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A Scoping Review of Social Media Sites as a Tool for Clinical Trial Recruitment and Retention (Preprint)


 BACKGROUND
 Clinical trials are an essential process in discovering new biomedical or behavioral outcomes in disease processes. There are several steps involved in creating a clinical trial. One step, patient recruitment, is often touted as the largest contributor to trial delays, which has financial, scientific, and ethical ramifications. Approximately 1.2 billion dollars in the United States is spent each year on this process and as many as 86% of clinical trials do not meet recruitment targets within their perspective timeframes, and 19% of trials had to be terminated early due to insufficient recruitment and/or patient retention1. 
Social media is a viable, inexpensive tool that can be utilized to improve both recruitment and retention rates2. To date, platforms such as Facebook, Twitter and others have been widely utilized in recruitment for clinical trials, communication among stakeholders, and educational tools. Social media also has the advantage of reaching populations that otherwise would be more difficult to reach3. A list of these platforms and each of their distinct advantages for clinical trial recruitment can be found in Table 1. This review aims to highlight the unique characteristics of several social media platforms and their advantageous properties in increasing recruitment and retention during clinical trials.
 
 
 OBJECTIVE
 This narrative review analyzes the current use of several social media sites in clinical trial recruitment and retention. It also offers insight concerning potential uses of these sites that are not currently utilized.
 
 
 METHODS
 A literature search was performed using PubMed, Google Scholar, and ResearchGate to access and review relevant articles published in peer-reviewed journals concerning social media and its use in clinical trials. Two independent researchers with education and experience in dermatology screened publications to select studies featuring quantitative results concerning social media and clinical trial recruitment.
 
 
 RESULTS
 13 social media applications were studied and reviewed. 7 of these social media sites or applications have currently been studied, and their use in complementing traditional recruiting methods such as advertisements in newspapers, health fairs, and direct mailing, has been analyzed and reported. 6 additional social media applications have further been studied, and their potential use within clinical trial research has been additionally analyzed.
 
 
 CONCLUSIONS
 A large number and variety of social media platforms exist to aid in the recruitment and retention process for clinical trials, many of which can utilize niche features and reach a targeted demographic. Although recruitment remains a barrier for researchers involved in clinical trials, the potential to recruit through social media may be underutilized. 

Many avenues that exist to improve recruitment have not been leveraged. For example, partnering to create collaborative videos with social media influencers on platforms such as Instagram and Youtube may help to broaden the audience and increase clinical trial enrollments. Creating biomedical educational profiles or channels that discuss details of clinical trials with descriptions of these trials could also be employed to increase the scope of the audience. Reddit, Smart Patients, and Patients Like Me can target difficult-to-reach patient populations due to their use of subgroups, allowing researchers to reach their target audience. Additionally, many of these platforms provide user engagement features that allow users to respond directly to videos or posts and could be used to encourage enrollment by allowing users to react directly to clinical trial advertisements.
