Clinical trial recruitment materials: Study shows what works

Picture colors, people's clothing matter

Clinical research professionals at Summa Health System in Akron, OH, have found that some details on recruitment materials can make a big difference in how potential research participants view a clinical trial.

For example, most people who saw a photo of a person undergoing a stress test didn't like that image, says Jere M. Boyer, PhD, CIM, CIP, CCRP, director of research compliance for Summa Health System, and faculty member and scheduled speaker at Clinical Trials Administrator Conference: Fresh Perspectives on Fundamentals, March 9-11, 2008, in Atlanta, GA.

Investigators had 185 people look at 10 different photographs that could be used as clinical trial recruitment materials. Participants' impressions of the materials were recorded, and their answers were analyzed from the perspective of their gender, age, educational level, and other demographics.

Nearly half of the participants had completed only high school, and about 68% of the participants were women, Boyer says.

"Initially, we were just looking at the differences between males and females," Boyer says. "There were a lot of data, and so we analyzed that data for various groups."

The 10 photos included these images:

  1. A person is having his blood pressure taken.
  2. A woman is in rehabilitation, and she's working on the arm-strengthening machine.
  3. An elderly man in rehabilitation has a ball in front of him.
  4. A physician is interviewing a subject.
  5. An elderly woman is in rehabilitation and is walking down a flight of stairs with assistance from a health care worker.
  6. A health care provider is looking at someone who is signing a consent form.
  7. Someone in a wheelchair is being interviewed by an informed consent professional.
  8. An elderly woman is having her medications reviewed by a health care provider.
  9. A man is undergoing a heart stress test.
  10. A young woman is being weighed.

"There are quite a variety of potential photos that might be used in recruiting materials," Boyer notes.

Investigators did not select them because investigators typically do not select their own recruitment material, Boyer says.

"We allowed media services to select the photos," he adds. "These came from stock photos in media services, except for two that came from a brochure from the National Institutes of Health that we had permission to use."

In the first study Boyer and co-investigators completed, it was discovered that men liked photos with gadgets, and women liked photos that had a lot of color.

Both men and women liked photos that did not appear posed. For instance, the fourth photo of the physician did not look real, according to the participants, because the physician was as good looking as a movie star, Boyer says.

"Most people liked the lady in the eighth photo where she is being shown her medications because she looks enthusiastic," he notes.

Participants also did not like seeing the backs of people in photos, Boyer says.

"Women like people who are dressed appropriately," he adds. "In the second photo, they didn't like the way the health care professional was dressed."

The photo depicted a woman with a long shirt that isn't tucked in assisting a patient in physical exercise. Although the health care professional's clothing might be appropriate for that particular work, it didn't appeal to the people reviewing it; women particularly rated it negatively, Boyer says.

"In another picture where a young man is helping a lady on the stairs, photo number five, both people were dressed nicely, and people said they liked that picture," Boyer adds.

In the ninth photo of the stress test, some men found it appealing, but most women disliked it, and no one liked the 10th photo of the woman being weighed, Boyer says.

"The question of whether a picture would turn them off the study was asked, and they said they wouldn't necessarily turn them off the study if they really wanted to be in it," Boyer says. "But if they were on the fence about the study, then the photo would have an influence."

When the participants' likes and dislikes were analyzed according to educational background, researchers found that the photo of the woman on the stairs was liked the most by people with graduate degrees, Boyer says.

"All educational levels liked the photo of the woman receiving medication education, except for those with vocational backgrounds," he says.

Customize recruiting materials

In general, researchers found that people were very candid about their likes and dislikes in the recruitment material, Boyer says.

"People preferred photos depicting people who appeared to be happy and attentive," Boyer says. "And the colors need to be sharp, because they didn't like dull pictures overall."

Also, the study's results suggest that clinical trial sites might create more effective recruitment material if they tested through a study or marketing focus group their own pictures and enrollment items.

Any CR site that would like to duplicate this type of research is welcome to review the study's methodology, Boyer says.

"Each area of the country is going to be different," Boyer says. "The culture of an area is different; the ethics and morays differ from one area to another, so you really should have this data for yourselves."

CR sites could advertise in a hospital for people to sign up for the study or focus group, and there should be some effort to find people who are similar to the area's population demographically, he suggests.

"Be very open to their responses and open to which direction they're going with their responses," Boyer says. "We had a set of questions, but our interviewers were allowed to elicit other responses out these subjects."

Investigators have used the study's results to improve their recruitment materials for studies by using brighter colors and omitting photos that elicited the most negative responses, Boyer notes.

"Researchers agree with our findings because they make sense," Boyer adds.