Presented by Nariman Nasser, Director of UCSF Participant Recruitment Service, in May 2012 at CHR sponsored workshop on the UCSF Campus. This presentation on ‘Recruitment: What Methods Are Appropriate’, discusses the use of social media in clinical trial recruitment, as well as emerging technologies such as SMS text messaging for patient recruitment and retention.

1. Technology & Best Practices
for Recruitment
Nariman A. Nasser, Director
UCSF Participant Recruitment Service

2. SOCIAL MEDIA & EMERGING
TECHNOLOGIES

4. What is
Social Media?
The use of web-based and
mobile technologies to turn
communication into
interactive dialogue
1. Collaborative projects
2. Blogs and Microblogs
3. Content communities
4. Social networking sites
5. Virtual game worlds
6. Virtual communities
Kaplan and Haenlein, Business Horizons, 2010

5. The Power of Social Media
• Recommendations by family/peers are more
influential
• Reach wide number of motivated/interested
individuals in a short time
• Encourages empowerment and proactive behavior
• Able to communicate in real-time
• Ideal for AE reporting and post-marketing
surveillance (FDA/NIH Safety Reporting Portal)

6. Clinical Trials Networking Sites

7. The Unwieldy Power of Social Media
• Unless social media is used for real-time
communication it is no different than a
traditional media advertisement
• Real-time communication in the context of
clinical trials recruiting must be carefully
moderated
• FDA regulations are not conducive to brevity,
no guidance to date (Novartis widget incident
failed to communicate risk information,
implies superiority)

8. Emerging Technologies
• Electronic personal health records (Google
Health, HealthVault)
• Research volunteer registries (Volunteers for
Health, ResearchMatch.org, TrialX)
• Electronic communication methods (text
messaging, emailing health professionals,
online screening tools)
• Telemedicine

9. TEXT MESSAGING FOR
RECRUITMENT

10. Mobile phones are changing the way people
interact with the world around them
MOBILE FACTS POTENTIAL
5.5 billion Global Subscribers* Mobile devices are now practically ubiquitous
Penetration rates >80%* in most countries Worldwide Tool - large metropolitan areas to rural
(US = 285M subs or 91%) developing world
Mobile Phone within arms reach Mobile is the most effective and natural
of average users for 19 hours per day † way to maintain contact with clinical trial
participants
Mobile phone users read messages within
15 minutes of receipt† Mobile communications are immediate,
verifiable and actionable
Mobile phone users respond
within 60 minutes† Clinical trial participants will use their
mobile phones to provide information
Average mobile phone users send/receive
to clinical sites
4x as many text messages as voice calls†
•* Merrill Lynch Q3-2009/CTIA 2010 † Nielsen Q4-2008/10 ‡ Luth Research 2009.

11. Teens text, and so do their parents
parents text twice as
much as they call

12. SMS Recruitment – Data points
70% prefer to inquire via text message
90% response rate = highly engaged
Significant ROI
3 months traditional method followed by 3 months with text messaging
• Cost per Response decreased by 15%
• Cost per Referral decreased by 32%
• ROI > 650%
OmniScience Mobile

13. 100%
80%
60% Call
40% Center
20% Text
0% Messaging
Day 1
Day 2
Day 3
60% of those who use SMS are referred
“I contacted a subject who responded by text message and it
went great! She is scheduled for a visit within the week.” study
coordinator within 2 hours of receipt
“…it was very easy to maneuver.” anonymous patient

14. SMS for Recruitment

16. How NOT to Run an SMS Campaign

17. MOBILE APPS FOR
RECRUITMENT & RETENTION

18. Mobile Apps for Recruitment Have Limitations
• Limited Reach
– Smartphones only
– Used by only 36% of US mobile subscribers / 14% international subscribers
• Expensive
– software app must support all major platforms: iOS, Android, Windows, RIM,
Nokia
– significant cost for development & maintenance
• Highly Inefficient as Direct Response option – Promotional
materials driving traffic to an app there are too many steps:
1. Go to your phone’s app store
2. Find our app
3. Download it
4. Figure out where the app is on your phone
5. Click on the app to learn more about this study

19. Reference Apps Don’t Really Generate Referrals
Clinical Trials Mobile app
Who will take the time to find this app and use it to search
for clinical trials?

20. QR CODES

21. The Good and the Bad
• Inexpensive
• Only work for smartphone users
• Few have incorporated QR scanning into behavior
• Execution is tricky
– You can’t remember a QR code and ‘text’ it later
– Challenging for outdoor advertising
21

22. The Ugly
• No cell signal in NYC
subway
• Creative design blocks
code

23. Other Technologies
VOLUNTEER REGISTRIES &
RECRUITMENT PROTOCOLS

24. San Francisco General Hospital
Recruitment Pilot
• Investigators want to extend their reach
• 1 year pilot program for 10 studies
– 24/7 staffed phone line
– Weekly craigslist posting
– Outgoing calls to follow-up as needed
• Outcomes
– 692 volunteers (validated unique)
– 25% contacted for screening visits
– BMI was most beneficial data field for search criteria

25. Airway Clinical Research Center
Asthma Recruitment Database
• Local disease-
specific database
• Used as recruitment
protocol/registry
– Characterize asthma
severity
– Recruit for current studies
real-time
– Register for contact
regarding future studies –
already prequalified
•UCSF Airway Clinical Research Center (ACRC)

26. Recruitment Trends by County
San Francisco 52%
Alameda 16%
San Mateo 11%
Contra Costa 7%
Santa Clara 4%
Marin 3%
Sonoma 2%
Solano 1%
•UCSF Airway Clinical Research Center (ACRC)

27. BEST PRACTICES

28. Performing Initial Analyses
Study Design
 Site-specific protocols for study-specific and SOC
procedures
 Placebo arms, excessive inclusion/exclusion criteria
Site-specific
 Staff resources
 Location(s): accessibility, interoperability, features /
disadvantages
Competing Trials

29. Planning & Budgeting
Screen Failure Rate
Budget for the unexpected
 Design revisions
 Increased production & shipping costs over time
 Protocol revisions impacting recruiting
methods/materials

31. Implementing the Plan
Staged approach Communication Plan
 Sponsor/Site Staff
Multiple
 Primary contacts
simultaneous
 Secondary contacts
advertising efforts
Plan on changing Identify screening
your plan – analyze appointment
relatively often schedule workflow,
tools and conflicts

32. Ensuring High-Quality Participants
Start by casting a wide net
Think about a wide number of things or people when choosing the
thing or person you want*
Don’t skip the prescreening step
Ask the right questions at the right stage of
the recruitment process
*Idioms by The Free Dictionary

33. Monitoring Progress
Set realistic expectations up front
Identify benchmarks for success/failure
Simple tracking tools go a long way
Receiving logs & reports is not enough –
they have to mean something and be
actionable

34. THE UCSF PARTICIPANT
RECRUITMENT SERVICE

35. Create a centralized service to facilitate the enrollment of research
participants into UCSF clinical studies
 Assume a large part of the burden of recruitment efforts
 Provide expertise in recruitment materials development
 Ensure materials meet regulatory guidelines and requirements
 Offer an economy of scale for many recruitment activities
 Use established vendor relationships
 Increase the volume of high quality volunteers
 Facilitate a wider catchment and more robust networks

36. Recruitment Analysis and Planning
Robust recruitment plan
Analysis of recruitment landscape
Protocol complexities, procedures, SOC
Competing studies
Geographic/demographic population
Marketing & Outreach methodologies
Suggested strategies
Timelines
Budgets for suggested strategies

37. Cohort ID and Direct Mail
Identify cohorts from inpatient medical
records (UCare and ThREDS)
ICD-9 codes
Demographics
CHR modification
Coordinate data extract services from ARS
Print and mail direct mail letters to cohort

38. Recruitment Materials Toolkit

40. Future Services/Resources
Recruitment Plan Implementation
Centralized call center, text messaging, online
screeners
Marketing & outreach
Referral networks
Searchable database of actively recruiting
studies – matching
Real-time recruitment from EMR

41. THANK YOU