Recruitment of participants to, and their retention in, RCTs is a key determinant of research efficiency, but is challenging (Treweek 2013). As a result, trialists and CTUs are increasingly exploring the use of digital tools to identify, recruit and retain participants.
Examples of these tools include:
• Eligibility: searches and interactive record tools to support clinicians screening participants (e.g. Koepcke et al. 2013)
• Recruitment: trial websites, social media and email campaigns to engage with the public
• Retention: Emails, websites, text messages or apps to retain patients in trials and help them meet drug, behavioural adherence or outcome assessment criteria
These tools should benefit research by reducing costs, avoiding waste and speeding delivery of results, improve recruitment reach and reduce recruitment of ineligible patients (around 6% in Koepcke’s study 2013). However, selecting appropriate digital tools is challenging because few have been evaluated rigorously. Also, different success metrics are used: for example, reduced screening time, improved coverage of recruitment or percentage of patients recruited. We need to understand which metrics are most relevant to stakeholders, to ensure wider uptake of effective tools.
We identified only one systematic review in this area, on databases to improve trial recruitment [Koepcke 2014]. The methods used were not rigorous by current standards, and it located only 9 studies using reasonably robust methods. It concluded that databases could reduce the time taken to screen participants, improve participant coverage and actual recruitment rates by between 14% and 6 times, though 4 of 5 studies used an uncontrolled before-after design and the fifth was confounded.
Our view, is that the evidence base for these tools needs to be assembled, mapped and critically appraised before synthesis, where appropriate. Only then can we confidently advise on the wider use of such tools by trialists, or on further primary research.
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