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Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low.
This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials.
A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used.
Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%).
The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed.
Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307
Parenting programs, aimed at strengthening parenting skills and increasing knowledge on adolescent development, have shown positive effects on parent-adolescent relationships and parent-adolescent well-being [
Recently, there has been a surge of interest in the development of mobile health (mHealth) interventions as a means of expanding intervention reach [
In this paper, we describe the recruitment and retention methods used in the MyTeen trial. This is the first study to systematically document the process and identify key lessons learned from a text-messaging parenting program for parents of adolescents. We aim to report on our recruitment experience with MyTeen to support parents of adolescents. The paper provides insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials.
This section provides an overview of the study design of the MyTeen trial, including the recruitment plan developed.
The study was approved by the University of Auckland Human Participants Ethics Committee (UAHPEC, Ref 019659), and the study protocol has been published elsewhere [
We aimed to recruit a representative sample of 214 parents (n=107 per randomized group; 1 parent per household) residing in New Zealand across a 6-month period. This sample size provided 80% power (
Strategies for successful recruitment and retention were considered at the onset of the project, and a recruitment plan was developed, monitored, and modified as needed throughout the project. Potential barriers (eg, budget constraints, timeframe, and attrition) and strategies to facilitate recruitment (eg, program content and recruitment material, staff characteristics, recruitment strategies, and study procedures) were identified. Each of these strategies are outlined below.
A key factor to program success was to ensure that the program met the needs of the targeted population. To this end, formative work was conducted comprising 5 focus groups (n=45) of parents or primary caregivers of adolescents (10-15 years) to ensure the content, duration, and mode of delivery were acceptable and feasible for these parents. We examined the parents’ perspectives on youth well-being, parenting, and parenting support and their input on the development of MyTeen text messaging parenting program (details reported elsewhere [
One project manager and 2 research assistants conducted the recruitment, retention contacts, and logistical arrangements, with oversight by the principal investigator (JC). One of the research assistants who identified as Māori (indigenous people of New Zealand) actively engaged with ethnic minorities via her own networks, as well as promoted visibility of the program within the Māori community. Primary recruitment activities included communicating with various organizations and networks, reviewing enrolment reports, communicating the enrolment status to the steering committee, and monitoring social media and communications with our data management team.
The proposed recruitment period was 6 months. However, we reached our targeted sample within 5 months (March 2018 to August 2018).
Recruitment strategies used over timea.
Recruitment strategies | Week | ||||||||||||||||||||||||||||||
0 | 2 | 4 | 6 | 8 | 10 | 12 | 14 | 16 | 18 | 20 | 22 | 24 | 26 | 28 |
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Targeted minority recruitment | ✓ | ✓ | ✓ |
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Flyers | ✓ | ✓ | ✓ |
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Community event | ✓ | ✓ |
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Social media (eg, Facebook) | ✓ | ✓ | ✓ |
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Paid Facebook ad | ✓ |
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Email Listserv | ✓ |
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School newsletter | ✓ | ✓ | ✓ | ✓ |
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Website advertisement | ✓ |
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aWord of mouth is not shown in the table as it was used throughout the recruitment period.
Specifically, recruitment strategies varied by site or context, as described below.
Emails explaining the study process and asking for permission to advertise via schools were sent to 388 schools across New Zealand. Of those, 7 (1.8%) schools included our advertisement in their e-newsletter.
Approximately 50 hard copies of flyers were distributed in the community via community events and local and community organizations. Community organizations and individuals were encouraged to forward or share the information among others who might be interested. The visibility of the flyers in the community helped provided legitimacy and familiarity of the study and made initial contacts more positive.
Participants were also recruited via word of mouth, with the message spread among local community organizations. Participants who enrolled in the study were also encouraged to share and inform others who might be interested, serving as agents to expand recruitment.
A free editorial piece was written for a website that provided information, guides, and events in Auckland for families with children. The website was widely accessed by parents, with over 37,000 followers on their Facebook page. The study was also advertised on the University of Auckland’s research opportunity website.
A recruitment email describing the study was sent to demographically diverse email lists of organizations across New Zealand, including the University of Auckland and “Health Promoting School” (now inactive), with subscribers comprising educators and health professionals. Individuals were encouraged to forward the recruitment email to parents who might be interested.
A number of community organizations were approached via email and personal network for permission to post our advertisement on their social media pages. Of the 47 organizations approached, 9 (19.1%) promoted our study and posted the advertisement on their social media pages. Furthermore, a paid Facebook ad post was set up during week 18 of recruitment, and it lasted for 2 weeks and targeted parents who resided in New Zealand. We monitored the performance of the ad campaign, as response drop-offs were common over time.
Multiple strategies were used to recruit the ethnic minority. These included focused outreach efforts utilizing social networks of our research team and emphasized heavily on direct person-to-person contacts and community referrals. In addition to initiating contacts with key members of the community, our research staff also relied on other events and group settings that involved the target community, such as community events, church groups, and sports clubs, where they informally provided information about the study.
Care was taken to minimize participant burden, a factor that likely contributes to study enrolment and retention [
Screening and eligibility of interested participants were assessed over the phone. Our research assistant provided information about the study and made sure that the participants understood the importance of follow-up data collection being essential and integral to the research. Participants were explicitly told that participation involves completion of 3 sets of questionnaires at various time points. Eligible individuals had 2 weeks to provide consent and complete the baseline assessment. Personalized reminder emails were sent to eligible individuals between 3 and 5 days postscreening if they had not completed the assessment. On day 10, a phone call was made to remind the study participants to complete the baseline assessment. Up to 3 emails and 2 phone calls were made before the eligible participant was deemed unable to contact or as someone who refused participation.
Assessments were conducted immediately post intervention (1 month) and 3 months after randomization. To maximize data retention at each assessment, multiple methods of communications were used to support participant retention, including texting, emailing, and phone calls. Five days before the assessment was due, participants were sent a reminder email to thank them for their participation and remind them about the upcoming assessment. For the control group, the email also specified that the participant would have the option to receive MyTeen text messages upon completion of the final assessment. For participants who did not complete the assessment within 3 days of the assessment email, up to 2 text message reminders (3-4 days apart) were sent and a final email or phone call was sent after 2 weeks of noncompletion. We incentivized participants with a NZ $20 (US $13.60) supermarket voucher upon completion of all assessments and the option to be included in a draw for a supermarket voucher valued at NZ $150 (US $102).
Number of participants who expressed interest in the study over time.
Demographic characteristics of the study sample classified by ethnicities.
Characteristic | Maori (n=29) | Pacific (n=17) | Non-Maori, non-Pacific (n=175) |
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Child’s age (years), mean (SD) | 12.4 (1.5) | 12.2 (1.7) | 12.3 (1.6) |
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Female | 14 (48.3) | 7 (41.2) | 79 (45.1) |
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Male | 15 (51.7) | 10 (58.8) | 96 (54.9) |
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Mother | 27 (93.1) | 15 (88.2) | 166 (94.9) |
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Father | 1 (3.4) | 1 (5.9) | 5 (2.9) |
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Stepparent | 0 (0) | 1 (5.9) | 1 (0.6) |
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Grandparent | 1 (3.4) | 0 (0) | 2 (1.1) |
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Close relative | 0 (0) | 0 (0) | 1 (0.6) |
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Married or de facto | 20 (69) | 14 (82.4) | 183 (82.8) |
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Divorced, separated, or widowed | 7 (24.1) | 2 (11.8) | 30 (13.6) |
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Never married | 2 (6.9) | 1 (5.9) | 8 (3.6) |
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University | 13 (44.8) | 11 (64.7) | 144 (82.3) |
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Trade or technical college | 4 (13.8) | 0 (0.0) | 6 (3.4) |
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High school or less | 7 (24.1) | 5 (29.4) | 19 (10.9) |
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Other | 5 (17.2) | 1 (5.9) | 6 (3.4) |
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Original family | 17 (58.6) | 12 (70.6) | 130 (74.3) |
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Stepfamily | 3 (10.3) | 2 (11.8) | 15 (8.6) |
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Sole parent family | 6 (20.7) | 2 (11.8) | 22 (12.6) |
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Living with extended family | 3 (10.3) | 0 (0) | 9 (3.4) |
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Other | 0 (0) | 1 (5.9) | 2 (1.1) |
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Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%) follow-ups. On average, participants in the intervention and control groups took 3.72 (SD 5.43) and 2.33 (SD 3.83) days, respectively, to complete the 1-month assessment, and 3.82 (SD 6.74) and 4.09 (SD 7.71) days, respectively, to complete the 3-month assessment.
Our recruitment efforts were successful—the target sample size was achieved, with a high completion rate for the trial and within the anticipated time frame. However, we did not achieve the representative demographic makeup (ethnicity and socioeconomic variables) in our trial. Below, we describe and reflect on the lesson learned.
First, reliance on traditional recruitment methods, such as distribution of flyers and posters, targeted minority recruitment via word of mouth, and community referral was not particularly effective. There were few referrals from community organizations where we had posted our flyers. Similarly, handing out flyers at community events resulted in limited responses. It is likely that merely posting and handing out these flyers was not enough in these settings. Recruitment of parents from schools attended by their children was also not very fruitful. In all, 388 schools nationwide were contacted for recruitment, but only a few responded. Nonetheless, those that did advertise our study spiked an increase in expression of interest. Our findings on engagement with schools are similar to that of other studies [
Web-based strategies appear to have yielded the most response in our trial. A number of parents responded to our Facebook post and website advertisements. The use of email listserv also appeared to have yielded a spike in interest; however, it was not possible to know how many parents were reached, as individuals were encouraged to forward the email to others who might be interested in the study. It is worth noting that the ability of email lists to target a select population may result in a sample that is not representative of all parents. Our advertisement email sent to the University listserv resulted in sample of highly educated parents, which was thus less representative of the general population. Obtaining permission to post to listservs, which may accept posts only from group members, can also be challenging. Nonetheless, this approach required minimum staff effort. Studies examining web recruitment strategies have reported large variation in how many participants researchers can recruit, cost per participant, diversity of the sample, and the length of time required for recruitment [
Second, although we actively sought to recruit ethnic minorities, we failed to attract interest. We were aware of our limitations at the onset of the project in recruiting minority populations but were restricted by resources and time to address the challenges. We recognize that recruitment strategies should be culturally sensitive and tailored to the needs of a given group. Time to build relationships and resources to comprehensively reach a community is a requisite. By developing a partnership with trusted individuals and organizations early during the research process, researchers can build a bridge to communities that may feel disenfranchised from traditional academic research [
In addition to the strategies used, the success of our recruitment and retention efforts may have been attributed to the following factors. First, careful planning and continuous monitoring throughout the recruitment process appeared to be critical for success. We set realistic recruitment targets, monitored progress, and modified our recruitment plan against those targets as needed. Recruitment was boosted when there was a decline in interest, whereas recruitment strategies were put on hold when there was a sudden increase in the expression of interest, leading to a backlog of participants requiring to be screened. A high degree of flexibility in the recruitment strategies was thus deemed necessary.
Second, our use of simple appreciation and reminder emails between assessments appeared to help with participant retention. On average, participants completed the follow-up assessment within 2 to 3 days of receiving the email link to the survey. These efforts encouraged participants to feel connected to the project, fostering an overall sense of commitment from the beginning through the completion of the study.
Third, the strength-based and delivery mode of the program may have attributed to achieving our target sample. The framing of the program as a strengthening approach to support families was important. This led to subsequent communication with potential participants in a positive way and reduced the stigma of help-seeking. For example, our formative work identified that the word “intervention” was off-putting for parents; hence, the word “program” was used in all subsequent advertising material for the trial. In addition, text messaging was a proactive approach to delivering parenting information to participants, requiring minimal effort and time commitment. The low attrition rate in our study is consistent with other studies on text messaging programs. Previous meta-analyses across a variety of text messaging–based programs found a mean retention rate of 86% [
Finally, there was a demand for support for parents of adolescents in New Zealand. Our formative work reported that parents perceived a lack of support in the community and were interested in parenting support [
Our target population comprised parents of New Zealand adolescents. Therefore, the findings may not be generalizable to studies involving other populations. Different recruitment strategies also vary substantially in cost per participant recruited, but because the study was not designed to compare the effectiveness or cost-effectiveness of recruitment strategies, we are unable to estimate the cost-effectiveness and the investment yield ratio for these strategies. Rather, our findings provide lessons to inform future studies.
Despite efforts to recruit parents from diverse population groups, our sample was predominately female, married, and of high social economic status. Many of our participants have also completed tertiary education. This is consistent with past research that reported higher levels of parent education is a predictor of parent uptake in programs [
Fathers were underrepresented in our study. This is a common challenge in parenting research, with fathers considered as
We also did not obtain any information from those who did not participate. Parents who do not initially engage could reveal different barriers or characteristics to those recruited into the program. Their views are therefore important and should be captured in future studies.
Recruitment and retention are critical aspects of research for parenting programs, and it is unlikely that there will be a one-size-fits-all recommendation. It is therefore important that efforts are well documented to enable researchers to make more informed decisions on how and where to best recruit and therefore maximize outcome [
With the rapid development of technology and web-based platforms, the field would greatly benefit from empirical research designed to test the efficacy and necessity of different recruitment and retention strategies, as well as more detailed reports regarding recruitment and retention methods. Web-based recruitment strategies provide a viable means for obtaining a geographically diverse sample. Recruiting the most affected populations should be a priority, and more resources are needed to do so. Further research is needed to examine the effectiveness of tailoring recruitment strategies to different populations.
Facebook ad and flyer designed for recruitment.
CONSORT-eHEALTH checklist (V 1.6.1).
mobile health
Parenting Sense of Competence scale
We acknowledge the commitment of the project staff and all study participants. This study is funded by The National Science Challenge: A Better Start/Cure Kids (Project grant 3713711).
JTWC is the primary investigator of this study and wrote the first draft of the manuscript. AW oversaw the management and day-to-day operations of the project. JTWC and YJ reviewed and conducted the analyses. YJ, CB, KS, and MS contributed to the design of the study and were involved in revising the manuscript. All authors read and approved the final manuscript.
None declared.