Recruitment, Retention, and Participant Diversity in the Context of a Heart Failure Self-Care Digital Intervention...

Low participant accrual is a persistent concern in physiological disease intervention trials, inflating costs and jeopardizing the timeliness and validity of findings. Investigators are increasingly adopting decentralized methods to facilitate participation.

To add to the recruitment evidence base by describing the performance of direct and remote recruitment strategies in a decentralized randomized controlled trial of a digital intervention to improve heart failure self-care behaviors.

We conducted a descriptive analysis of referral, enrollment, and retention rates; cost; and sociodemographic diversity of participants across six recruitment streams. Data were collected from Sept 30, 2022 to June 30, 2025.

Decentralized recruitment channels generated 97.5% of enrollments and achieved varying success with respect to sample representativeness. Enrollment rates progressed in accordance with proposed timelines. Retention at 6 months was 82.6%.

Decentralized recruitment strategies are feasible, cost effective, and conducive to achieving enrollment targets.