Department of Family Medicine researchers at the University of Michigan found that social media and remote communications were highly effective replacements for in-person study recruitment efforts during the COVID-19 pandemic, particularly in reaching out to pregnant women at high-risk of STIs.
The research team, which included first author and Associate Professor Golfo Tzilos Wernette, Ph.D., recently published their findings in, “A Whole New World: Overcoming Methodological Challenges in the Post-Pandemic Recruitment of Pregnant Women at Risk of STIs” in Prevention Science.
Traditional in-person recruitment efforts were halted as the team was recruiting for the Health Check-up for Expectant Moms, a technology-delivered, behavioral skills intervention aimed at empowering and motivating pregnant women engaging in substance use and sexual health risks to reduce their likelihood of STIs and substance use during pregnancy.
At the pandemic's onset, the study team modified recruitment efforts, transitioning from in person to remote activities (i.e., phone, text messaging and email) and social media with a confidential, web-based screening questionnaire. They also enlarged the study’s demographic catchment area, adding 27 Michigan counties to the initial eight surrounding counties near Michigan Medicine.
During in-person recruitment pre-COVID, the team approached 860 women, 213 of whom went on to take the screening questionnaire. Of these, 126 were eligible, and 70 enrolled.
In comparison, during remote recruitment, the team contacted 6,238 women, 1,360 of whom completed the study screening questionnaire. Ninety were eligible and 73 were enrolled. For social media recruitment, the team had 2,512 women complete the pre-screening questionnaire. Of these, 501 women went on to complete the full study screening questionnaire, 25 women were eligible, and 20 were enrolled.
“Our 5% eligibility rate from our social media campaign is on par with our remote and in-clinic recruitment methods yet took far less time (15 weeks vs. 150 weeks vs. 48 weeks, respectively),” Tzilos Wernette et al said. “Despite study recruitment challenges related to the pandemic, remote recruitment—particularly social media—was found to be a successful approach, may have a broader reach, and a cost-effective alternative to active recruitment.
The researchers avoided invalid or duplicate applicants and internet bots by using reCAPTCHA verification and open-text response questions during the pre-screening recruitment stage. They also checked IP addresses and required interested women to leave their contact information for a follow-up phone call. They also checked email and phone number lists, removing duplicate information. Additionally, they adjusted incentive rewards so that they were disbursed at the end of the study, ensuring applicant validity.
Tzilos Wernette and her co-authors note that their study is one of the first to describe the pandemic’s impact on the recruitment of pregnant women with heightened behavioral risks, as well as the lessons learned in overcoming recruitment barriers.
“Remote recruitment has important implications, even in our now ‘post-pandemic’ world,” the authors write. “Once implemented, these methods can offer efficiency, lessen the burden on study teams and participants, and can also vastly expand the pool of recruits far beyond what is feasible with traditional in-person recruitment methodology.
Online survey anonymity also elicited more frank information sharing and provided a greater level of comfort for the participating patients.
“This digital nature also allows the participant to choose the space and time that they feel most comfortable for completing surveys and other study tasks, the importance of which cannot be understated,” the authors write. “Removing the invisible barrier of perceived stigma and judgement is not only a more person-centered approach, but it could lead to more authentic responses and therefore less bias-prone data.”
Article Citation: Tzilos Wernette, G., Countryman, K., Chen, D., Mmeje, O., Sen, A., Ngo, Q. M., & Zlotnick, C. (2025). A whole new world: Overcoming methodological challenges in the post-pandemic recruitment of pregnant women at risk of STIs. Prevention Science. https://doi.org/10.1007/s11121-025-01775-1
