Agile nudge implementation to improve minority recruitment in community-based research

Recruiting underrepresented populations into community-based research remains a persistent challenge in the United States, driven in part by inequities, historical mistrust, and institutional barriers that limit access to and engagement in research. Community-Based Participatory Research (CBPR) emphasizes community engagement but offers limited guidance on how to iteratively test and refine recruitment strategies. Agile Science and specifically Agile Nudge Implementation (ANI) may provide a structured, stepwise approach to iterative improvement. The goal of the study was to determine the association between ANI strategies applied within an ongoing CBPR-informed health study and recruitment of immigrants.

We conducted a quality improvement initiative embedded within the Indy Muslim Immigrants Study, a community-based survey assessing the health of Muslim immigrants from Africa and the Middle East residing in the Indianapolis metropolitan area. The study was conducted between January and August 2025. Recruitment occurred over 32 weeks and was divided into three phases: (1) a 12-week pre-implementation phase using standard CBPR-informed strategies;(2) a 12-week ANI phase; and (3) an 8-week post implementation observation phase. The ANI process followed eight-step iterative framework to design, test, and refine behavioral nudges targeting recruitment. The primary outcome was the weekly number of completed surveys. We used run chart methods to assess recruitment trends and to detect non-random variation and intervention-related changes over time.

A total of 709 participants completed the survey over the 32-week recruitment period. Mean weekly recruitment increased from 20.9 participants during the pre-implementation phase to 30.0 during the ANI phase (29% increase from Week 12 to 13), followed by a decline to 25.9 during the post-implementation phase, remaining above baseline. Run chart analysis demonstrated non-random variation, including a sustained shift from consecutive weeks below the baseline median prior to implementation to consecutive weeks above the median during implementation phase, consistent with meaningful improvement in recruitment performance.

Application of the ANI process was associated with increased recruitment of Muslim immigrants, with partial sustainment recruitment after the conclusion of the formal implementation phase. Use of a structured implementation approach grounded on behavioral economics may support engagement and recruitment of immigrant and other underrepresented populations in community-based research.