 2014 ). Others bemoan the lack of attention given to recruitment in the literature (e.g. Lysaght, Kranenburg, Armstrong & Krupa, 2016 ; Nasser, Grady & Balke, 2011 ). Few authors have “dissected their studies” ( Luck et al., 2017 , p. 44) to review their recruitment strategies and it is not always clear how researchers accessed potential participants. Recruitment is not adequately or widely reported in many research publications as I found when searching the literature for this article. Kaba and Beran (2014 , p. 578) state that “researchers often spend less than a few sentences summarising access to the sample”.

Details highlighting the processes used to engage participants often remain unclear ( Lysaght et al., 2016 ). Guidance and tips (e.g. Kaba & Beran, 2014 ) are thin on the ground despite an appeal from Lysaght et al. for light to be shone on the specifics of recruitment to “enhance methodological transparency and inform practice” (2016, p. 136). Innovative strategies have the potential to engage participants’ attention ( Kaba & Beran, 2014 ) yet even less attention has been given to developing such methods ( Nasser et al., 2011 ). Rife et al. suggest that social media (in this case Facebook) are a “promising new (recruitment) space for social scientists” (2016, p. 80). In their systematic review, Whitaker et al. (2017 ) found that Facebook as a recruitment method was faster and cheaper and had the potential to improve participant selection in harder-to-reach demographics. However, only one publication (Khatri, Chapman, Glasbey, Kelly & Nepogodiev, 2015) adopted the approach I took, i.e. a purpose-made YouTube video – which they reported as a “novel feature of the study” (p. 7) – as part of their recruitment strategy. In summary, then, there is a paucity of literature ( Khatri et al., 2015 ) on recruitment and insufficient methodological attention ( Kaba & Beran, 2014 ) has been paid to the challenges, opportunities and practicalities of different recruitment approaches.

Consideration of an appropriate recruitment strategy for my study was part of the wider research design process which took into account the particularly sensitive nature of the research question. Research which delves into deeply personal experiences can be stressful for the participant and the researcher ( Dickson-Swift, James, Liamputtong, 2008 ; Lee & Renzetti, 1993 ). Sensitive research topics can deepen the emotional connection between the researcher and participant, as both co-construct the narrative history (e.g. Fahie, 2014 ). It was clear to me that I would need to establish a trustful relationship and rapport with potential participants from the outset. Video can be one step in establishing trust, as participants get to see the researcher and get a sense of their sincerity, credibility and enthusiasm ( Hendrickson, 2007 ). Hendrickson (2007 ) also describes how video can be used for promoting studies, recruiting participants and gaining consent, but suggests that video-based recruitment methods are generally difficult to evaluate, rarely utilised and/or underreported.

Integrity is a key element of the research process and a vital characteristic of the researcher; clearly, the application for ethics approval for this study had to consider the sensitive nature of the research topic and assess the risk of potential harm to participants. Confidentiality and anonymity were particularly pertinent as was my duty of care to participants; I provided details of external, professional support at all interviews with participants. The ethics application process was underpinned by guidelines set out by the British Educational Research Association ( BERA , 2011 ) and approved by the relevant ethics committee at my university.

In the section below, I describe the approach I adopted when recruiting participants for a study exploring what it means to be struggling as a teacher.

• 3 Recruitment Strategy: an Approach Using YouTube

Recruiting teachers who would be prepared and able to talk about their experience of struggling had the potential to be difficult but was central to the success of this research. Careful consideration had to be given to the approach I took, how I worded any recruitment documentation and, more practically, how I would access potential participants. Gaining access to the sample population is a key consideration ( Kaba & Beran, 2014 ) once the inclusion and exclusion criteria for participation have been decided ( Patel et al., 2003 ).

Establishing a rapport with the participants was always going to be crucial and potential participants needed to be able to relate to the person they would be opening up to. Being amenable and approachable are dimensions of having good interpersonal skills and are some of the key attributes highlighted as important in the literature (e.g. Kaba & Beran, 2014 ; Patel et al., 2003 ). Non-verbal cues and affect-based messages are also more likely to attract potential participants ( Kraichy & Chapman, 2014 ). Researcher credibility is also mentioned as essential as it influences people’s willingness to participate ( Hendrickson, 2007 ; Lysaght et al., 2016 ). Kaba and Beran suggest that introductions are best made “in person” (2014, p. 582) and researchers should not underestimate the “personal touch” ( Luck et al., 2017 , p. 44). Kaba and Beran also suggest that if the researcher has “excellent networking skills” they should “use this strength” (2014, p. 583). It is, however, important to remain mindful of ethical considerations and the possibility of pressurising potential participants into taking part ( Luck et al., 2017 ).

Taking this into account, I created a short recruitment video which I posted on YouTube and shared on social media, mainly through my Twitter account and my blogsite. The video lasted three minutes and showed me in my office holding a cup of tea, talking about the rationale for my study and the kind of teachers I was hoping to attract. My main reason for posting the video was to be seen as approachable, credible and sensitive. I also liked that it was a way to provide a consistent presentation ( Hendrickson, 2007 ) of a “standardised message” to all potential participants ( Khatri et al., 2015 , p. 7). I hoped viewers would sense that we shared a similar background and professional concerns ( Caldwell et al., 2010 ; Ibrahim & Sidani, 2014 ; Luck et al., 2017 ). The video attracted about 100 views within two weeks of being posted and a number of participants mentioned that they had watched it. I subsequently conducted a separate survey to elicit feedback about the merits of this particular approach to recruitment. Results of the survey are presented below.

The only other study I was familiar with which used a purpose-made YouTube video is a 2015 clinical study targeting medical students. It combined the use of YouTube, Twitter, Facebook and a website to recruit participants for a “national, multicentre cohort study” in England ( Khatri et al., 2015 , p. 3). The research team created an introductory, narrated, step-by-step video to explain the project and protocol to potential participants. A link to the registration form was placed in the comments section. The video was 7:53 minutes long and is no longer available for viewing. This was a large-scale project in comparison to my study and involved a team of researchers. Similar to that project, however, I found this approach “easy and intuitive to use… as it provides an accessible medium by which to distribute” ( Khatri et al., 2015 , p. 7) information about the study. It was also “far less time intense” than other possible approaches ( Khatri et al., 2015 , p. 7).

My video was the main promotional tool; the main channel of communication to potential participants was via emails to secondary schools I know within about 40 miles of where I live. The text of the emails included a link to the YouTube video. Information for research participants can often look academic and professional but the text can be difficult to read ( Haynes, Chen, Wincott, Dayanandan, Lay, Parish, Bowman, Landray & Armitage, 2019 ); the language I used in both the video and all written communications was “pitched at a level that can be understood by the potential participants” ( Patel et al., 2003 , p. 231) whilst also adhering to the “usual rules of written professional correspondence” ( Kaba & Beran, 2014 , p. 580). The first challenge, according to Lysaght et al., is to identify the “best first point of contact” (2016, p. 136) and I identified the need to circulate information about the study via the use of gatekeepers, in this case school leaders. The emails were sent either to the Headteacher or to a Senior Leader with responsibility for staff training and/or wellbeing. In all correspondence with gatekeepers and potential participants, I emphasised my professional experience as a teacher and, to some extent, my personal experience of struggling. I also made it clear that any further contact was to be made directly with me. It was important to make the initial presentation “palatable” ( Lysaght et al., 2016 , p. 136) by creating a “buzz” about my research and explaining how it might directly impact teachers ( Kaba & Beran, 2014 , p. 580). I was not offering any particular incentives to participants but hoped that their intrinsic motives for getting involved might include “curiosity, altruism… and knowledge” ( Kaba & Beran, 2014 , p. 583).

I was mindful of the fact that any willingness to participate can depend on the perceived “attractiveness of the research question” ( Nasser et al., 2011 , p. 1334) and that participants will only take part if they can identify with and “understand the validity and relevance” of the study ( Kaba & Beran, 2014 , p. 581). Relevance of the topic and applicability to personal context are factors which can influence the decision to participate (Caldwell, Hamilton, Tan, Craig & Boutron, 2010; Luck et al., 2017 ). The topic of struggling as a teacher is both relevant and timely in the English secondary state school system. However, some researchers struggle with recruitment of participants ( Rife, Cate, Kosinski & Stillwell, 2016 ) and I was aware that under-enrolment on the study would affect the contribution to knowledge I was seeking ( Nasser et al., 2011 ). Successful recruitment is critically dependent on the initial contacts made ( Patel et al., 2003 ) and this underpinned the rationale for the approach I took. Initial concerns about not recruiting sufficient participants were soon allayed when I was contacted by more than twenty potential participants. It is not possible to report the direct influence of the video as data were not collected on how many participants had or had not viewed the video.

I turn now to a reflective analysis of the recruitment video and take a forensic approach to the video transcript. I also present feedback from an online survey conducted after completion of the study. First, however, I describe the thinking behind the creation of the video itself.

• 4 The Recruitment Video: a Reflective Analysis

In this section I describe the recruitment video I uploaded to YouTube and reflect on its relative effectiveness. The video was filmed in one take, after preparing some notes to refer to if needed and with helpful guidance from my son who was regularly vlogging at the time. I was keen to aim for multiple exposures and wanted to use a “variety of different methods (to) engage multiple stakeholders and collaborators” ( Kaba & Beran, 2014 , p. 584) to increase the “likelihood of participation” ( Kaba & Beran, 2014 , p. 579). The video was pivotal and would act as more than a useful “adjunct to traditional methods” ( Khatri et al., 2015 , p. 2) such as email and personal networks.

The video was created in March 2017 (posted on YouTube: 30/03/2017), as part of the recruitment strategy for my doctoral study ( Culshaw, 2019a ). I was looking for teachers who would be willing to talk about their experience of struggling. The video can be viewed here: https://www.youtube.com/watch?v=3S_wlotcuF4

The rationale for the video was to appear approachable, credible and sensitive. I planned it to be a clear, concise and consistent summary of the project as well as an opportunity for potential participants to see who I was; an “in-person introduction,” ( Kaba & Beran, 2014 , p. 582) albeit on screen. I hoped to show a “caring and compassionate attitude” ( Patel et al., 2003 , p. 234) and to be “passionate about [my] research” ( Kaba & Beran, 2014 , p. 581). When potential participants made an initial approach, supplementary written details were provided.

Patel et al. suggest that the language used should be “pitched at a level that can be understood by potential participants” (2003, p. 231). My background as a teacher gave me an insider view and allowed me to gauge the type of language to use. I was particularly keen not to alienate viewers by using overly academic language. Indeed, throughout the study I adopted a more informal register in written and spoken correspondence. This goes, perhaps, against the advice of some who suggest adhering to the “usual rules of written professional correspondence” ( Kaba & Beran, 2014 , p. 580). I maintain that my conduct and correspondence remained professional, if unconventional, throughout. The text below is an extract from the introductory email which accompanied the video and is an example of the written register I used. It also mirrors the style of spoken language used in the video:

Looking for participants for a PhD research study! I am a former teacher and now full-time PhD student at the University of Hertfordshire. My research is looking at the experience of struggling – what it feels like and what it means to be struggling as a teacher. If you feel that this is something you could talk to me about, in confidence, then I’d love to hear from you. If you’d like to know a bit more about my study and what taking part would involve, then please follow the links below. My contact details are included at the bottom of the blog, and below. Blog: https://musingmindfully.wordpress.com/2017/03/23/its-good-to-talk/ YouTube: https://youtu.be/3S_wlotcuF4 Twitter: follow and dm @SuzanneCulshaw Email: [email protected]

The literature reviewed above purports to provide practical guidance on how to recruit participants and also draws on the experience of the authors (e.g. Kaba & Beran, 2014 ; Khatri et al., 2015 ). Indeed, Kaba and Beran outline twelve tips to “improve the quantity and efficiency of recruitment to provide high-quality outcomes and evidence on the effectiveness of research” (2014, p. 583). Nasser et al., however, highlight the lack of attention on how to implement “best practices for achieving participant recruitment” (2011, p. 1334). Moreover, there appears to be a lack of empirical data from participants on their experience of recruitment. In their systematic review, Ibrahim and Sidani (2014 ) found that less than half of the reviewed publications reported the effectiveness of recruitment strategies; Caldwell et al. (2010 ) report, too, that recruitment findings tend to be inconclusive and not generalisable. In my study, I had not initially intended to collect feedback from the participating teachers about their recruitment experience nor the factors influencing their willingness to participate. To address this, in retrospect, and to explore more forensically the potential of a video-based approach to recruitment, I subsequently designed an online survey. This survey was not intended to be completed by participants in my study.

• 5 Post-study Survey Findings

A survey was created with a view to eliciting feedback on the specific recruitment video uploaded to YouTube in March 2017. The survey was conducted after completion of the study and its sole purpose was to gauge responses to this style of recruiting research participants. The respondents were anonymous and were highly unlikely to have been participants in the original study. It was a small-scale survey, designed to elicit perceptions and impressions of a video-based approach.

The survey consisted of six questions and the link was shared via my Twitter account. The tweet was directed at my followers (approx. 4,000 people and organisations predominantly in the fields of educational leadership, teaching and/or educational research). It was retweeted 14 times and had almost 200 engagements, according to the Tweet Analytics.

Tweet 1: Got 5 mins to watch short video & answers few questions for me, please? Looking for impressions, to help with journal article I’m writing. Video link. Survey link. (No prior knowledge of research participation or methods needed.) Please rt . Tweet 2 (2 days later): Thanks for the responses so far. One last push today… it literally takes 5 mins. All feedback gratefully received, as it will help inform a recruitment strategy for a new project (as well as a journal article I’m writing).

There were 17 returns and, from the responses, it was clear that respondents had engaged with the video to some extent at least. The wording of the questions, the type of questions and a summary of the results are presented in Table 1 .

• 6 YouTube Video and Survey Findings: a Reflective Analysis
• 7 Concluding Remarks
• Appendix: List of Reviewed Publications

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• J Med Internet Res
• v.24(8); 2022 Aug

Social Media Use for Research Participant Recruitment: Integrative Literature Review

Elizabeth mirekuwaa darko.

1 College of Health Sciences, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada

Manal Kleib

Joanne olson, associated data.

Top 10 Universities in Canada QS World University Rankings 2021.

Search strategy for keywords and subject headings of the search terms used in each database.

Characteristics of included studies.

Critical Appraisal Skills Program critical appraisal tools used to critically appraise and evaluate each of the included studies.

List of excluded studies.

Tentative guidelines to assist health sciences researchers in social media recruitment.

Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research.

This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method.

An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format.

A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment.

Conclusions

This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area.

Introduction

In this digital age, advancements in technology have created opportunities for researchers to use new techniques to recruit research participants. For health researchers, technological innovations present an opportunity to use digital platforms such as social media, the internet, web applications, multimedia, and smartphones to effectively and efficiently engage the community for research recruitment [ 1 ]. These digital platforms provide an additional source for participant recruitment for health research studies [ 2 ]. Within health sciences, social media is being quickly adopted because of its increased use as a method of communication with the public [ 3 ]. For many researchers, recruiting participants for trials can be a daunting task that can result in study delays or the termination of trials [ 4 ]. Less than one-third of trials reach their original target within a specified time frame, and approximately one-third required extension [ 5 ]. Hence, reaching targeted participants through social media platforms provides an important avenue for facilitating researchers’ work.

Social media refers to a group of internet-based communication services through which users create and participate in web-based exchanges, contribute user-created content such as videos, or join web-based communities to share information and ideas [ 6 ]. The trends and patterns of social engagement worldwide help provide researchers, policy makers, and other stakeholders with an overview of the different social media applications that users are engaged with [ 7 ] and how these tools could potentially be used to leverage health research. With a global population of 7.8 billion inhabitants [ 8 ], internet users stand at 4.54 billion, representing a 59% penetration rate, and active social media users at 3.80 billion, representing 49% [ 9 , 10 ]. Active social media platforms users include Facebook (63%), YouTube (61%), WhatsApp (48%), Facebook Messenger (38%), Instagram (36%), Twitter (23%), and Snapchat (13%) [ 9 , 11 ]. Social media provides an appropriate medium for user connection and communication, information collection and dissemination, knowledge sharing, discussion, and collaboration with communities for professional networking and business purposes [ 12 - 14 ].

Despite the numerous benefits and opportunities associated with social media, its use in the recruitment of research participants is still evolving. Health researchers using digital platforms for research participant recruitment encounter challenges such as efficiency, cost, information reliability, informed consent, confidentiality, privacy-related concerns [ 15 ], internet accessibility, information overload, informed consent, and interaction quality [ 12 , 13 ]. In traditional recruitment methods, researchers often face costs associated with personnel and resources, administrative changes, time-consuming recruitment processes, recruitment bias, and population homogeneity [ 16 - 20 ]. Cost plays an essential part in the success of a research process as a higher fraction of the cost is allocated to participant recruitment [ 21 ]. The cost involved in research studies varies and is dependent on certain factors such as the targeted population, geographical location, and type of recruitment approach [ 18 ]. To overcome the challenges associated with the cost of participant recruitment, researchers need metrics to determine the cost of recruitment.

To access social media, users are required to create a profile that requires certain mandatory information such as first name and last name, email address, or mobile phone number [ 22 ]. Although interested social media users willingly provide these data, they are often unknowingly signing away their privacy, which increases the possibility of privacy breaches [ 23 ]. Although research ethics boards (REBs) require removing identifying information of research participants from data using unique identifiers, such guidelines are rendered ineffective in the context of social media data as participants’ relational links are predictive of their attributes [ 24 ]. Nonetheless, Narayanan and Shmatikov [ 25 ] stated that such anonymization of participants’ data might be insufficient to protect social media networks’ privacy.

Researchers need guidance to navigate the ethical and logistical issues associated with using social platforms as a recruitment tool other than the “Terms and Conditions” stated by the application software providers [ 26 ]. Therefore, researchers often turn to ethics boards within their institutions for guidance on social media and internet recruitment; however, this information is not always readily available. To determine this, we reviewed the REBs of the top 10 higher education institutions in Canada to identify any standard ethical guidelines currently being used or recommended for using social media tools to recruit participants for research studies beyond adopting the Tri-Council Policy Statement on research. We used the QS World University Ranking criteria, which determine universities’ rankings worldwide based on 6 metrics [ 27 ]. This strategy was deemed appropriate as these universities are known for their high-impact research productivity. The results revealed that only 3 universities had guidelines available on social media use in research studies, which further supported the need for this integrative review ( Multimedia Appendix 1 ). A standard protocol that could be adopted by postsecondary institutions, research organizations, and researchers could help mitigate the pitfalls researchers encounter during participant recruitment for research via social media applications. Such protocols may facilitate the research process, expedite data collection, and ensure that digital research recruitment practices protect participants’ data and rights.

Regarding the published literature, only 1 review [ 15 ] examined the evidence of cost, effectiveness, and the characteristics of participants recruited through Facebook compared with other web-based, social media, and traditional recruitment methods for adult health research. Little is known about the use of other social media platforms for participant recruitment in health research. Therefore, this study was warranted to address these gaps in the literature.

Objectives and Research Questions

This review sought to examine the evidence available on all the applications identified as social media tools and identify the best practices to facilitate participant recruitment through these tools. We addressed the following research questions:

• What are the different social media tools commonly used by health science researchers for recruiting research participants and in what populations?
• What is the proportion of nursing researchers who use social media platforms for recruitment?
• What are the benefits and challenges of using social media to recruit research participants?
• What are the best practices and ethical considerations for using social media tools to recruit research participants?

An integrative review guided by the Whittemore and Knafl [ 28 ] framework was conducted. This review type allows for the inclusion of diverse research methodologies and data sources to understand and generate new knowledge on the phenomenon of interest [ 28 , 29 ]. A comprehensive search strategy was formulated in consultation with a health science librarian. The initial search was conducted on October 11, 2020, and updated on February 24, 2022, in the EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost) databases using a search strategy of keywords and subject headings through an iterative process ( Multimedia Appendix 2 ). The criteria for eligibility were (1) all types of published research on primary and secondary studies, including qualitative, quantitative, and mixed methods; (2) discussion papers, white papers, reports, brief reports, specific guidelines, conference proceedings, dissertations, and published manuscripts that reported on social media use; (3) research reports published between January 2000 and February 2022; and (4) research reports that focused on research participant recruitment and advertisements on social media platforms, including all types of populations and health sciences disciplines, and (5) all geographical locations. The following articles were excluded: (1) non–English-language articles; (2) unpublished manuscripts and non–peer-reviewed publications such as descriptive papers, editorial papers, opinion papers, letters, book reviews, and article reviews; (3) review articles (scoping, integrative, narrative, and systematic) already published on the topic; and (4) all non–health sciences articles. The time frame for the published reports was chosen to capture the contemporary views that reflect the trends and popularity of digital platforms in participant recruitment.

Data Evaluation and Analysis

Records from the databases (initial search N=1197) were retrieved and imported into the Covidence Management Software for data screening and extraction. Overall, 2 reviewers (EMD and MK) independently conducted the screening process in Covidence, screening titles and abstracts, followed by full-text screening. All decisions made to either include or exclude records against the predetermined inclusion and exclusion criteria were documented. Where conflicts arose, the 2 reviewers consulted and resolved them through a voting process. We conducted another search on February 24, 2022, to update the results. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Protocols template in Covidence was used to map out the screening process, and the results as shown in Figure 1 .

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 flow diagram.

The following details were extracted from the included records: name or names of the author or authors, year of publication, country of publication, study design, study population, total number recruited, total number of participants enrolled or recruited through social media, social media platform used, other recruitment strategies, type of advertisement (paid or not paid), incentives provided, whether the study was funded, limitations of social media reported by the authors, and duration of advertisement ( Multimedia Appendix 3 [ 2 , 18 , 20 , 30 - 115 ]). The extracted data from these records were analyzed by identifying codes and categories to characterize emerging themes, patterns, trends, and relationships to aid in synthesizing the findings logically and coherently. In addition, descriptive statistics were applied where appropriate to describe and summarize the data pertinent to the distribution of research and other characteristics. The Critical Appraisal Skills Program [ 116 ] was used per the research methodology to appraise and evaluate each of the included studies critically to ensure the quality of the available evidence included in this review ( Multimedia Appendix 4 [ 18 , 20 , 31 , 50 , 53 , 54 , 55 , 58 , 60 , 61 , 76 , 77 , 81 , 106 , 109 , 114 ]). The studies were assessed and rated as “low quality” or “moderate quality” based on their theoretical or methodological rigor [ 28 ]. Ethics approval was not required as this study did not involve human participants.

In total, 1197 records were retrieved from the initial database search; in Covidence, 441 (36.8%) duplicate records were removed from the imported references, and a total of 756 (63.2%) records were moved for screening. In the first stage of screening, the titles and abstracts of each record were screened for full-text review. In the second stage of screening, 187 full-text studies were reviewed entirely and assessed for eligibility for inclusion or exclusion. For records that were not available in the full text, the Health Science Library was contacted to obtain those records. A total of 6 articles that reported on conference proceedings were retrieved but did not have any substantial information, as reported in the abstracts. Nonetheless, the full texts of these articles were requested through library services but could not be retrieved; thus, a decision was made to exclude them from the results. It should be noted that although the Covidence software automatically removes duplicates, there were instances of errors where some records were missed; therefore, removing these duplicates manually was warranted. Of the initial search, a total of 83 records were included. The updated search returned a total of 89 records. Of the 89 articles, after 11 (12%) duplicates were removed, a total of 78 (88%) articles were screened. A total of 23 articles underwent full-text review, of which 10 (43%) were excluded as they did not meet the inclusion criteria, and 13 (57%) articles were retained and included in the review. Finally, 96 records were included in the review. In total, 114 records were excluded ( Multimedia Appendix 5 ).

Characteristics of Included Studies

The range of publication years of the articles included in the review was between 2011 and 2022 ( Multimedia Appendix 3 ). Most publications were from the United States (63/96, 66%) and Australia (20/96, 21%). Besides that, they were from Canada (5/96, 5%), the Netherlands (2/96, 2%), and the United Kingdom (2/96, 2%). There was only one publication from each of the following countries: Taiwan, Ecuador, India, and Brazil. Out of the 96 included studies, 92 (96%) were papers reporting primary research and 4 (4%) were reports on using social media. The methodological approaches used were cross-sectional studies (38/96, 40%), web-based surveys (15/96, 16%), secondary data analysis (14/96, 15%), randomized controlled trials (10/96, 10%), reports (4/96, 4%), mixed methods studies (4/96, 4%), qualitative studies (3/96, 3%), cohort studies (3/96, 3%), clinical trials (3/96, 3%), quasi-experimental studies (1/96, 1%), and longitudinal studies (1/96, 1%).

Social Media Use by Nursing Researchers and Other Health Researchers

We were interested in determining the proportion of nursing researchers using social media; however, this was not easy to identify as researchers have published studies that have used social media for the recruitment of research participants in a variety of interdisciplinary journals. On the basis of the journal names where these articles were published, these researchers could be from any health discipline, including nursing, medicine, psychology, rehabilitation, nutrition, pharmacy, or public health. Of the 96 included studies, 71 (74%) were published in general health science journals or interdisciplinary journals [ 18 , 20 , 26 , 30 - 92 , 117 - 121 ], and 25 (26%) were published in nursing-related journals [ 2 , 93 - 115 , 122 ].

Social Media Tools Commonly Used by Health Researchers

Researchers used a variety of social media platforms to recruit participants, as reported in the included studies. Researchers either exclusively used social media (43/96, 45%) or social media in conjunction with other recruitment methods (49/96, 51%) to recruit participants ( Multimedia Appendix 3 ). For studies that exclusively used social media, ≥1 social media platform was used simultaneously. Social media platforms included Facebook, Twitter, Craigslist, Instagram, YouTube, LinkedIn, Reddit, Snapchat, and Tumblr. For social media in conjunction with other recruitment strategies, researchers used the identified social media platforms in addition to blogs, social media, Grindr, and WhatsApp Messenger. It was noted that, at times, researchers used the term “social media” but did not specify the type of social media used. In both approaches, most participants relied on the use of Facebook for research recruitment.

Age Groups of Research Participants Recruited via Social Media

Although researchers used social media platforms for advertisement and recruitment of participants for research, they sometimes did not target specific populations. In addition, the age group distribution of these populations varied, and the definition of the age group differed depending on the study aims. To address this, initially, the range of age groups was specified as follows: children (aged <9 years), adolescents (aged 10-18 years), young adults (aged 19-35 years), middle-aged adults (aged 36-55 years), older adults (aged 56-64 years), and older adults aged ≥65 years. The included studies were then scanned against this categorization to identify which age group was most targeted for social media recruitment ( Table 1 ).

Age groups of research participants recruited via social media (N=92).

a Not available.

Populations Targeted in Social Media Recruitment and Their Characteristics

Researchers have targeted different populations in their research studies. Largely, there were many studies (46/96, 48%) that included the general population [ 2 , 18 , 20 , 31 , 32 , 36 , 37 , 40 , 41 , 43 , 46 , 47 , 49 , 51 , 54 , 55 , 58 , 60 , 63 , 64 , 65 , 67 , 69 , 70 , 71 , 72 , 73 , 74 , 77 , 79 , 80 , 84 , 85 , 91 , 92 , 93 , 94 , 104 , 106 , 108 , 112 , 114 , 115 , 119 , 120 ]. In addition, a significant proportion (36/96, 38%) of the included studies focused on recruiting hard-to-reach populations ( Table 2 ). Hard-to-reach populations are groups that are socially disadvantaged and present a challenge to access for researchers because of ethnicity, low income, or health literacy [ 123 , 124 ]. In this review, these populations had addiction problems, unique medical disease conditions, or lifestyle choices or belonged to an ethnic minority group. A few studies applied social media recruitment to target health care professionals as research participants (10/96, 10%) [ 96 , 98 , 99 , 100 , 101 , 103 , 105 , 106 , 107 , 113 ].

Hard-to-reach populations targeted in social media recruitment.

Cost-effectiveness, Efficacy, and Feasibility of Social Media in Comparison With Other Recruitment Methods

The costs of recruitment reported in all the included studies are presented in tabular form ( Tables 3 and ​ and4) 4 ) to help ascertain how money was dispensed, as well as the cost-effectiveness of each recruitment strategy. However, it was noted that although some researchers included personnel costs, advertising costs, and other recruitment costs in the total cost, other researchers did not include these costs. Hence, researchers should use only this information as a guide. Few studies specifically compared social media effectiveness to other platforms with the goal of establishing cost-effectiveness, efficacy, and feasibility. In this review, 7% (7/96) of the included studies aimed to determine the effectiveness of social media compared with other recruitment strategies [ 39 , 51 , 52 , 58 , 70 , 74 , 106 ], and 9% (9/96) of studies that did not compare social media platforms with any other strategy [ 30 , 38 , 41 , 46 , 63 , 72 , 73 , 93 , 111 ] found social media as an effective recruitment strategy in both instances.

Cost of social media recruitment methods.

b Records from the updated search.

Cost of other recruitment methods.

Few studies did not conclusively find social media to be cost-effective or efficient. The findings reported by these researchers differ because of the different populations targeted, scale of recruitment, and whether the research was funded. In their funded study, Moreno et al [ 18 ] found that in-person strategies yielded more participants in a geographic area at a lower cost than social media, and the cost per enrollee by social media was higher than that of traditional methods. In addition, Frandsen et al [ 48 ] suggested that Facebook was cost-effective in obtaining eligible participants at the initial stage of the recruitment process. The mailing of letters was cost-effective compared with Facebook, according to Waltman et al [ 106 ].

Best Practices and Strategies Used to Enhance Social Media Recruitment

Diverse advertisement strategies are adopted by researchers when recruiting research participants through social media platforms. Each social media platform advertisement differs in specification, advertisement content, word count, and design language [ 47 ]. In the included studies, researchers identified and used one or multiple paid, targeted advertisement campaigns with different themes to reach potential participants on various platforms within a specific advertisement duration. Some models of advertisement included the use of paid targeted advertisement [ 18 , 30 , 31 , 37 , 39 - 44 , 46 - 52 , 54 , 58 - 60 , 63 , 65 , 69 - 75 , 77 , 78 , 80 , 81 , 91 , 93 , 95 , 102 , 109 , 113 , 114 , 117 , 119 , 120 ]. In addition, some researchers used untargeted advertisements [ 38 , 62 , 111 ], untargeted but paid advertisements [ 45 , 74 ], “boosted” posts [ 94 , 106 ], posts [ 34 , 61 , 76 , 90 , 105 , 110 , 115 ], both advertisements and posts [ 55 , 57 , 64 , 68 ], tweets [ 79 , 104 , 108 ], targeted advertisements and posts [ 36 ], advertisements [ 56 ], blasts [ 33 ], paid and unpaid social media channels [ 32 , 35 ], and messengers [ 92 ] to strategically advertise and recruit their potential participants.

Another identified strategy was the use of cost-related model strategies to determine the cost of the advertisements. Researchers who are engaged with any social media platform to advertise and recruit participants are billed by cost per click, cost per thousand impressions, cost per view, or cost per action or per conversion [ 125 ]. With the cost per click model, researchers are billed when a potential participant clicks on the advertisement. This approach was one of the most preferred models for researchers in the included studies used for advertising. The cost per click model budget is set at a daily, weekly, or lifetime spending limit depending on the researcher’s choice [ 18 , 30 , 33 , 38 , 40 , 41 , 46 , 47 , 48 , 51 , 54 , 55 , 59 , 60 , 64 , 69 , 71 , 73 , 74 , 75 , 77 , 80 , 93 , 102 , 111 , 126 , 129 ].

Researchers also noted considerations related to the display and design of an advertisement for a desktop application, which differed from that of a mobile app, and this affected how participants viewed and reacted to the recruitment advertisement. The displayed advertisements targeted either the user’s browser or the newsfeed [ 91 , 117 ]. For Facebook, the advertisement is displayed on the user’s web browser [ 58 ] or on the right-side panel of the Facebook newsfeed or placed directly in the newsfeed [ 47 , 55 , 65 ]. For Instagram, images are displayed in a linear format. Snapchat images are displayed using the story feature [ 47 ], and on Grindr, advertisements are displayed as pop-ups [ 57 ]. Therefore, cost is an influencing factor that determines the placement of the advertisement and the social media application of choice, thereby influencing the decisions that researchers make regarding recruitment.

Some researchers identified ethical challenges inherent to social media recruitment, such as privacy, confidentiality, and informed consent, and provided strategies to minimize the challenges for the researcher and the potential participant. The strategies offered and reported in the included studies included the use of a study-specific page for recruitment [ 2 , 51 , 76 , 78 , 82 , 91 , 94 , 107 , 112 , 113 ] and the use of secure landing sites or study webpages for data collection [ 35 , 43 , 48 , 50 , 58 , 75 , 106 , 118 ]. In addition to the strategies proposed by health researchers, there were 4 reports identified in the included studies that outlined guidelines and recommendations for social media recruitment ( Table 5 ).

Recommendations for best practices on social media recruitment.

Principal Findings

Although we intentionally excluded 13 reviews from this study, 7 (54%) of them are discussed here against the findings of our review. The results from our review show an increased interest in using social media for research recruitment by researchers from different health disciplines in which social media strategies have fulfilled researchers’ recruitment needs. Considering the wide range of publications, the scope of this literature review, and the social media applications examined in this review, it can be concluded that the use of social media is on the rise, as evidenced by the increase in the number of publications in the past few years. The different research methods identified in the included studies suggest increased use of social media for a variety of research methods. Notably, a few of the included studies recruited participants for clinical studies, with most recruiting participants for cross-sectional studies. Despite social media’s reach within a broad geographic location, health researchers are still challenged with participant recruitment for clinical trials. This suggests that social media may be best suited for recruiting participants for noninterventional studies. Researchers recruiting for clinical trials may have to diversify their recruitment strategies to reach their recruitment goals until a comprehensive strategy to navigate social media platforms is established. This finding is similar to that of the review by Topolovec-Vranic and Natarajan [ 127 ], which found that only a few studies used social media to recruit participants for interventional studies as opposed to observational studies. Although the Topolovec-Vranic and Natarajan review [ 127 ] used a smaller number of studies to draw this conclusion, their findings are still significant, considering this review.

Researchers from different health disciplines, including nursing, medicine, public health, mental health, and pharmacy, have used social media for recruitment and have published their findings in a variety of journals. Some of these journals are discipline specific or interdisciplinary. This suggests different avenues for health researchers to publish their work. Within the nursing discipline, nurses are increasingly using social media for the recruitment of research studies, as published in multiple nursing and nonnursing journals. However, there are opportunities to continue promoting the use of social media among nurses for research and educational purposes.

On the basis of this review, researchers used different social media applications to advertise and recruit potential research participants. The preferred social media applications were Facebook, Instagram, Snapchat, LinkedIn, Twitter, Grindr, Reddit, Tumblr, WhatsApp, Craigslist, YouTube, and blogs to be used either solely to recruit or in conjunction with other recruitment strategies to achieve recruitment and study goals. Owing to its popularity among users and global penetration, Facebook was the most widely used application among researchers. Different social media applications enabled researchers to recruit participants with different demographics and characteristics. For instance, Facebook was used to recruit younger participants [ 77 , 113 ] and older individuals [ 67 ], whereas other researchers recruited young people through Tumblr [ 61 ]. This finding is similar to that of Arigo et al [ 128 ], who identified web-based platforms such as social networking sites (Facebook, Twitter, Instagram, Tumblr, and LinkedIn) as some of the common platforms that health researchers use to recruit research participants, including a diverse population for their research studies. In addition, researchers used multiple approaches and strategies to recruit participants. An approximately equal number of participants were recruited through social media alone or social media in conjunction with other strategies. This finding agrees with the general literature on the increasing acceptance of digital platforms for recruitment and with some health researchers using social media and traditional methods [ 129 ] for recruitment. In addition to the findings in this review, reviews conducted by some researchers [ 15 , 127 , 130 - 134 ], although focusing on only one social media application or using the term “social networking sites” broadly in their research, exclusively and comprehensively reported on a wide range of different social media applications used in research recruitment.

The different social media platforms used to target the different groups of populations such as the general population, hard-to-reach populations, and specialized populations, depended on the research aim. The hard-to-reach populations included people with addictions, sensitive health issues, ethnic groups, and poor and stigmatized populations [ 135 ]. Social media was found to be effective in reaching and recruiting hard-to-reach potential participants who were otherwise unreceptive to traditional recruitment methods because of their conditions and representations within their communities and society [ 50 ]. Researchers must weigh all available options to determine the best approach to proceed when recruiting from these populations.

The age group distribution of the research participants included in this review spanned different age categories. As shown in Table 1 , the most targeted population from an age perspective was young adults. According to Kemp [ 10 ], the engagement of social media platforms among youth stands at 58% between the ages of 16 and 24 years. This is not surprising because of the acceptability of social media among youth who are considered technology savvy and their tendency to use social media regularly. As such, targeting such an age group for research studies can lead to increased participation. An observation of interest in this review is the low involvement of children and adolescents aged <18 years and older adults. Only 2% (2/96) of studies [ 18 , 120 ] involved adolescents between the ages of 13 and 14 years. As researchers require parental consent among the children and the adolescent group, research studies involving these groups are relatively limited. This finding is similar to that of Amon et al [ 130 ], who suggested that instead of focusing on adolescents who require parental consent, targeting parents or guardians of the intended group could help waive parental consent.

For older adults, the usability of social media platforms presents a challenge, such as platform design and content, as these platforms are tailored to the interests of the younger population [ 136 ]. Owing to the complex design, nature, and privacy-related concerns associated with social media platforms, older adults are more comfortable and familiar with traditional forms of recruitment than social-mediated platforms [ 137 ]. Other barriers encountered by older adults include intrapersonal, interpersonal, functional, and structural elements that hinder the use of social media platforms [ 138 ]. Although social media presents a challenge for recruitment in the older population, researchers can continue to explore traditional methods in such populations to offer an equal chance of participation in research studies. The trade-off between using traditional methods and social media for recruiting research participants is a complicated issue, requiring health researchers to weigh options and the benefits and risks to the participant and the research study, as well as more creative ways of engaging low participating groups.

There is a debate on the cost-effectiveness of social media in the literature. Some studies found the social media method to be cost-effective, whereas other studies disagree with this assertion [ 18 , 58 ]. In this review, the cost of other recruitment strategies compared with social media recruitment strategies was presented as part of this review to assist researchers in making an informed decision ( Tables 3 and ​ and4). 4 ). In addition, in this review, the factors that influenced the cost associated with recruitment varied from one study to the next. Some researchers reported advertising, recruitment, and other administrative costs as the total cost, whereas others reported only aspects of social media advertisement and recruitment as the total cost. Owing to the inconsistency in cost reporting, having a standardized cost reporting system to maintain consistency would help to effectively determine whether social media recruitment is cost-effective. On the basis of the analysis of the cost-effectiveness of both social media and other recruitment strategies, this review found that social media was viewed by researchers as a cost-effective strategy. Although 28% (27/96) of studies in this review reported on the cost of social media compared with other recruitment methods, not all researchers found social media as a cost-effective method. Nonetheless, given that a large proportion of these studies found social media to be cost-effective, this review supports this conclusion. Compared with the previously published reviews by Reagan et al [ 15 ] and Topolovec-Vranic and Natarajan [ 127 ], this review provides additional insights and includes a broader range of studies. This review captured additional literature not included in the review by Reagan et al [ 15 ], which relied only on 18 articles, of which only 10 articles reported on cost. In the review by Topolovec-Vranic and Natarajan [ 127 ], the authors included 30 studies, of which 5 reported on cost-effectiveness, and 7 did not find social media to be a cost-effective method. The findings also revealed that the cost of recruitment for hard-to-reach populations differs from that for the general population. Jurascheck et al [ 58 ] found that recruiting through Facebook advertisements for the African American population was costly; however, advertisements were effective in directing eligible participants to the website. Hence, researchers hoping to recruit research participants through social media must consider these factors to make decisive choices on the most suitable method for recruitment.

Best Practices for the Use of Social Media in Recruitment of Research Participants

Researchers are increasingly tapping into the available opportunities to use social media platforms for their research studies. However, there is a need for best practices to guide this process. To adequately explore and navigate social media platforms successfully for recruitment, adhering to best practices, including those of ethical considerations (informed consent, privacy, confidentiality, and transparency) that protect the researcher and participants, is of utmost importance [ 26 , 118 , 122 ]. In the review by Amon et al [ 130 ], the authors found that participants recruited on web-based platforms were subjected to the same ethical standards as though they were responding to a traditional recruitment method. In that regard, Gelinas et al [ 26 ] were of the view that REBs should standardize social media techniques by clarifying their similarity to traditional recruitment. Furthermore, the findings from the review also establish the need to take additional steps to make available informed consent through other means, where the potential participants are well informed with detailed information about the research study before participation. To curb and curtail the complexities and complicated nature of informed consent, the findings from this review support the recommendations suggested by Herbell and Zauszniewski [ 94 ] and Stokes et al [ 105 ] in their studies to make an information sheet in a downloadable version available for participants and send web-based consent forms to potential participants after meeting the eligibility criteria. To maintain the confidentiality of both researchers and participants, Shaver et al [ 71 ] suggested using anonymous surveys and directing interested participants through a survey link to a landing page for study information. Researchers are discouraged from directly recruiting participants on social media platforms but instead using the social media platform to advertise, as the confidentiality and privacy of participants’ data cannot be guaranteed. To further ensure the provision of privacy, Bender et al [ 121 ] used privacy-enhancing measures aligned with the principles of Privacy by Design by disabling the comment feature, developing privacy notices for social media campaigns, sending disclaimers about the privacy risks of social media pages, and building privacy protection into the recruitment strategy. Although the tenets of the foundational principles were incorporated to avoid privacy-related issues, Bender et al [ 121 ] were of the view that the principles of transparency and user-centric options of Privacy by Design provide inadequate guidance on how to design privacy notices using these key principles.

In addition, some factors were identified to influence advertisements, such as advertisement targets, crafting of multiple advertisement campaigns with different wordings and themes, rotating and alternating advertisements, payment model, duration of the advertisement, and location of the advertisement on the social media platform. To favorably achieve the results of recruiting an increasing number of participants for research, researchers advertising on social media must strategically reach out to their participants. On the basis of the findings of this review, using an appealing image and simple and consistent language through both the text caption and image [ 69 ] influences and attracts participants to the study. Some social media platforms’ advertising policies provide details on advertisement content, including the choice of words and counts and the duration of an advertisement on their platforms. The advertisement policies differ from platform to platform. Researchers must research any platform they wish to engage in, understand the policies, and adhere to them. In addition, working with REBs on social recruitment messages and strategies helps avoid ineffective strategies and enhance ethical conduct. Incorporating prescreening questions before allowing participants to enter details for study participation reduces the rate of ineligible participants and maximizes the reach and sample representativeness. Researchers can use these applications simultaneously because of the feasibility of incorporating social media platforms such as Instagram, Snapchat, and Facebook into a study without difficulty [ 47 ].

Implications

The findings from the review show the increasing accessibility and multifunctionality of social media platforms that could be leveraged to further support health science research. In fact, one of the benefits of social media for conducting research recruitment has been amplified during the COVID-19 pandemic because of the limitations to in-person recruitment, thus sustaining the continuity of research.

Generally, social media platforms provide avenues for a practical approach to reaching diverse, extensive, and targeted audiences [ 139 ] or populations, particularly those that are hard to reach. Further research may be needed to understand the barriers to and facilitators of older adults’ engagement with social media platform recruitment.

Although different approaches to recruitment, advertisement, cost determination, and efficiency reporting can challenge novice researchers planning to use social media, there are ways of mitigating some of these challenges. For example, with the availability of funds and resources, researchers can benefit from hiring specialized companies or third-party service organizations to assist with the marketing and development of social media recruitment strategies and other innovative recruitment approaches targeting potential research participants. It is also recommended that these strategies be discussed and coordinated with the researcher’s academic institution’s REB to ensure no risks to participants.

The lack of explicit regulations by REBs to guide researchers continues to prevent the full exploration of social media platforms to support health science research. As such, stakeholders and collaborative efforts from research-based organizations, academia, researchers, think tanks, and student groups must partner to develop guidelines that reflect the use of social media in research studies. The different guidelines developed and published by researchers and academic institutions can provide a context for what is available. Therefore, based on our review, we propose a tentative description or guideline to guide researchers based on what we have synthesized from the literature included in this review ( Multimedia Appendix 6 ). Ultimately, this guide could serve as a starting point to inform stakeholders in the development of a standardized protocol to guide health science researchers in the use of various social media platforms for research participant recruitment.

Finally, there are opportunities to advance health science education regarding social media use in general and its use for the recruitment of research participants. As students become technologically savvy, incorporating social media into their learning process will allow them to effectively engage with the platform. Schools can also provide guidelines on social media platforms on their websites to enhance learning about their applications in research processes. In addition, teaching students about best practices that support professional social media use and including social media applications as part of ethics training programs are also recommended.

Strengths and Limitations

The findings of this review offer a broad perspective on the use of social media platforms for participant recruitment by health researchers. A large number of studies were included for analysis in this review. The timelines for the included studies span >20 years and provide sufficient time to capture all studies published during the popularity of social media. This study comprehensively synthesized available literature from all health science disciplines. However, the review was limited to studies reported only in English.

The purpose of this integrative review was to explore the literature on recruiting participants for research studies through social media application tools and identify best practices to assist researchers in conducting research participant recruitment via social media tools. This integrative review expanded on the review by Reagan et al [ 15 ], which focused primarily on Facebook, by including other social media applications used by health researchers to recruit research participants, such as Facebook, Craigslist, Instagram, LinkedIn, Reddit, Tumblr, Twitter, and YouTube. Overall, the findings showed that social media is a suitable, viable, and cost-effective channel for recruiting research participants, despite some challenges associated with its use. Health researchers are increasingly embracing various social media platforms in their research to recruit participants from various age groups and diverse backgrounds; however, there is less use of social media to recruit older adults. Adhering to best practices when targeting various populations through social media advertisements is vitally important to protect participants’ and researchers’ rights and increase participation. REBs must proactively provide protocols and best practice guidelines that researchers can apply during the advertisement and recruitment of research participants.

Acknowledgments

The authors acknowledge the assistance of Janice Kung, Laura Hamonic, and Allison Sivak of the University of Alberta Health Sciences Library for their support during the literature search.

Abbreviations

Multimedia appendix 1, multimedia appendix 2, multimedia appendix 3, multimedia appendix 4, multimedia appendix 5, multimedia appendix 6.

Conflicts of Interest: None declared.

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Recruitment of Research Study Participants

Scientific progress depends on successful recruitment and retention of participants in research studies. Often the most difficult and challenging aspect of conducting research studies can be the execution of efficient and effective recruitment and retention strategies of research study participants.  Implementing these strategies can dramatically contribute to increased workload and complexity of managing research studies, but can be pivotal to the success of achieving key research objectives.

It is also important to design a protocol that will clearly identify the study population and allow for easy identification and enrollment of participants. Complex protocols should be reviewed for recruitment feasibility.  If the complexity is not necessary for answering the scientific question, then the researcher should consider revising the protocol for easier participant recruitment.

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CCTS Recruitment/Retention Services

Recruitment, and in fact retention, begins with the first contact that a potential participant has with your study.   Each protocol is unique, but the first impression the public has of your study is the most important. The CCTS can help you make that best first impression by discussing best practices and assisting in the development of brochures, flyers, mailings, surveys, posters, newsletters and appointment reminder strategies for IRB approval. The CCTS can also help you strategically plan for recruitment of special populations. 

Recruitment Resources

ResearchMatch  is a complementary participant recruitment tool that was created through the collaboration of institutions involved with the CTSA Consortium, including The Ohio State University and Nationwide Children’s Hospital (NCH).  ResearchMatch aims to ‘match’ two groups of people: ResearchMatch Volunteers (individuals who wish to learn about studies that might be of interest to them) with ResearchMatch Researchers (researchers who register their study through this tool).

ResearchMatch can be used as an additional recruitment strategy for your study.  There are thousands of volunteers registered in this database and about 12% of the national registry is located in Ohio; 10% are within 25 miles of Ohio State and NCH.  ResearchMatch can be included in the initial protocol submission and in future amendments as a specific participant recruitment tool. 

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StudySearch  is a web-based application that provides a searchable listing of research studies at Ohio State and NCH seeking volunteers. StudySearch contains basic descriptive information about each study including study title, the purpose of the study, eligibility criteria and study personnel contact information.  A user-friendly keyword search feature is also available which can easily search conditions, interventions, and other eligibility criteria.

When you register your trial with ClinicalTrials.gov it will automatically download information into lay language for this listing.  According to the Food and Drug Administration Modernization Act of November 1997, trials "of experimental treatments for serious or life-threatening diseases or conditions” must be registered with ClinicalTrials.gov .  If your research study is not required to be registered with clinicaltrials.gov then your research study can be added to the StudySearch database by the CCTS team.

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Participant Recruitment for Research

Participant recruitment is a major challenge in many research studies involving human subjects.  Recruitment involves a number of activities, including identifying eligible participants, adequately explaining the study to the potential participants, recruiting an adequate sample based on study goals and design, obtaining informed consent and maintaining ethical standards, and retaining participants until study completion.  Findings from several studies suggest that recruitment often takes longer than anticipated, projects incur higher costs than expected, and scientists routinely overestimate the number of participants available for enrollment in their studies.  Even in studies that succeed in recruiting large numbers of patients, participation rates arelow; only 3-20% of the eligible participant pool chooses to participate.   A survey of research studies found that 34% recruited less than 75% of their planned sample, and this reduction in the sample size leads to reductions in the statistical power of the study.   Despite the widely acknowledged fact that recruitment is a challenge, details about recruitment efforts and outcomes are rarely published, resulting in limited knowledge about why recruitment rates vary between studies and what the most successful approaches are for recruiting study participants.

NRC Activities

The AHRQ National Resource Center (NRC) has held a series of one-on-one discussions with AHRQ health information technology (IT) grantees funded under the Ambulatory Safety and Quality (ASQ) Program in order to understand how their projects are progressing and discuss the challenges they are facing.  Several grantees, especially those in the Enabling Patient-Centered Care Through Health IT (PCC) initiative that are using IT to support communication and/or the exchange of health information with patients, indicated that they had challenges recruiting patient participants into their projects.  It became apparent that grantees might benefit from talking more directly with one another about how to effectively and efficiently recruit participants.  To facilitate that discussion, the NRC team summarized the recruitment approaches used across projects into background information that was shared with grantees during an open forum focused on this topic.

The open forum took place on July 8, 2009, with 15 participants across 9 projects.  Its purpose was to provide an opportunity for information sharing and discussion of the specific ways in which grantees conduct recruitment.  The attendees represented projects that targeted either individuals with a specific condition and/or within a specific demographic population, or the general adult population.  Some projects focused on particular chronic conditions such as diabetes, hypertension, cancer, chest pain, and obstructive sleep apnea, while others were focused more generally on medication management or prevention.

Approaches and Challenges with Recruitment

Through the course of the NRC activities noted above, the team collected information on grantees' approaches to and challenges with recruitment from a variety of sources, including grant applications, grantees' quarterly progress reports, one-on-one discussions with grantees, and the open forum. 

Recruitment approaches

• Grantees are employing a variety of strategies to make potential participants aware of their projects, including:
• Sending letters or postcards (often from the patient's provider);
• Distributing or displaying flyers, pamphlets, brochures, and/or posters;
• Approaching patients one-on-one in their primary care provider's office or local community clinic;
• Conducting or participating in health fairs and/or other community outreach activities;
• Placing phone calls, emails, or sending messages via patient portals or listservs; and,
• Advertising in university newsletters, local newspapers, radio, or television stations. 

Several grantees mentioned that they have found it necessary to use more than one recruiting approach - one (or more) to inform potential participants about the project and additional strategies for followup.  In addition, most do not recruit differently depending on factors such as patient demographics, type of care setting, or type of health IT application.

Recruitment challenges The overarching recruitment challenge noted during both the one-on-one calls and the open forum was identifying participants that meet project-specific inclusion criteria.  In addition, grantees noted difficulties in communicating the complicated information required during the consent process and in overcoming general resistance to participation in research studies, while still encouraging patients' interest.  Grantees also mentioned language barriers as a challenge, in that their rate of enrollment is slowed when the project does not have enough staff members who can speak the primary language of their potential participants.  Finally, grantees noted participants' limited access to, discomfort, and/or inexperience with computers as a challenge in recruiting for health IT research studies.

Noteworthy Recruitment Experiences and Guidelines

During the open forum, grantees shared their projects' recruitment approaches and provided each other with suggestions based on their experiences and project commonalities.  Grantees did not comment on the differences between the effectiveness and efficacy of particular methods.  Rather, they remarked on their particular chosen recruitment methods and discussed the differences between overarching categories of methods.  The following key themes summarize the information provided during the open forum.

Grantees aim to minimize the burden on participants in terms of their monetary costs incurred, time spent, and initiative required to join the project.  Most grantees provide incentives for those who join, compensating participants for their time.  These incentives are often monetary compensation, but may also be gift cards from local businesses.  Grantees also provide medical devices such as continuous positive airway pressure machines, glucometers, and blood pressure meters, which participants are often able to keep after the research studies have finished.  Grantees make an effort to minimize patients' time necessary to participate by reducing the steps required through the screening, consenting, and enrollment processes.  They also mentioned organizing recruitment around patients' pre-scheduled primary care visits and traveling to patient locations instead of requiring them to travel.  Finally, some grantees consider passive approaches, such as general advertising, to be less effective because the onus is on the patient to take the initiative and contact the project, resulting in lower response rates.  The grantees prefer to have the project personnel actively contact potential participants and meet with them individually. 

Grantees develop partnerships to collaborate with community organizations or individuals with relevant expertise. Grantees spoke of the benefit they found in developing relationships with other organizations to meet their recruitment goals.  These partners either are other researchers in the same field or organizations that fill a gap in the project team's expertise.  For example, a grantee working with patients with a particular condition found it helpful to identify other researchers interested in that condition in order to share ideas and refer eligible patients.  Another example is a grantee that, after developing the first set of recruitment materials, consulted with a marketing specialist who used her knowledge to review and provide guidance on how to improve the materials.  Grantees also found value in reaching outside the health care community to churches and other community organizations that serve their population of interest.  A grantee focusing on African-Americans with hypertension developed relationships with local churches to assist in recruitment.  While grantees noted that they could not rely on other groups to replace their recruitment efforts, the relationships they developed enabled them to expand the pool of potential participants. 

When trying to recruit particular patient populations based on clinical criteria, grantees use "indirect" recruitment methods.  The projects that target particular sub-populations found it more efficient to first analyze clinical patient data to determine if individual patients meet the project's inclusion criteria, and then to contact only those eligible for participation.  These projects rely less on "direct" recruitment methods, such as health fairs, where project personnel interact one-on-one with potential participants.  The grantees noted that, even though these approaches are effective ways to recruit participants, they are not efficient because of the level of effort required of the project personnel to screen those eligible for the project.  In these cases, several grantees noted the value of identifying a person the grantee trusts to introduce the project to the participants, such as their primary care provider or church leader.  This "person of trust" builds a connection between patients and the project team.  The project team is therefore often not the first to inform potential participants about the project.  Instead, the team members contact patients after they are already familiar with the goals and scope of the research study.   Limited experience with technology does not appear to hinder patient participation in health IT studies.  Based on the experience of this group of grantees, people who are less familiar with technology in general are not considerably less able to participate in health IT research studies.  Grantees noted that, even when potential participants have limited experience with technology, the vast majority could be trained to use computers and the Internet within a relatively short period.  However, depending on the complexity of the health IT application, training for the project can be a major component of the enrollment process.  There may be a difference between the effort required to train a patient to use a computer sufficiently enough to access a personal health record (PHR) and the effort required to use that PHR productively.  Training participants on the project's health IT application can absorb a large amount of time during enrollment, and researchers should plan for this accordingly.

External forces may affect whether people are willing and/or able to enroll in research projects.  Grantees agreed that even when using exemplary recruitment methods and strategies, many eligible participants who could benefit clinically from these projects still are not interested in joining, and those who join often cannot be retained through the course of the project.  In the majority of cases, potential participants do not to respond to recruitment efforts because of a general lack of interest.  In addition, for projects that are studying services provided through a specific private health care organization, the participant may need to be able to afford health care services from that location to participate in the project.  In those cases, other factors such as insurance status and income can prevent those interested from being able to participate in the study. 

Recruiting participants into research studies is a challenging task that often requires a higher level of effort than anticipated.  AHRQ health IT grantees funded under the Ambulatory Safety and Quality Program involved in patient recruitment for their health IT projects encountered issues similar to ones other researchers have faced in the past.  Grantees noted the approaches they are using and identified the variety of challenges they face when recruiting participants into health IT research studies.  By talking directly with other researchers who are also actively recruiting participants, the grantees have had the opportunity to share their concerns, hear suggestions from those most equipped to provide them, and make connections for future collaboration.

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• Open access
• Published: 13 April 2024

Trust-building in temporary public health partnerships: a qualitative study of the partnership formation process of a Covid-19 test, trace and protect service

• Eva Krczal 1 &
• Doris A. Behrens 1 , 2 , 3  

BMC Health Services Research volume  24 , Article number:  467 ( 2024 ) Cite this article

Metrics details

Public health initiatives require coordinated efforts from healthcare, social services and other service providers. Organisational theory tells us that trust is essential for reaching collaborative effectiveness. This paper explores the drivers for initiating and sustaining trust in a temporary public health partnership, in response to a sudden health threat.

This qualitative study analysed the formation process of a multisector partnership for a Covid-19 contact tracing service. Data was collected through 12 interviews, two focus groups, one feedback workshop, and an online survey with workforce members from all seven partner organisations. Purposive maximum variation sampling was used to capture the reflections and experiences of workforce members from all seven partner organisations. A deductive code scheme was used to identify drivers for building and sustaining trust in inter-organisational collaboration.

Relational mechanisms emanating from the commitment to the common aim, shared norms and values, and partnership structures affected trust-building. Shared values and the commitment to the common aim appeared to channel partners’ behaviour when interacting, resulting in being perceived as a fair, reliable and supportive partner. Shared values were congruent with the design of the partnership in terms of governance structure and communication lines reflecting flat hierarchies and shared decision-making power. Tensions between partner organisations arose when shared values were infringed.

Conclusions

When managing trust in a collaboration, partners should consider structural components like governance structure, organisational hierarchy, and communication channels to ensure equal power distribution. Job rotation, recruitment of candidates with the desired personality traits and attitudes, as well as training and development, encourage inter-organisational networking among employees, which is essential for building and strengthening relationships with partner organisations. Partners should also be aware of managing relational dynamics, channelling behaviours through shared values, objectives and priorities and fostering mutual support and equality among partner organisations.

Peer Review reports

Public health initiatives aim to promote health, prevent disease, and extend life through coordinated efforts by society, organisations, communities, and individuals [ 1 ]. This involves healthcare, social services, education, environmental protection, and non-governmental and voluntary organisations. To achieve effective coordination across the resulting organisational diversity, partnerships and alliances are established among (primarily non-profit) organisations within and outside the healthcare industry [ 2 , 3 ]. However, establishing and maintaining collaboration requires continuous managed efforts [ 4 ] as organisations rarely share identical bureaucratic norms, rules, processes and structures [ 5 ]. A growing body of research has been conducted to comprehend the elements and processes that promote or hinder successful collaboration between healthcare organisations [ 6 , 7 , 8 ]. Empirical research has been presented predominantly from networks and collaborations that were established with a long-term perspective. There is scarce evidence of temporary cooperations that were formed to react quickly to an emergency situation. The recent Covid-19 pandemic exemplifies such a scenario, wherein public health providers had to quickly form cross-sector partnerships to contain the spread of the virus. This paper analyses a case where public health providers formed collaborative relations at an exceptionally fast pace to respond to a sudden health demand.

Specifically, this study explores trust building in a temporary partnership. In a collaborative setting, perceptions of trust as well as implicit norms of reciprocity and mutual support typically play a central role in guiding partner organisations’ interactions [ 9 ]. Trust has been identified as a critical determinant of collaborative success [ 10 , 11 , 12 , 13 ], where “success” refers to effectively reaching health and health system goals [ 14 ]. Once trust is established among collaborators, time and effort can be freed to achieve collaborative synergies, such as pooling resources and knowledge, sharing best practices, and developing innovative healthcare solutions [ 15 ].

Organisational theory addresses trust-building in collaborations as a reciprocal relationship between trust and risk tolerance [ 16 , 17 , 18 ]. Vangen and Huxham propose trust building as a reinforcing loop [ 19 ]. From their model’s perspective, organisations rely on their expectations about partner behaviour and collaborative outcomes to decide whether to (further) engage in a partnership. Vangen and Huxham [ 19 ] suggest that trust increases incrementally through partners’ interactions. These interactions shape expectations about cooperative or opportunistic behaviours [ 17 ], where expectations solidify when met and subsequently affect actions (which in turn affect expectations, and so on). In the case of incrementally solidifying the expectation of cooperative behaviour, trust is being built between partners [ 16 ]. Likewise, trust is reinforced whenever expected collaborative outcomes are observed [ 19 ]. Therefore, it has been recommended that organisations set modest goals at a collaboration’s onset to achieve “first gains” swiftly. These quick wins then boost confidence in the collaboration and its benefits [ 20 ]. When actors individually and collectively believe that the collaboration will be beneficial, they are willing to dedicate time and effort to engage in collaborative behaviours [ 21 ].

Vangen and Huxham further introduce the trust-building loop as a conceptual and pragmatic tool [ 19 ]. They propose five management themes dedicated to initiating and sustaining trust-building. Those management themes are summarized in Table  1 .

Research on inter-organisational healthcare collaborations suggests that trusting attitudes need time to develop pointing to the incremental element of trust-building [ 13 ]. Our case study provides the opportunity to test the trust-building loop for a temporary collaboration in an emergency situation. Building on the conceptual framework from Vangen and Huxham (Table  1 ) we explored trust-building in a British contract tracing service formed in May 2020 as a multisector partnership to respond to Covid-19 challenges. Partner organisations rapidly formed collaborative structures and established inter-organisational teams facing time pressure, and uncertainty and pursuing ambitious goals from the outsets. Through the lens of the “trust-building loop” [ 19 ], we examined the critical drivers for initiating and sustaining trust in a temporary collaboration, in response to a sudden health threat.

Study design

The present research was part of a more extensive, qualitative exploratory case study to obtain in-depth information on the management and leadership issues involved in the partnership formation process [ 22 ]. We used a qualitative approach to understand partner organisations’ views on enablers and barriers to reaching collaborative effectiveness [ 23 ]. This paper focuses on one facet when striving for collaborative effectiveness: the trust-building in a public health partnership.

Research site and context

This study examined the collaboration between Aneurin Bevan University Health Board (ABUHB), Public Health Wales (PHW) and five county borough councils (Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen). The overall objective of the collaboration was to rapidly create a test, trace and protect service in South Wales, UK, to break the chains of SARS-CoV-2 transmission within the Gwent population (roughly 600,000 people). The partnership between the local health board and Gwent’s local authorities sought to establish regional and local contact tracing structures, manage pooled resources, and coordinate the joint pandemic policy (following Welsh-Government guidelines). In peak times, the staff comprised more than 400 employees recruited (or temporarily deployed) from public service providers and the private sector. For a detailed description of the set-up, evolution and culture of the Gwent Test Trace Protect Service (GTTPS), see Behrens et al. [ 22 ].

Participant selection and recruitment

The case study analysis rests on a cooperation agreement between the University for Continuing Education Krems and the Aneurin Bevan University Health Board. The Aneurin Bevan University Health Board (ABUHB)’s Research and Development Department has approved all study activities under R&D reference number SE/1338/21. The selection of study participants (across all partner organisations, accounting for gender parity) followed a maximum variation sampling approach [ 24 ]. I.e., interviewees and workshop members were purposefully sampled from leading positions of member organisations. In contrast, focus group participants were sampled from diverse professions and job roles to gather information on partnership members’ (different) perspectives and interpretations at the lower end of organisational hierarchies [ 25 ]. Interviewees, focus group participants and workshop members were invited via email to join an MS-Teams meeting, receiving a short explanation of the purpose and a suggested date. All invited persons agreed to participate. Verbal informed consent was obtained prior to starting the interviews or focus groups.

Additionally, the service’s project management office at ABUHB invited 570 current and former GTTPS team members to participate in an online survey. Respondents were mostly current employees. The response rate was around 33%. For more information on the study participants, see Table  2 .

Data collection

Data were collected over five months from Oct. 2021 – Feb. 2022 through 12 semi-structured interviews, two focus group discussions with 13 participants, one feedback workshop with eight participants, an online survey, and documentary evidence.

EK and DB conducted semi-structured interviews and focus groups. The interview guide focused on participants’ reflections on their working experience within the GTTPS and covered three main themes: organisation, communication and leadership. Study participants were encouraged to reflect on factors that facilitated/hampered collaboration, benefits, drawbacks, and how critical issues were addressed. This exploratory and non-directive questioning method was used in previous research on the dynamics of trust in collaborations [ 26 , 27 ]. The researchers conducted all interviews and focus groups via Microsoft Teams. Individual interviews lasted 30–45 min; focus groups lasted around 90 min. A final 90-minute feedback workshop on preliminary findings was used to consolidate the results and collect further data. DB conducted the workshop via Microsoft Teams and recorded information as unstructured notes.

The questionnaire comprised 65 closed and two open questions and was conducted using Microsoft Forms, with responses from a third of the service’s current and past workforce ( \(n=188\) ). The 70 non-empty answers (37%, \(\stackrel{-}{n}=70\) ) to the open question, “Is there anything else you wish to share about how GTTPS has developed?” were used for this study. EK screened this single item for themes relating to trust-building. The full survey results can be found in [ 22 ].

Documents were gathered from people involved in the planning and implementation of the GTTPS. Documentary evidence covered the governance framework, internal reports, job interview questions, and training programs. The documentary evidence complemented (and verified) study participants’ narrations of their experiences and perceptions of the partnership.

Data analysis

Interviews and focus-group discussions were audio-recorded and transcribed externally. Transcription was done verbatim, with annotations following Dresing and Pehl’s recommendations [ 28 ]. Content analysis was applied to produce a structured and comprehensive data set reflecting study participants’ perceptions and opinions on the critical drivers for initiating and sustaining trust. Specifically, we conducted a qualitative content analysis by extraction [ 29 ]. This method follows the common procedure of content analysis involving categorising, extracting and consolidating information to address the research question [ 30 ]. Typically for the content analysis by extraction, the extracted data also included information about how categories were connected and the study participants’ reflections on the causes and effects of a specific issue [ 31 ]. This procedure facilitated an exploration of the interplay between the categories providing us with a comprehensive insight into the drivers for initiating and sustaining trusting partnership relations [ 32 ]. Five main categories formed the basis for structuring the data. These main categories were defined deductively based on the management themes proposed by Vangen and Huxham on how to initiate and sustain the trust-building loop (see Table 1 ).

The first author assigned text segments from the interviews, focus groups and the open question from the survey to the main categories. Next, the first author inductively created sub-categories to develop a more refined data set. Sub-categories were defined according to central themes that emerged within each main category. Next, qualitative data was coded in a second round along the sub-categories. During the coding process, preliminary findings and interpretations were compared and blended with existing theory, moving toward higher levels of theoretical abstraction [ 33 ]. Coding was refined in an iterative process that involved the introduction of new sub-codes or the re-evaluation and re-definition of existing sub-codes. It was decided to delete the main category “Managing dynamics”, sub-codes were integrated into the category “Managing power-imbalances”. The modification in the coding scheme was more appropriate for this case. As a temporary partnership, the service was disbanded when the purpose and funding faded. A sample data extraction sheet used for this analysis can be found in Additional Table 1 (Additional file 1 ).

Categories and their relations were discussed with other members of the research team. In a final step, the researchers visualised and discussed ‘emerging’ drivers for initiating and sustaining trust. Recognising their role in reconstructing and interpreting qualitative data, the researchers applied the following techniques recommended by the literature to enhance the validity of findings [ 29 , 30 , 34 ]: (1) The researchers collected data from multiple sources (interviews, focus groups, feedback workshops, survey participants and documentary evidence). (2) DB spent prolonged time (21 months) in the field conducting interviews, obtaining feedback from study participants and observing interactions between partnership members. (3) A journal continuously documented the research process (including developing the coding system and analytic reflections). (4) Peer debriefing with other researchers was used to discuss emerging findings and patterns.

The content analysis yielded six key themes and 15 subthemes epitomising enablers for trust-building (see Table  3 ). A summary of the trust-building processes emanating from the content analysis can be found in Additional Table 2 (Additional file 2 ).

Initiating the trust-building loop

Forming expectations.

The outcome of partnership decisions was heavily influenced by experiences gathered in former collaborations, situational circumstances, and a shared dedication to a common aim. The collaborators emphasised that established personal relationships and prior connections between the organisations facilitated the partnership formation process. One focus group participant explained:

“There were some existing good relationships with the [other] organisations that we were sort of able to build on to get the agreement for establishing the service.” [Participant Focus Group 2] .

Study participants noted that partner organisations collectively aimed to safeguard their communities and maintain the smooth functioning of services. Facing the same challenge (like making decisions under uncertainty while coping with limited resources and know-how) further united the partners. For example, one participant stated:

“I think that position of everybody not knowing what’s going to happen was quite unifying. […] It wasn’t that somebody knew what was going to happen, and other people didn’t. We were all in the same boat.” [Interviewee 10] .

The collective effort and commitment towards the collaboration were highly evident and appreciated by the participants, who perceived a strong sense of dedication towards the common goals. One participant specifically emphasised “the willingness of [all] partner organisations to participate in the planning and the implementation and the further improvement of that service.” [Interviewee 3] .

One of the focus group participants expressed how working together with a common goal created a sense of camaraderie and connection. The following quote exemplifies the bonding experience that resulted from shared commitment and goal orientation:

“There are six teams working together across Gwent, and at one point, it was over 500 employees that all work together for the common aim. And that’s what brings us together, and in our daily chats, we always put #TeamGwent – one team, and that’s what we are. We are one team working together for a common goal.” [Participant Focus Group 1] .

One feedback workshop participant remarked that partner organisations aligned objectives and prioritised goals in the same order to safeguard their communities. The feeling that everyone was working in the same direction was referred to as the “glue” between partner organisations [Interviewee 4] and created a “big team feeling” [Participants Focus Group 1 & 2, Interviewee 6] .

The backing of Human Resource (HR) strategies and leadership reinforced the dedication to the common aim. Internal documents on the leadership development program revealed that NHS leaders were strongly advised to instil a shared sense of purpose and promote connections within the service. According to the study participants, leaders were role models demonstrating commitment and collaboration towards shared goals. For example, one participant used terms like “working extremely hard” and “genuinely” trying to do “the right thing for Gwent” to describe leaders’ commitment to the common aim [Interviewee 8] . Besides, the inaugural team of spring 2020 brought together people from various organisations who mainly volunteered to work for the service in the making. Thus, Human Resource strategies have successfully attracted and pre-selected people highly committed to the service and its purpose.

Managing risk

The rapid and structured set-up of the service was associated with partnership effectiveness. One participant reflecting on the establishment of the contact tracing service stated that it was “incredible [to see] the way in which organisations came together to set up the service” and highlighted “the amazing progress that was made, very, very rapidly when the service was first established.” [Interviewee 3].

This “first gain” emerged from data analysis to have strengthened faith in the collaborative functioning of the service. Study participants considered collaboration, the ability to work together as a team, as a crucial success factor of the service: “[…] the key success for me is just their ability to pull together and get something together.” [Interviewee 6] .

Another participant added: “[…] because that’s the learning from COVID: the more collaboration, the better the job is done. Whatever the job is.” [Interviewee 2] .

Sustaining the trust-building loop

Managing power imbalances.

Insights gained from data analysis showed that partner organisations strived for equal power distribution. The individuals who took part in the study highlighted the absence of hierarchical thinking and appreciated equal representation, decentralised structures and local control. The GTTPS governance framework Footnote 1 promoted equality among the partners, and our analysis showed that the power distribution within the service followed suit. The Regional Oversight Group played a significant role in strategic planning and coordinating activities. It was referred to as a “collective” or “shared decision-making forum” with participation from all partners, who were encouraged to express their views [Interviewee 8, Interviewee 2] . Further, study participants explained that the Coordination Unit, responsible for managing contact tracing across the five councils, moved from the health board to a local council to avoid public service partners “feeling like they were being dictated or controlled by the health board” [Interviewee 1] . Also, the Head of Service, who led the unit, was recruited from within the councils—with the Coordinating Unit offering support instead of enforcing authority or control.

At the formation stage, some participants noticed tensions between the partner organisations concerning the service’s design and structure. At the same time, these participants reported that the partner organisations overcame these tensions by collectively developing a road map to working together. One participant outlined:

“[…] Consensus decision-making is vitally important, and that is what happens at our governance groups, the Regional Oversight Group, the operations groups. […] There are people in leadership positions reporting to other people in leadership positions in different organisations. That simply does not happen in very many places, does it?” [Interviewee 2] .

According to study participants, decision-making resulted from frank discussions where contributions from all members were recognised. One participant stated:

“[…] all team members are allowed to put their contributions in. I think that it is really important that any team member, irrespective of where they are in the hierarchy, is allowed to have a say because that is the only way a set-up like this can work.” [Interviewee 9] .

Data analysis revealed some inequalities regarding central control versus locally-based decision-making. One participant outlined:

“I expressed these views, […] until I was told to shut up, which is absolutely fine. I was heard. My views, my concerns were heard again. This was again […] the governance issue. It is the central control versus local, and you know we were, we were told … it was made clear that we will be part of the group, and we were expected to abide by it, which we largely did.” [Interviewee 8] .

Increasing bureaucracy led to tensions between partner organisations, particularly in the mature phase of the partnership. Other examples of tensions indicated by study participants derived from a lack of acceptance of particular professions or when one partner claimed not to receive sufficient information, explanation or support from another partner. When the service was under pressure, one interviewee noted a tendency to prioritise the needs of the own sending organisation, which challenged collaboration with this partner.

Partner organisations tried to overcome such tensions through frank discussions, explaining the reasons for decisions and showing interest in others’ views and opinions. Understanding people’s behaviours and attitudes was considered essential to get to the bottom of the tension’s cause. One participant explained:

“[…] it could be quite tough […] the atmosphere could be tense, at times. You know, sometimes asks were made; I think I would say they were not reasonable because they had not been thought through. So, I think the challenge was trying to get to the bottom of that. Trying to work out where people were coming from and to use that as we have a constructive dialogue .” [Interviewee 9] .

Trust was considered a foundation for this open and problem-focused discussion climate:

“We don’t always agree, we don’t always get on, but there is trust.” [Interviewee 8] .

Participants described a partnership culture where failures were not stigmatised. One participant expressed: “We need to accept that things can go wrong. That no system is ever perfect. […] Understanding the pressures people are under is another lesson to be learned.” [Interviewee 9] .

Indeed, failures were considered an opportunity to learn and adapt. The resulting organisational climate made staff feel confident and trusted. Study participants outlined throughout the interviews that they were not afraid to admit mistakes or discuss challenging issues. One study participant explained:

“But occasionally they would get it wrong, and I think it is having the confidence, […] feeling confident and trusted […] that it wasn’t the end of the world .” [Interviewee 8] .

Nurturing collaborative relationships

Our analysis confirmed that the study participants placed great importance on effective communication for building trustworthy relationships. They highlighted the significance of frequent formal and informal meetings, job rotations, and non-hierarchical service structures in facilitating seamless communication within and between organisations. A participant emphasised the relevance of spending time together to nurture empathy and trusting relationships:

“[…] We know each other reasonably well, and we’ve established that through our regular team meetings and our morning catch-up. […] a bit like a well-worn suitcase where we are comfortable with each other. We don’t always agree, we don’t always get on but – but – but there’s a trust there, […], and it has developed through time as we got to know each other better. Having spent quite a lot of time in each other’s pockets .” [Interviewee 8] .

The study participants stated that the workforce exuded a welcoming and supportive environment throughout the partnership network, spanning from top executives to team members across all partner organisations. Emanating from the service’s governance framework, which identified “mutual aid” as a fundamental principle, study participants highlighted that they felt surrounded by a support network which induced positive working experiences and high-quality relationships between service members. One survey participant outlined: “I feel no barriers between each team and would happily seek support and advice from any partner” [Survey Participant 89]. Similarly, an interviewee mentioned that “there is certainly that support network across Gwent TTPS that we can call upon. And we built up some fast, fantastic […] working relationships” [Interviewee 6].

This collaborative and supportive culture was promoted by the innate characteristics and values of leaders and employees and a shared commitment to a common goal. Partners’ willingness to widely share information, advice, expertise and support when managing their workload was paramount. One participant remarked:

“I would have no hesitation to phone up somebody of the leadership team from the health board if I needed to know something, whereas that’s not traditionally what I have witnessed before. I think, you know, it is strong leadership, and that’s down again to personalities and down to the focus and commitment and passion. But they are also very, very approachable leaders.” [Interviewee 11] .

Meetings were described as two-way communication focusing on solving problems, connecting service members, creating understanding for decisions and actions and creating “ situational awareness ” by keeping everyone informed and involved [Interviewee 3] .

The free exchange of information and advice supported mutual recognition and respect. In sharing knowledge and expertise and discussing problems, partners demonstrated their professional competence and willingness to help each other. One survey participant outlined:

“The TTP service was created through passionate people with a variety of skills and experience. […]. People worked at pace and trusted each other to take on activities within their expertise and then develop knowledge and skills for each other. The recognition of people’s strengths really did help get the service implemented.” [Survey participant 89] .

Leaders were described as (acting like) role models by accepting each other’s professional roles but also claimed this attitude from team members. The following quote reflects leaders’ attitudes:

“And often I would have to intervene and say yes, you are part of the team, but there are other regional players in this, and it’s important that you accept that […] and acknowledge the role they have been playing.” [Interviewee 9] .

Further, common gains strengthened partner organisations’ confidence in the collaboration and its benefits. The partnership’s high performance during peak infection times confirmed participants’ perceptions of collaboration effectiveness. One interviewee outlined:

“ […] our performance has been incredibly high reaching, you know 90 odd percent of people within 24 hours” and added, “to be able to do what we’ve done in such a short space of time whilst keeping a level of governance, I find truly outstanding.” [Interviewee 2] .

Besides, study participants experienced knowledge gains and personal learning opportunities attributed to collaborative synergies. A focus group member highlighted the following:

“We have seen some amazing innovation and collaboration across departments, and I think those communication skills and adaptability skills as something that can be really built upon and used in future programs of work.” [Participant Focus Group 1] .

This study explored drivers for building and sustaining trust within a public health partnership of non-profit organisations. The study used a theoretical framework (19) as a starting point for analysing factors contributing to the partnership’s trust-building process.

Findings suggest that the foundations for trust for the present collaboration were established before and during the formation stage of the partnership. Previous positive experiences in collaboration and the perceived need for a collective approach to strive for the shared aim evoked partners’ commitment to the partnership. Amid the unpredictable context of the pandemic, partner organisations demonstrated a willingness to collaborate, share knowledge and consider others’ perspectives and opinions in making joint decisions to decide on the best way of action. Partner organisations entered negotiations about forming a partnership by displaying cooperative behaviours. Initial tensions that arose from discussions concerning the design and structure of the service were solved by consensus, i.e., no partner appeared to dominate the decision-making process. These interactions between partners appeared to generate initial confidence in partners’ behaviours and expected outcomes of the collaboration.

As proposed by the trust-building loop, we observed that first gains increased faith in the collaboration and partners’ behaviour. The positive effect of first gains on trust in collaboration has been demonstrated in previous research [ 35 ]. Participants of this study considered first gains proof that partner organisations could collaborate effectively and achieve the common aim of the service. More ambiguous gains, such as high performance during peak infection times or organisational learning, reinforced faith in collaboration and partners’ behaviour.

Our findings additionally highlight the role of shared values in sustaining the trust-building loop. These shared values appeared to be continuously nurturing the collaborative relationships between partner organisations. The connection between shared values, organisational culture and trust has been addressed in previous research. Similar norms, values, beliefs, and collaborative organisational cultures are expected to reduce conflict and increase confidence [ 36 , 37 , 38 ].

Our results suggest that the first gains not only increased faith in the collaboration and collaborative behaviour of partners but also supported the development of a distinct partnership culture. When developing partnership structures and relations, partner organisations were guided by certain behavioural norms and values that have proved successful during the formation stage of the partnership. According to Schein, the organisational culture evolves from decisions, actions and behaviours that proved successful when solving problems by working together or adapting to external circumstances [ 39 ]. Our findings align with this by indicating that the core values of the service represented critical success factors for service effectiveness, indicating that these shared values have induced the evolution of a partnership culture.

The five features of the partnership culture observed in this study are (1) commitment to the common aim, (2) mutual support, (3) recognition and respect, (4) equality, and (5) open failure culture. Figure  1 illustrates the trust-building processes induced by the shared values that have evolved from data analysis blended with the organisational and behavioural theory to explain the mechanisms observed in our study. Boxes in grey and with odd lines represent the theoretical foundation for the process of trust-building. Boxes in blue and with flat lines represent mechanisms that were uncovered through analysis of the empirical data from this case study.

Trust-building processes induced by shared values observed in the study and blended with theory

Collectively shared norms and values are suggested to shape members’ behaviour [ 40 ]. According to Zaheer et al. [ 18 ], trust is the expectation about a partner’s behaviour concerning three components: reliability, predictability and fairness (see Fig.  1 ). Developing a shared partnership culture thus increases the reliability and predictability of each partner organisation’s behaviour, producing higher levels of trust whenever expectations about partners’ behaviour are met [ 18 ]. Besides, the high commitment to the common aim encouraged partners in our study to align objectives and prioritise goals in the same order. Pursuing the same priorities and objectives might also channel behaviours, thus increasing the reliability and predictability of partners’ behaviour.

Next, participants stressed mutual support and open exchange of information and expertise between partner organisations, indicating reciprocity and mutual exchange of benefits in partners’ interactions. The results align with the Social Exchange Theory, which proposes that trust develops through mutually beneficial (trans)actions [ 41 , 42 ]. This means that when one party provides a benefit to another party (e.g., professional expertise, social support, recognition), the recipient feels obligated to return the favour. Consequently, trust is built iteratively through a consistent exchange of benefits and broadening interactions between the parties [ 43 ]. Hence, the principle of reciprocity should increase confidence in expectations about partners’ behaviour and the outcomes of the collaboration.

Moreover, study participants noted that striving for the same aim and sharing the same values and beliefs evoked a “ big team ” feeling. According to Social Identity Theory, individuals tend to categorise themselves and others into subgroups based on sociocultural distinctions [ 44 ]. When one party perceives that the other party is similar to them in some way, such as sharing the same values or beliefs, they will be categorised as ingroup members. Shared ingroup membership is suggested to increase expectations of reciprocity which in turn reinforces trusting behaviours [ 45 ].

We also analysed the impact of the power structure on trust-building processes. Findings demonstrate that the principle of equality guided partner organisations’ interactions through consensus decision-making, respecting partners’ contributions and opinions, and sharing information and expertise. We could also observe a fit between organisational culture and structure in a way that the principle of equality guided partner organisations when designing governance structures and communication channels. First, the service and governance structures of the partnership were characterised by an absence of rigid hierarchies. Second, governance structures were organised in several inter-organisational groups, such as information-sharing and joint decision-making forums. In this regard, we can assume that the principle of equality and the partnership structure reinforced partners’ cooperative behaviours. Previous research has documented that the power structure is related to resource distribution in collaboration [ 46 ], thus affecting expected outcomes and the level of trust in a collaboration [ 47 ]. For example, in analysing cases of a healthcare alliance, Murray et al. [ 48 ] reported that expectations on using funds and providing expertise affected trust in a partnership. When expectations were not met, this led to a reduction of trust.

Besides, our results demonstrate that leaders played an important role in channelling behaviours directed towards the common aim and acted as role models for cooperative behaviour. Our study reiterates findings from existing research on collaboration effectiveness, stressing the importance of leadership for engaging, mobilising and involving all partners [ 49 , 50 ].

Supporting previous research [ 47 ], our study results stress the importance of frequent formal and informal communication for building relationships and trust in collaboration. Findings indicate that organisational structures, and specific HR-Strategies such as job rotation and recruiting candidates with the desired personality traits and attitudes, encouraged network communication across partner organisations. Similar HR strategies, including training and development, have been addressed before to promote inter-organisational networking [ 51 ].

In the present study, we observed that the shared values strengthened partnership relations on the one hand. On the other hand, these shared values jeopardised the partnership if they were not observed. Study participants noted tensions between partner organisations when one partner perceived a violation of shared values by another partner. For example, when one partner provided only insufficient information to the other partner, the value of “ mutual support ” was not shared. The infringement of this value caused tensions between partners as expectations about partners’ behaviour (being supportive) and the outcomes of the collaboration (receiving information) were unmet.

Strengths and limitations

This study was a qualitative case study to obtain an in-depth understanding of the drivers for building and sustaining trust from the perspective of service members. The explorative approach allowed us to identify and understand in detail the trust-building processes emerging from the experiences and reflections of participants. To the best of our knowledge, there is no research on how the underlying mechanisms of shared values and beliefs affect trust-building in a public health collaboration. Our results provide insights into this issue. However, some limitations have to be considered when interpreting results.

The purposeful sampling strategy might have induced a selection bias, when individuals highly committed to the partnership were nominated to participate in the interviews and focus groups. Further, the enthusiasm expressed by many study participants might have prompted a positivity bias, favouring positive associations with the partnership experience. Several situational factors appeared to influence the collaborative behaviour of partnership members. The unprecedented level of uncertainty, the perceived need to consolidate efforts, and the dynamic work context might have prioritised the need to collaborate. Further, study participants stressed that the funding was not a limiting factor in the partnership as there was a firm funding commitment from the Welsh Government for the service. This situation differs from cases analysed in previous research where funding commitment or the distribution of funds have been reported as substantial sources of conflict and may ultimately lead to the collaboration’s end [ 48 , 49 ]. The uniqueness of contextual factors poses limitations on the generalisability of findings. On the other hand, unconventional research contexts or samples can offer novel insights and pose new impulses for research [ 52 ].

Further research on the impact of shared values on trust can contribute to a better understanding of collaboration functioning. For example, the features of the partnership culture identified in this study point to a psychologically safe working climate. The concept of psychological safety has been developed and studied in the context of team learning and team performance [ 53 , 54 , 55 ] and is also considered essential when forming temporary teams [ 56 ]. Analysing trust-building in the context of psychological safety would enrich findings on the interplay between shared values and trust.

Some of the partnership features described in this study might challenge traditional management principles of public health organisations, especially those with a high degree of formalism and hierarchical orientation. Our findings echo research on organisational learning, stressing that it needs flat hierarchies to foster innovation and adaptability [ 57 ]. Future research in this area can study organisational learning in a broader context by exploring potential ‘spillover’ effects from learning experiences deriving from inter-organisational collaborations with partner organisations.

Guided by a theoretical framework, this study analysed the drivers for building and sustaining trust in a public health partnership. Results of this study suggest that relational mechanisms emanating from the commitment to the common aim and the shared norms and values, as well as partnership structures, affect trust-building. These factors appeared to channel partners’ behaviour when interacting, resulting in being perceived as a fair, reliable and supportive partner. In our study, shared values are congruent with the design of the partnership in terms of governance structure and communication lines reflecting low hierarchies and shared decision-making power.

When managing a collaboration, partners should pay attention to structural components to ensure equal power distribution in a partnership. For example, equal representation of all partner organisations and/or a rotating chair in strategic decision-making forums can ensure (the perception of) equality. Partner organisations are also advised to ensure smooth communication channels and encourage informal communication between partner organisations to support information exchange and mutual understanding of partners’ decisions and behaviours.

Further, partners should be aware of the role of leadership in encouraging commitment to the common aim and collaboration. The promotion of cooperative leadership styles can support trust-building processes in a partnership. For example, servant leadership has been found to promote trust, fairness and reliability in a relationship because of the enhanced empowering and supportive behaviours of the leader [ 58 ]. Recruitment and training strategies can be designed to support inter-organisational networking and collaboration among the workforce. Selecting people with traits like being supportive, committed, and open to other opinions could be a recruitment strategy supporting a culture of collaboration. Job rotation can be used as a personnel development measure to expand personal networking and increase mutual understanding.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to potential confidentiality concerns but are available from the corresponding author on reasonable request.

The Contact Tracing Governance and Delivery Framework represents the collaboration agreement between partner organisations. It contains the purpose, collective aim and objectives of the service, the principles of the service, the organisational structure of the service, and the roles and responsibilities of partner organisations and groups. The latter formed the governance structure of the partnership: strategic planning and decision-making was executed in several groups with representatives from partner organisations.

Abbreviations

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Human Resources

Public Health Wales

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Acknowledgements

This work was made possible by the collaborative spirit, genuine learning interest and organisational skills of Dan Westwood, Eryl Powel, Jonathan Keen, Ruth Betty, Holly Townsend and zealous (other) Gwent Test Trace Protect team members. The authors are grateful to Marlene Kritz for her valuable methodological advice and for discussing the results of the study.

The research team did not receive financial compensation for executing this project.

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DB led the overall study. EK conceptualised the qualitative study. EK and DB collected and analysed the data. EK wrote the manuscript with the support of DB. DB contributed to literature research, literature analysis and visualisation of the extended trust-building process and focused on core messages plus finetuning of the paper. Both authors read and approved the final manuscript.

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Aneurin Bevan University Health Board (ABUHB)’s Research and Development Department reviewed the study protocol according to relevant guidelines and regulations in October 2021 and provided ethical approval under R&D reference number SE/1338/21. Informed verbal consent was obtained from participants before starting the interviews/focus groups after describing the purpose of the study and the confidentiality and anonymity of the information that they were to provide. Participants responding to the online survey was deemed as consent.

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Additional file 1..

Data Extraction for “Managing risk”, “Collaborative set-up of service”. Sample data extraction sheet for theme “Managing risk “Collaborative set-up of service”.

Additional file 2.

Summary of trust-building processes emanating from content analysis. Summary of drivers for initiating and sustaining trusting partnership relations resulting from an exploration of the interplay between different variables extracted from data analysis.

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Krczal, E., Behrens, D.A. Trust-building in temporary public health partnerships: a qualitative study of the partnership formation process of a Covid-19 test, trace and protect service. BMC Health Serv Res 24 , 467 (2024). https://doi.org/10.1186/s12913-024-10930-3

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