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      Cost Per Participant Recruited From Rural and Remote Areas Into a Smoking Cessation Trial Via Online or Traditional Strategies: Observational Study

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          Abstract

          Background

          Rural and remote residents are more likely to smoke than those who live in major cities; however, recruitment of research participants from rural and remote areas can be challenging. The cost per participant recruited from rural and remote areas via online (eg, social media) and traditional strategies (eg, print) has implications for researchers on how to allocate resources to maximize the number of participants recruited. Participant characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with recruitment method (ie, online vs traditional), and so it is important to understand whether certain subgroups are more likely to be recruited via a particular strategy.

          Objective

          This study aimed to determine the cost per participant recruited and examine whether characteristics such as demographics, financial stress, mental health, and smoking-related factors may be associated with the recruitment method (ie, online vs traditional).

          Methods

          Participants were recruited into a randomized trial that provided smoking cessation support. Eligible participants were aged 18 years or older; used tobacco daily; had access to video communication software, internet, and telephone; had an email address; and lived in a rural or remote area of New South Wales, Australia. This study describes the natural (observed) experience of recruiting participants via online and traditional methods into a smoking cessation trial.

          Results

          Over 17 months, 655 participants were recruited into the smoking cessation trial. A total of 88.7% (581/655) of the participants were recruited via online methods. Moreover, 1.8% (12/655) of the participants were recruited from remote locations and none from very remote areas. The cost per participant recruited by the various online strategies ranged from Aus $7.29 (US $4.96, £4.09, and €4.43) for Gumtree, a local online classified website, to Aus $128.67 (US $87.63, £72.20, and €78.28) for email. The cost per participant recruited using traditional strategies ranged from Aus $0 (US $0, £0, and €0) for word of mouth to Aus $3990.84 (US $2757.67, £2227.85, and €2477.11) for telephone. Women had greater odds of being recruited via online methods than men (odds ratio 2.50, 95% CI 1.42-4.40). No other characteristics were associated with the recruitment method.

          Conclusions

          The cost per participant recruited via online and traditional strategies varied, with the range being smaller for online than traditional recruitment strategies. Women have greater odds of being recruited via online strategies into rural smoking cessation trials.

          Trial Registration

          Australian New Zealand Clinical Trials Registry ACTRN12617000514303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372584&isReview=true

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          Most cited references37

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          A reinvestigation of recruitment to randomised, controlled, multicenter trials: a review of trials funded by two UK funding agencies

          Background Randomised controlled trials (RCTs) are the gold standard assessment for health technologies. A key aspect of the design of any clinical trial is the target sample size. However, many publicly-funded trials fail to reach their target sample size. This study seeks to assess the current state of recruitment success and grant extensions in trials funded by the Health Technology Assessment (HTA) program and the UK Medical Research Council (MRC). Methods Data were gathered from two sources: the National Institute for Health Research (NIHR) HTA Journal Archive and the MRC subset of the International Standard Randomised Controlled Trial Number (ISRCTN) register. A total of 440 trials recruiting between 2002 and 2008 were assessed for eligibility, of which 73 met the inclusion criteria. Where data were unavailable from the reports, members of the trial team were contacted to ensure completeness. Results Over half (55%) of trials recruited their originally specified target sample size, with over three-quarters (78%) recruiting 80% of their target. There was no evidence of this improving over the time of the assessment. Nearly half (45%) of trials received an extension of some kind. Those that did were no more likely to successfully recruit. Trials with 80% power were less likely to successfully recruit compared to studies with 90% power. Conclusions While recruitment appears to have improved since 1994 to 2002, publicly-funded trials in the UK still struggle to recruit to their target sample size, and both time and financial extensions are often requested. Strategies to cope with such problems should be more widely applied. It is recommended that where possible studies are planned with 90% power.
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            The importance of place of residence: examining health in rural and nonrural areas.

            We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
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              Online social networking and mental health.

              During the past decade, online social networking has caused profound changes in the way people communicate and interact. It is unclear, however, whether some of these changes may affect certain normal aspects of human behavior and cause psychiatric disorders. Several studies have indicated that the prolonged use of social networking sites (SNS), such as Facebook, may be related to signs and symptoms of depression. In addition, some authors have indicated that certain SNS activities might be associated with low self-esteem, especially in children and adolescents. Other studies have presented opposite results in terms of positive impact of social networking on self-esteem. The relationship between SNS use and mental problems to this day remains controversial, and research on this issue is faced with numerous challenges. This concise review focuses on the recent findings regarding the suggested connection between SNS and mental health issues such as depressive symptoms, changes in self-esteem, and Internet addiction.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                November 2019
                12 November 2019
                : 21
                : 11
                : e14911
                Affiliations
                [1 ] University of Newcastle Callaghan Australia
                [2 ] Hunter New England Population Health Wallsend Australia
                [3 ] Hunter Medical Research Institute New Lambton Heights Australia
                Author notes
                Corresponding Author: Judith Byaruhanga judith.byaruhanga@ 123456uon.edu.au
                Author information
                https://orcid.org/0000-0003-0382-1552
                https://orcid.org/0000-0002-9914-2732
                https://orcid.org/0000-0002-0504-5246
                https://orcid.org/0000-0001-6361-9685
                https://orcid.org/0000-0001-6168-0167
                https://orcid.org/0000-0002-8931-473X
                Article
                v21i11e14911
                10.2196/14911
                6880230
                31714253
                f51858fd-a041-40fb-85d6-97a955b9e665
                ©Judith Byaruhanga, Flora Tzelepis, Christine Paul, John Wiggers, Emma Byrnes, Christophe Lecathelinais. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.11.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 3 June 2019
                : 6 July 2019
                : 9 August 2019
                : 29 August 2019
                Categories
                Original Paper
                Original Paper

                Medicine
                smoking cessation,tobacco use,rural population
                Medicine
                smoking cessation, tobacco use, rural population

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