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Variations in Recruitment Yield and Characteristics Of Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM) The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Merchant, Roland C., Justin Romanoff, Melissa A. Clark, Tao Liu, Joshua G. Rosenberger, Jose Bauermeister, and Kenneth H. Mayer. 2017. “Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who- Have-Sex-With-Men (YMSM).” American Journal of Men's Health 11 (5): 1342-1357. doi:10.1177/1557988317717383. http:// dx.doi.org/10.1177/1557988317717383. Published Version doi:10.1177/1557988317717383 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34651968 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA JMHXXX10.1177/1557988317717383American Journal of Men’s HealthMerchant et al. 717383research-article2017 HIV/AIDS/STIs American Journal of Men’s Health 2017, Vol. 11(5) 1342 –1357 Variations in Recruitment Yield and © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav Characteristics of Participants Recruited DOI:https://doi.org/10.1177/1557988317717383 10.1177/1557988317717383 Across Diverse Internet Platforms in an journals.sagepub.com/home/ajmh HIV Testing Study of Young Adult Men- Who-Have-Sex-With-Men (YMSM) Roland C. Merchant, MD, MPH, ScD1, Justin Romanoff, MA2, Melissa A. Clark, PhD3, Tao Liu, PhD2, Joshua G. Rosenberger, PhD4, Jose Bauermeister, MPH, PhD5, and Kenneth H. Mayer, MD6 Abstract The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered. Keywords risk behaviors, behavioral issues, health screening, HIV/AIDS, gay, special populations, research Received February 27, 2017; revised May 10, 2017; accepted May 15, 2017 The Internet is a medium commonly employed for policies across platforms. In addition, methodological recruiting harder-to-reach, geographically dispersed, limitations may threaten the internal and external validity smaller populations quickly (e.g., young adult men-who- of Internet-based studies, such as the recruitment meth- have-sex-with-men [YMSM]). Internet-based recruit- ods utilized and low participation rates. Moreover, best ment has the advantages of ubiquity of the Internet across practices on Internet-based research methodology have society, low costs, presence of websites designed for spe- yet to be established. These and other concerns can affect cific populations (e.g., sex seeking), and ability to enroll the conclusions of studies of significant public health participants in a shorter time period than some other strat- importance, such as investigations on HIV/AIDS among egies. Internet recruitment strategies are in constant flux YMSM. due to continuous changes in Internet platforms over For studies that aim to recruit YMSM, there is no time, varying popularity of social networking sites, and national database or registry from which to draw a ran- dissimilar recruitment abilities and advertisement domly selected representative sample, nor is there a Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Merchant et al. 1343 perfect method of assuring external validity of the sample third objective was to learn if variations in participant obtained. Internet platforms may differ by mode of deliv- characteristics of those recruited and the homogeneity of ery (web-based vs. app-based), cater to different audi- the sample by race/ethnicity varied by Internet platform. ences (e.g., by sociodemographic characteristics and/or The ultimate aim of this investigation was to assess how interests), and have different functions in YMSM lives the choice of Internet platform affects the participant (e.g., socializing vs. purely sex seeking). Thus, relying on population and data obtained so that best practices on a single platform for recruitment may create uninten- Internet-based research involving YMSM and other tional selection bias and lack of representativeness in a groups eventually can be developed to improve and research study. One approach to improve reach, diversity, inform the quality of research methodology. and representativeness is to employ multiple Internet platforms for recruitment. The utility of this approach has Method not been studied adequately, and its impact on the compo- sition of the study sample recruited as well as on study Study Design results and conclusions is not yet known. Knowing the variations across platforms of participants recruited is This investigation was a secondary analysis of enrollment and questionnaire responses from an anonymous, imperative in assisting researchers investigating impor- Internet-based survey of Black, Hispanic, and White tant public health topics and choosing platforms for YMSM recruited across multiple Internet platforms Internet-based recruitment, and this informs efforts to between August 2014 and December 2014. Data were improve Internet-based research methods. collected as part of a larger parent study of the HIV test- This team of researchers recently completed an ing histories and opinions about HIV testing methods of Internet-based study that aimed to understand YMSM 18- to 24-year-old Black, Hispanic, and White YMSM HIV testing history and sexual risk-taking behaviors (Merchant R. C., 2017). The hospital’s institutional (Merchant R. C., 2017) HIV-uninfected Black, Hispanic, review board approved the study. and White YMSM (18 to 24 year-olds) from across the United States were recruited specifically for that study because they are disproportionately affected by HIV in Participant Recruitment the United States (US) and collectively form a popula- A variety of general and MSM-specific social media and tion for whom interventions are needed to reduce HIV other Internet platforms was chosen as venues for study acquisition. The objective of the current investigation recruitment for the parent study based on the popularity, reported in this manuscript was to examine the impact of target audiences, cost, advertising availability, and techni- using the multiple Internet platforms chosen for the par- cal capabilities of these platforms. Participants were ent study to recruit these YMSM in regard to recruit- recruited from the Internet platforms Bender, BGCLive, ment, retention, and participant characteristics. To Facebook, Grindr, Growlr, Pinterest, and Reddit (Table 1). address knowledge deficits regarding recruitment and Recruitment strategies varied by platform capabilities, retention patterns among YMSM recruited online, the which included targeted advertisements, pop-up advertise- first objective was to compare advertising and enroll- ments, banner advertisements, and postings. The recruit- ment metrics (e.g., time to recruit, clicks, costs) across ment strategies included brief information about the study Internet platforms used in the parent study. The second and a link to the study website where potential participants objective was to compare demographic characteristics, could receive more information. Recommended tech- HIV testing history, and HIV sexual risk-taking behav- niques (Pequegnat et al., 2007) were followed to reduce iors of participants recruited across these platforms.
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