Abstract
BackgroundIn response to the COVID-19 pandemic and associated adoption of scarce resource allocation (SRA) policies, we sought to rapidly deploy a novel survey to ascertain community values and preferences for SRA and to test the utility of a brief intervention to improve knowledge of and values alignment with a new SRA policy. Given social distancing and precipitous evolution of the pandemic, Internet-enabled recruitment was deemed the best method to engage a community-based sample. We quantify the efficiency and acceptability of this Internet-based recruitment for engaging a trial cohort and describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools.MethodsWe recruited 1971 adult participants (≥ 18 years) via engagement with community partners and organizations and outreach through direct and social media messaging. We quantified response rate and participant characteristics of our sample, examine sample representativeness, and evaluate potential non-response bias.ResultsRecruitment was similarly derived from direct referral from partner organizations and broader social media based outreach, with extremely low study entry from organic (non-invited) search activity. Of social media platforms, Facebook was the highest yield recruitment source. Bot activity was present but minimal and identifiable through meta-data and engagement behavior. Recruited participants differed from broader populations in terms of sex, ethnicity, and education, but had similar prevalence of chronic conditions. Retention was satisfactory, with entrance into the first follow-up survey for 61% of those invited.ConclusionsWe demonstrate that rapid recruitment into a longitudinal intervention trial via social media is feasible, efficient, and acceptable. Recruitment in conjunction with community partners representing target populations, and with outreach across multiple platforms, is recommended to optimize sample size and diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.Trial registrationClinicalTrials.gov NCT04373135. Registered on May 4, 2020
Highlights
In response to the COVID-19 pandemic and associated adoption of scarce resource allocation (SRA) policies, we sought to rapidly deploy a novel survey to ascertain community values and preferences for SRA and to test the utility of a brief intervention to improve knowledge of and values alignment with a new SRA policy
As about 1% of website traffic originated from organic searches, compared to the 55–60% from direct website entry or referral and 40–45% from social media recruitment, likelihood of un-invited survey participation is relatively low (Table 1)
Observed website traffic reflected the shift in recruitment strategy from outreach through partner organizations from May through July to broader social media based recruitment in August
Summary
In response to the COVID-19 pandemic and associated adoption of scarce resource allocation (SRA) policies, we sought to rapidly deploy a novel survey to ascertain community values and preferences for SRA and to test the utility of a brief intervention to improve knowledge of and values alignment with a new SRA policy. Concern for health system capacity and virus containment prompted many health officials, universities, and hospitals to undertake development of scarce resource allocation (SRA) policies [1] These policies outline rules for distribution of limited resources, such as ventilators or hospital beds, and aim to do so in a way that is both consistent and ethical, with imperatives for maximizing benefits, equal treatment, and prioritization on instrumental value and need that can be operationalized in a number of ways [2]. Though medical ethicists have written extensively on how to construct such a framework, there are limited studies that aim to evaluate and intervene on knowledge of and agreement with these ethical principles during an active pandemic when the threat of their application is extant [3] Conducting such a study requires reaching populations who may be the subject of allocation decisions and may be responsible for applying allocation decisions; both of which can be hard to reach during an active crisis. These methods have proven especially useful for the rapid recruitment into COVID-related studies during the current pandemic [12]
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