The Michael J. Fox Foundation for Parkinson’s Research (MJFF) aims to speed clinical research by removing obstacles that stand in the way of therapeutic development for the Parkinson’s community. In pursuit of this mission, the Foundation gathers insights from a wide range of stakeholders and uses these perspectives to enhance clinical trial processes from start to finish. In this introductory column (look for more articles in the “Eye on Patient Advocacy” series in next year’s Applied Clinical Trials print editions), we will highlight best practices and lessons learned from the field of Parkinson’s research that can be applied to clinical trials across disease states. For access to the full suite of MJFF best practices, please visit the Parkinson’s Clinical Trial Companion. In this month’s article, we explore how digital marketing can enhance clinical trial recruitment efforts.
 

Background and objectives

With 80% of individuals going online to learn more about specific diseases or treatments, digital media has become a leading source of health information.¹ More and more, people use mobile devices to find this information, making it easier to gather consumer demographics, such as age, gender, and location.² This growing population of online users represents an opportunity for clinical researchers to engage with and recruit a broader audience at a lower cost than through traditional marketing channels. 

To determine the efficacy of digital marketing as a low-cost method of recruitment, MJFF designed a pilot to recruit individuals with late-stage Parkinson’s disease (PD) to Fox Insight. Fox Insight is MJFF’s virtual longitudinal study aimed at better understanding the heterogeneity of the disease by collecting health information using online self-reported questionnaires and other remote data like wearable sensors and personalized genetic testing results. Fox Insight is open to people with and without PD. Objectives for the marketing pilot were to: 1) increase the volume of enrolled participants; 2) target and enroll participants at specific stages of disease; and 3) examine costs of recruitment using digital methods.

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Methods

Participants

To ensure that Fox Insight accurately reflects the Parkinson’s community, it is imperative that individuals at different stages of disease are equally represented in the study. At traditional brick and mortar research sites, individuals with later-stage PD are often underrepresented due to factors³ such as advanced age⁴ and motor and non-motor symptoms. To address this sampling challenge, the Fox Insight study team identified individuals with late-stage PD as an important target population for the marketing pilot. To be shown an ad, prospective participants had to meet the following eligibility criteria:

• Currently living in the U.S.

• Age 60 or older

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• Indicated “Parkinson’s disease awareness” as an individual interest and selected interests in subject areas related to PD or clinical trials (e.g., clinical trials, PD symptoms, and PD organizations) on Facebook

• Not already involved in the MJFF online community (e.g., had not visited the MJFF website in the past 30 days and had not ever “liked” the MJFF Facebook page)

Facebook was selected because of its vast reach, many targeting capabilities,⁵ and tracking techniques that enabled referral source attribution for those individuals recruited to Fox Insight.
 

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Materials

Two types of Facebook ads were designed for the marketing pilot. One was aimed at individuals (“me” language) and the other emphasized the collective effort of clinical research (“we” language). Two subthemes were tested for each type of ad.

• Individual (me): Language appealed to users on an individual level, to be empowered to impact research by participating in an online clinical study (Fox Insight). An image of an individual participating in Fox Insight on their computer accompanied these ad variations.
• Subtheme: Research Reimagined (see Image 1)

• Subtheme: Lead the Way (see Image 2)

• Collective (we): Language encouraged the user to contribute to a larger cause by participating in an online clinical study (Fox Insight). An image of a family sitting together in a waiting room accompanied these ad variations.Subtheme: Join a Collective Goal (see Image 3)
• Subtheme: Impact the Future (see Image 4)

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Design and procedures

The different ad variations were tested in three sequential phases over a period of six weeks. Each phase cost approximately $8,000. At the end of each phase, the number of individuals recruited to Fox Insight along with the cost per recruit was evaluated.

Phase 1

• Timing: Weeks one and two; ads shown approximately twice a day.

• Variables tested: Compared the efficacy of the four different ad variations to determine if users were more responsive to language/image combinations that fell in the individual or the collective categories, and within these categories, which messaging was most effective.

Phase 2

• Timing: Weeks three and four; ads shown approximately twice a day.

• Variables tested: Compared levels of responsiveness to the winning ad variation from phase 1 among individuals with different Facebook interests. The two interest groups compared were: 1) individuals with interests in PD awareness and terms related to PD symptoms; and 2) individuals with interests in Parkinson’s disease awareness and terms related to clinical research. The two interest groups were mutually exclusive. Interest-targeting is made possible on Facebook by information that individuals add to their timeline, keywords associated with pages they like, apps they use, or ads they have clicked on.

Phase 3

• Timing: Weeks five and six; ads shown approximately twice a day.Variables tested: Assessed the efficacy of the winning ad variation from phase 1 among a broad target audience without any interests defined.

Fox Insight enrollment after each phase of marketing pilots was compared to baseline (a six-week period, pre-intervention) where no special promotion of Fox Insight took place, and recruitment was only facilitated through MJFF educational content and Fox Trial Finder, a smart-match tool. Campaign success was primarily assessed using participants’ self-reported date of diagnosis. Additional validation on stage of disease was conducted using information from the Fox Insight platform about medication history and symptoms based on the Non-motor Symptoms Questionnaire (NMS-quest) and the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS Part II).

Results

Total enrollment

Compared to baseline (n=123), the marketing pilot significantly increased (825%) participant enrollment (n=1,138). Of those newly enrolled, 46% were individuals with PD, and 760 (67%) came directly from the Facebook ads (i.e., clicked on an ad link and registered for the study). Those registrants who did not come directly from Facebook (33%) may have been exposed to the Facebook ads during the six-week pilot but entered through other channels such as MJFF educational content or Fox Trial Finder. 

Population-specific targeting

The Fox Insight Facebook Ads Campaign was successful in targeting and recruiting individuals with late-stage Parkinson’s disease as evidenced by an increase in the number of individuals who met the following criteria compared to baseline (see Figure 1):

• PD diagnosis of 10 or more years

• A score of 25 or higher on the MDS-UPDRS (Part II)

• A Non-motor Symptoms Questionnaire (NMS quest) score of 13 or higher

Recruitment costs

The cost per conversion (i.e., the total cost of advertising/# of enrollees) of those individuals who came directly from Facebook (n=760) was $31.51/per enrollee, an incremental increase compared to traditional direct-mail methods ($30.45/per enrollee) within a similar population.⁶

Discussion and conclusion

Digital marketing is an effective outreach tool with substantial capacity to increase access to and engagement with prospective research participants. The success of the digital marketing pilot to recruit individuals with late-stage Parkinson’s disease indicates potential applications for recruiting individuals from diverse racial and socioeconomic backgrounds who are also underrepresented in clinical research, and for driving broad populations of prospective participants from digital advertisements to online study resources. Finally, the comparability in cost per conversion of digital marketing to that of traditional methods demonstrates its utility as a tactic that clinical trial teams can employ as part of a comprehensive recruitment strategy.

References

1. Fox, Susannah. “The Social Life of Health Information, 2011 | Pew Research Center.” Pew Research Center: Internet, Science & Tech, Jan. 23, 2014, www.pewinternet.org/2011/05/12/the-social-life-of-health-information-2011/.

1. Stempel, Dan. “2016 Trends for Digital Recruitment in Clinical Trials.” Medical Marketing Insights, 2016, www.mdconnectinc.com/medical-marketing-insights/2016-trends-for-digital-recruitment-in-clinical-trials.

1. Mody, Lona, et al. “Recruitment and Retention of Older Adults in Aging Research.” Journal of the American Geriatrics Society, vol. 56, no. 12, 2008, pp. 2340–2348., doi:10.1111/j.1532-5415.2008.02015.x.

1. Varanese, Sara, et al. “Treatment of Advanced Parkinson’s Disease.” Parkinson’s Disease, vol. 2010, 2010, pp. 1–9., doi:10.4061/2010/480260.

1. Stempel, Dan. “How Digital Marketing Lowers Clinical Trial Recruitment Costs.” Medical Marketing Insights, 2017, www.mdconnectinc.com/medical-marketing-insights/digital-marketing-lowers-clinical-trial-recruitment-costs.

1. Stephenson, Hugo, Bharmal, Murtuza. “Direct-to-Patient Enrollment Strategies.” Applied Clinical Trials, Feb. 12, 2015, www.appliedclinicaltrialsonline.com/direct-patient-enrollment-strategies?id=&sk=&date=&pageID=4.

The MJFF Recruitment and Retention Team includes: Christine Cowles, MPH, Senior Associate Director; Sarah Berk, MPH, Associate Director; and Bernadette Siddiqi, MA, Associate Director; all with The Michael J. Fox Foundation in New York, NY. To contact the MJFF Recruitment and Retention Team, email: trialsupport@michaeljfox.org