Text Messaging: Enhancing Clinical Trial Patient Recruitment and Enrollment

There is a lot of new research that evaluates the impact of Short Messaging System (SMS, Text Messages) in healthcare settings, such as appointment reminders and medication adherence. Results have demonstrated that SMS intervention groups significantly improved patient behavioral outcomes; patients who received SMS reminders were more likely to show up to appointments on time,⁴ and patients who received SMS reminders were more adherent to medications.⁵ Nonetheless, there is limited research available on the effect of SMS on clinical trial subject enrollment. This article will tell a story about a study site that faced challenges with patient recruitment, and how they used SMS to overcome that challenge. Moreover, this article will analytically assess the impact of SMS on clinical trial subject enrollment.

Johnson County Clin-Trials (JCCT), a clinical research facility that specializes in executing 10-15 vaccine clinical trials per year, was facing issues with enrolling patients rapidly in a tight time frame; traditional enrollment campaigns were slow and time consuming. JCCT used to send e-mail blasts to recruit and enroll patients, however, patient response rates started declining in recent clinical trials. The team at JCCT wanted to be proactive and find another way to better engage patients.

Recent studies suggest that 90% of emails are spam,¹ and only 22% of emails are read.² Alternatively, 98% of text messages are read,² and 90% of text messages are read within the first 3 minutes of receipt.³

Mazen Zari, JCCT's Co Founder, acting VP and Director of Operations in collaboration with other team members decided to try text messaging and contacted Mosio to design and implement a text messaging campaign to recruit and enroll patients in a vaccine clinical trial. Zari was blown away by the results. During the first eight weeks operation, Zari sent 1,541 text messages, screened 795 patients and enrolled 265 patients.

Upon further analysis, Figure 1 confirms that the increase in text messages also increased enrollment rates, and Figure 2 verifies that there was a statistically significant relationship between text messaging and patients enrolled.

Figure 2 suggests that every 1.5% increase in text messages sent resulted in a 1% increase in subjects enrolled.  For example, when Zari sent 1,000 text messages, and enrolled 172 patients, sending an additional 15 text messages (1.5%) resulted in approximately two additional patients (1%) enrolled.

These outstanding enrollment results exceeded the sponsor’s expectations for JCCT’s enrollment potential, as the sponsor requested JCCT to halt enrollment three times during the eight-week timeframe. The sponsor allowed JCCT to continue enrollment for an additional three weeks, and JCCT enrolled a total of 338 patients.

“We had an amazing response! The minute we sent the text, we would immediately get a lot of calls. It was not double, not, triple, but five times the response, even with less people contacted (compared to e-mail),” said Zari. “We were initially concerned that patients weren't going to find text messaging useful, but on the contrary, patients really liked it!” added Zari.

While this analysis did not comparatively evaluate SMS against other forms of intervention related to patient enrollment, this case suggests that text messaging has demonstrated to be an effective tool that can be used to engage patients for clinical trial recruitment and enrollment, and deems for comparative research to be conducted in this area.

References:

1. Symantic – The State of Spam and Phishing 2009, Mobile Marketing Association
2. Frost & Sullivan 2010, Epsilon 2009
3. http://www.tatango.com/blog/90-of-text-messages-are-read-within-3-minutes/
4. Use of mobile telephone short message service as a reminder: the effect on patient attendance, Sumanth Prasad and Richa Anand, International Dental Journal 2012; 62: 21-26
5. Sahar Khonsari, et al., Effect of a reminder system using an automated short messaging service on medication adherence following acute coronary syndrome.  Eur J Cardiovasc Nurs. published 02, February 2014