Background
The problem: inadequate patient recruitment and retention
Potential solutions: digital tools
Current evidence
Rationale for systematic mapping as an evidence-synthesis approach
Systematic map research question
Aims and objectives
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To develop a systematic map to identify and characterise the research studies that have evaluated digital tools for recruiting and retaining participants in clinical and health RCTs
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Based on the results of the map, to summarise any key evidence gaps and areas where a more detailed, focused, evidence synthesis of effectiveness could be worthwhile; and to provide recommendations for further primary research as necessary
Methods
Project management and protocol
Searches
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Ovid MEDLINE (including MEDLINE Epub Ahead of Print, MEDLINE In-Process and Other Non-Indexed Citations and MEDLINE Daily; 1990 to July 2018)
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Ovid Embase (1990 to 17 July 2018)
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Inspec (Institute of Engineering and Technology) (1990 to 18 July 2018)
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Web of Science (a cross-database search including the BIOSIS Citation Index, BIOSIS Previews, Current Contents Connect, Data Citation Index, Derwent Innovations Index, Inspec and the KCI Korean Journal Database; 2000 to 18 July 2018)
Eligibility screening process
Eligibility criteria
Populations
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Health professionals (e.g. physicians, nurses, therapists)
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Researchers and study administration staff (e.g. study investigators, research managers)
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Patients, their carers or the general public
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Healthy volunteers
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People from disciplines outside health, medical or clinical research
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Mixed populations in which not all participants met the inclusion criteria and outcomes were not separately reported for those who met the inclusion criteria
Interventions
Comparators
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Standard practice for participant recruitment or retention (for the given study sponsor or institution conducting the study)
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Non-digital approaches (e.g. approaches that comprise paper-based or manual tools)
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Recruitment or retention approaches comprising digital tools other than those included in the intervention
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Digital approaches comprising ‘bundles’ of tools (i.e. where the comparator included more than one digital and/or non-digital tool)
Outcomes
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Recruitment rate (e.g. the proportion of the intended number of participants enrolled in the study)
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Qualitative assessment of recruitment accuracy (e.g. similarity of the characteristics of the recruited participants against the study eligibility criteria)
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Participant retention in a study (e.g. the proportion of recruited participants who remained in the study at the end)
Study designs
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The design of the RCT into which participants were recruited and retained. For clarity we refer to this as the host trial
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The design of the research that investigated the accuracy or effectiveness of the digital approaches for recruitment and/or retention in the host trial. We refer to this as the primary evaluation study. For clarity, throughout the rest of this paper we refer to ‘trial’ when referring to the host trial and ‘study’ when referring to the primary evaluation study
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To be eligible for inclusion, the host trial had to be an RCT. The primary evaluation study could be of any design (e.g. RCT, quasi-experimental study or observational study), provided that relevant outcomes (as specified above) were reported for the intervention (i.e. the digital recruitment or retention approach of interest) and at least one comparator. The primary evaluation studies could conform to the broad definition of a ‘study within a trial’ (SWAT), which is ‘a self-contained research study that has been embedded within a host trial with the aim of evaluating or exploring alternative ways of delivering or organising a particular trial process’ [66]. However, in order to fully capture the range of evaluative research studies that have been conducted on RCT recruitment and retention, our inclusion criteria are wider than those that would define a SWAT. For example, we permitted retrospective studies to be included; and we did not require evidence that studies were based on a formal protocol, as is recommended for SWATs [66].
Coding of eligible studies and development of the systematic map
Data extraction strategy
Results
Searching, study selection and map coding
Reviewer eligibility screening agreement
Reviewer map-coding agreement
Systematic map results
Characteristics of the studies
Characteristics of the digital approaches
Recruitment approaches and tools
Digital tool | Number of studies | % of recruitment studies (n = 96) | % of all studies (N = 105) |
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Internet site | 51 | 53 | 49 |
Social media | 40 | 42 | 38 |
email | 30 | 31 | 29 |
Television or radio | 30 | 31 | 29 |
Automated screening to identify potential participants | 22 | 23 | 21 |
Internet forum | 5 | 5 | 5 |
Smartphone or tablet App | 5 | 5 | 5 |
Video | 5 | 5 | 5 |
Automated identification of trials for which people are potentially eligible | 4 | 4 | 4 |
Instant-messaging or text-messaging | 4 | 4 | 4 |
Automated telephone call | 2 | 2 | 2 |
Other computer programme | 2 | 2 | 2 |
Chatbot | 1 | 1 | 1 |
Crowd-sourcing platform | 1 | 1 | 1 |
Virtual snowballing | 1 | 1 | 1 |
Smartphone or tablet other use | 1 | 1 | 1 |
Internet pop-up advertisements | 0 | 0 | 0 |
Digital lecture/presentation (e.g. PowerPoint) | 0 | 0 | 0 |
Others | 16 | 17 | 15 |
Retention approaches and tools
Digital tools | Number of studies | % of retention studies (n = 20) | % of all studies (N = 105) |
---|---|---|---|
email | 14 | 70 | 13 |
Instant-messaging or text-messaging | 10 | 50 | 10 |
Other computer programme | 3 | 15 | 3 |
Internet site | 2 | 10 | 2 |
Smartphone or tablet App | 2 | 10 | 2 |
Social media | 2 | 10 | 2 |
Smartphone or tablet other use | 1 | 5 | 1 |
Automated telephone call | 0 | 0 | 0 |
Chatbot | 0 | 0 | 0 |
Digital lecture/presentation (e.g. PowerPoint) | 0 | 0 | 0 |
Internet forum | 0 | 0 | 0 |
Video | 0 | 0 | 0 |
Virtual assistant/gadget | 0 | 0 | 0 |
Types of recruitment and retention outcomes studied
Application of digital tools in specific populations
Health-topic area where digital tools have been evaluated | Number (%) of studies | |
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Total studies | Studies on minority or under-served populations | |
Health promotion and public health | 37 | 8 (22) |
Cancers | 17 | 1 (6) |
Endocrine, nutritional and metabolic disorders | 17 | 0 |
Circulatory system diseases | 13 | 2 (15) |
Mental health | 10 | 2 (20) |
Other | 10 | 2 (20) |
Maternal health and pregnancy | 4 | 1 (25) |
Brain and nervous system diseases | 4 | 0 |
Infectious diseases | 3 | 1 (33) |
Digestive system diseases | 2 | 0 |
Bone and joint diseases | 2 | 0 |
Genito-urinary system diseases | 2 | 0 |
Respiratory diseases | 1 | 0 |
Skin diseases | 1 | 0 |