Barriers and Facilitators to Equitable Recruitment for a Clinical Trial of a Digital Health App for Asthma PROs

Savanna Plombon, BS, MPH
Department of Medicine
Division of General Internal Medicine and Primary Care
Poster Overview

Clinical trials often use digital methods for recruitment, which may unintentionally cause unequal recruitment of individuals from medically disadvantaged backgrounds. To promote more equal recruitment for our clinical trial of a smartphone application designed to monitor asthma symptoms, we used several recruitment methods, including mail, phone, texting, and messaging from Patient Gateway. Using our electronic health record, we identified 3,031 asthmatic patients who might be eligible. So far, we approached 612 and recruited 39. Approximately 76.6% were contacted through the patient portal and 23.4% were contacted only by mail. Of those who were mailed letters, 68.9% spoke Spanish. The 39 recruited participants had the following characteristics: 43.6% were Black or African American, 8 (20.5%) were Hispanic or Latino, and 16 (41%) were White. So far, we learned that some patients who have well-controlled asthma did not see a significant benefit in participating while other patients may have technological challenges. Several patients diagnosed with COVID-19 expressed interest in tracking their asthma symptoms more closely. Our next steps are to determine which methods are most successful at achieving equitable recruitment and to understand how COVID-19 influences recruitment into our study.

Scientific Abstract

 As digital tools are increasingly used to recruit participants into clinical trials, there is a need to better understand potential pitfalls to avoid underrepresentation of medically vulnerable patients. This study aims to assess a multi-pronged recruitment strategy designed to equitably recruit patients into a clinical trial of a digital health intervention. First, we queried the electronic health record to identify potential candidates using asthma related screening triggers. Of 3,031 potential participants identified, we approached 612 and recruited 39 to date. Of the 612 patients, 469 (76.6%) were enrolled in the institutional patient portal. Of 143 (23.4%) potential recruits who could only be contacted by mail, 31 (68.9%) were Spanish speakers. Of the 39 recruited patients, 17 (43.6%) were Black or African American, 16 (41%) were White, and 8 (20.5%) were Hispanic or Latino. Barriers for participation include, lack of perceived benefits by patients due to well-controlled asthma, and perception of poor technological literacy. Patients diagnosed with COVID-19 were interested in the intervention to track their asthma-related symptoms. Our next steps are to assess which methods are most successful regarding equitable recruitment and assess COVID-19 positivity within our cohort and its relationship to equitable recruitment into our clinical trial.

Clinical Implications
Medically vulnerable individuals are often underrepresented in clinical trials. A new study describes the methods and analysis of a multi-pronged recruitment strategy for equitable recruitment.
Research Areas
Savanna Plombon, MPH; Stephanie Roulier, Sofia Perez, Jorge Rodriguez, MD; Robert Rudin, PhD; David Bates, MD; Anuj Dalal, MD
Principal Investigator
Anuj Dalal, MD

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One reply on “Savanna Plombon, BS, MPH”

Is your trial app for Asthma independent from the EHR you queried the data from (as described in the Methods section of your poster)?
Database in EHR at BWH should have the demographic info of the potential candidates. Is your app not duplicating similar service available at the EHR or there is no such service available, hence you pioneered this work?
Who were the consumer of the data from your app? The recruiting departments and/or physicians/pharmacists …?
Are you planning to publish your finding?
Are you still in the research phase to gather more data and testing the results? aka is your work on this project finished?
In Results section, you said of the 88 recruits: 24 (White), 22 (Black), 11 (Hispanic), that only added up to 57. What are the demographics of the remaining 31?

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