The primary outcome variable for analysis was an aggregate measure of recruitment effectiveness defined by the recruitment rate and conversion rate. In the study, we investigated the following three hypotheses: (1) The recruitment rate is higher in online recruitment compared with offline recruitment (2) The conversion rate is higher in offline recruitment compared with online recruitment and (3) The cost per enrolled subject is lower in online recruitment compared with offline recruitment. Further, this study investigated the cost-effectiveness of online recruitment compared with offline recruitment in clinical research. The aim of this study was to evaluate the effectiveness of online patient recruitment by systematically reviewing studies that utilize online strategies for patient recruitment and by conducting meta-analyses comparing online and offline recruitment strategies on the following two recruitment metrics: recruitment rate (the number of patients enrolled in the study on average per month and per day of active recruitment) and conversion rate (the percentage of participants screened who proceed to enroll into the clinical trial). Herein, traditional in-clinic recruitment methods are referred to as offline recruitment. Similar arguments were made by Watson et al, Jones et al, and Carter-Harris et al who all reported social media advertisements to be a “viable tool for more efficient and cost-effective recruitment.” The potential reach of online recruitment by far exceeds the reach that traditional recruitment methods are able to generate, but whether online recruitment strategies outperform traditional offline recruitment strategies still remains unclear in the literature. In 2018, Akers et al found that Facebook advertisements gave “flexibility to monitor and modify advertisement tactics based on feedback,” and Shere et al argued that social media recruitment should be redefined as an active recruitment tool rather than a low-budget passive tool, as targeting specific populations effectively yielded high recruitment rates. Using online recruitment strategies, such as social media advertisements, Google search engine advertisements, and other website campaigns, may enable researchers to target specific study populations by demographic characteristics, location, and keywords previously used in potential participants’ user profiles. Potentially, this results in clinical research that lacks generalizability and makes it difficult for clinical trials to be a cornerstone for providing scientific evidence on the safety and efficacy of novel pharmaceutical compounds. Further, for traditional offline recruitment strategies, location of trial sites quickly becomes the bottleneck for participant diversity in clinical research, as sites only succeed in recruiting patients within a relatively short radius. Recruiting appropriate participants in a sufficient number to fulfill sample size requirements is critical for the validity of the research findings, and failure may lead to invalid or inconclusive results. The costs associated with recruitment are wasted, and data quality is hampered by a reduction in statistical power due to underrecruitment. As pointed out by Gul and Ali, slow and inefficient recruitment may have scientific, economic, and ethical consequences. Around 80% of trials fail to meet the initial enrollment target and timeline, and these delays can result in lost revenue of as much as US $8 million per day for drug developing companies. Ĭurrently, recruitment for clinical trials continues to be a challenge, as patient recruitment is the single biggest cause of trial delays. Such traditional recruitment strategies include, but are not limited to, soliciting subjects through mail and telephone using health records and registers, media campaigns, newspaper advertisements, and input during radio and television talks. Increasing needs for more effective recruitment methods have led to “trial and error” models, where a number of different recruitment strategies are utilized and modified according to observed effects on recruitment. Historically, recruitment of participants for clinical trials has been critically dependent upon physician referrals and overall site performance.
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