Recruitment for an internet-based diabetes self-management program: scientific and ethical implications

Area of Science:

• Digital Health Interventions
• Health Services Research
• Chronic Disease Management

Background:

• Limited understanding of the reach and engagement of online self-management interventions.
• Importance of evaluating participation metrics for digital health tools.

Purpose of the Study:

• To assess various definitions of participation rate in an internet self-management program.
• To compare demographic and clinical characteristics of participants versus nonparticipants.
• To analyze differences among subgroups of participants.

Main Methods:

• Analysis of recruitment data for 2,603 health maintenance organization members with type 2 diabetes.
• Utilized de-identified electronic medical record data for characteristic comparisons.
• Examined participation rates based on different recruitment strategies.

Main Results:

• Achieved a 37% participation rate among eligible individuals contacted.
• Identified significant differences in age, income, ethnicity, smoking, education, blood pressure, and HbA1c between participants and nonparticipants.
• Observed variations among participant subgroups (e.g., proactive volunteers vs. telephone respondents).

Conclusions:

• Recruitment methods significantly influence participation and may exacerbate health disparities.
• Recommendations are provided for reporting eligibility, participation rates, and representativeness.
• Findings have implications for generalizing results of internet-based health interventions.