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2023 HSR&D/QUERI National Conference Abstract

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1161 — Effectiveness, efficiency, and equitability of email versus postal-mail for recruiting VA patients for research studies: Results from the LAMP trial

Lead/Presenter: Diana Burgess,  COIN - Minneapolis
All Authors: Burgess DJ (Center for Care Delivery and Outcomes Research, Minneapolis; University of Minnesota Medical School), Hagel Campbell EM (Center for Care Delivery and Outcomes Research, Minneapolis) Taylor BC (Center for Care Delivery and Outcomes Research, Minneapolis; University of Minnesota Medical School) Bangerter A (Center for Care Delivery and Outcomes Research, Minneapolis) Cross LJ (Center for Care Delivery and Outcomes Research, Minneapolis) Allen KD (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham; University of North Carolina at Chapel Hill) Behrens K (Center for Care Delivery and Outcomes Research, Minneapolis) Branson M (Center for Care Delivery and Outcomes Research, Minneapolis) Meis LA (Center for Care Delivery and Outcomes Research, Minneapolis; University of Minnesota Medical School) Ferguson JE (Department of Rehabilitation Medicine, University of Minnesota)

Objectives:
Recruitment for large scale studies is challenging, especially ensuring equitable access for traditionally less represented populations. Email-based recruitment has the potential to increase efficiency, reduce costs, and improve access in recruiting participants for large-scale studies and clinical trials. However, no published studies have investigated email-based recruitment in a VA population and the potential impact on equity and access. This study examines the effectiveness, efficiency, and equitability of email versus postal mail recruitment.

Methods:
As part of a pragmatic clinical trial of a mindfulness-based intervention (Learning to Apply Mindfulness to Pain, LAMP), we used the VA electronic health record (EHR) to recruit patients with chronic pain diagnoses from 3 VA facilities. Recruitment materials were sent using either postal mail (N = 7,985) or email (N = 19,334), providing an opportunity to compare the effectiveness, efficiency, and equitability of these approaches. Email and postal mail addresses were obtained from the EHR. Effectiveness was measured by the response rate of patients who logged into the secure LAMP study web portal. Efficiency was measured by the number of days from when the email or postal-mail recruitment materials were sent, to when patients logged into the LAMP portal. To assess equitability, we examined whether email recruitment was less effective for demographic groups that experience disparities in VA (older, non-white, Hispanic, rural, and female Veterans) based on demographic information from the EHR.

Results:
28% of respondents were female; 37% were 65 years or older and 30% were rural. 66% identified as White, 22% Black, 2% Asian, 1% American Indian, 1% Hawaiian, 1% Multiracial and 8% unknown. Six percent identified as Hispanic. Response rates were greater for email versus postal-mail recruitment (18.9% versus 6.3%). Multivariate analyses controlling for age, gender, race, ethnicity, rurality, and site, showed that the odds of responding were over four times greater for email recruitment (OR = 4.2, 95% CI 3.7-4.7). Email recruitment led to higher response rates for all groups, including older, non-white, Hispanic, rural, and female Veterans. Time to respond was significantly less for email versus postal-mail recruitment. Administrative and postal costs were also significantly less for email recruitment.

Implications:
Email recruitment is an effective, efficient, and equitable way to recruit VA patients to large-scale studies and clinical trials.

Impacts:
VA researchers should consider email recruitment for VA studies, particularly as the use of mobile phones and telehealth is increasing in Veteran populations. Future studies are needed to further explore how email recruitment affects groups that experience disparities, including Veterans who experience homelessness and groups who lack access to computers, mobile phones, or broadband internet. As more VA studies consider using electronic recruitment and data collection methods, it will be important to ensure that all Veterans have access to resources that enable them to participate in VA research.