title: A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program.
abstract: Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs.
  
  
  
  The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention.
  
  
  
  The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants' baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews.
  
  
  
  A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app.
  
  
  
  Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment.
authors.affiliation: Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Geelong, Australia. r.laws@deakin.edu.au.
authors.forename: Rachel A
authors.identifier: 0000-0003-4328-1116
authors.initials: RA
authors.lastname: Laws
authors.forename: Eloise-Kate V
authors.identifier: 0000-0002-4618-1068
authors.initials: EK
authors.lastname: Litterbach
authors.forename: Elizabeth A
authors.identifier: 0000-0001-9879-4969
authors.initials: EA
authors.lastname: Denney-Wilson
authors.forename: Catherine G
authors.identifier: 0000-0002-0848-2724
authors.initials: CG
authors.lastname: Russell
authors.forename: Sarah
authors.identifier: 0000-0002-7228-8993
authors.initials: S
authors.lastname: Taki
authors.forename: Kok-Leong
authors.identifier: 0000-0003-4688-7674
authors.initials: KL
authors.lastname: Ong
authors.forename: Rosalind M
authors.identifier: 0000-0002-9239-7126
authors.initials: RM
authors.lastname: Elliott
authors.forename: Sharyn J
authors.identifier: 0000-0002-7876-6722
authors.initials: SJ
authors.lastname: Lymer
authors.forename: Karen J
authors.identifier: 0000-0002-4499-3396
authors.initials: KJ
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009035:Mothers; D018579:Patient Selection; D011247:Pregnancy; D061108:Social Media; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D055815:Young Adult
keywords: children; infant feeding; infants; mHealth; obesity prevention; parents; practitioners; primary health care; recruitment; social media