Marie Balfour, BA, Medical College of Wisconsin
Karna Baraboo, BA, Medical College of Wisconsin
Elise Kahn, BS, Medical College of Wisconsin
William Mead-Davies, BS, Medical College of Wisconsin
Annie Tuman, BA, Medical College of Wisconsin
Benjamin Wrucke, BS, Medical College of Wisconsin (Equal Contribution)
Rebecca Bernstein, MD, MS Department of Family and Community Medicine, Medical College of Wisconsin b
Corresponding Author: Marie Balfour, BA
The COVID-19 pandemic has highlighted health disparities across many communities in
the United States, and the call for community-engaged research has never been greater [1,2].
However, the minimization of in-person interaction has forced medical researchers to adjust their
methods of engagement significantly . As a group of community-engaged medical student
researchers, we encountered several challenges and developed solutions as we adjusted to virtual
recruitment of research participants for qualitative research.
Challenge 1: BUILDING TRUST
One barrier to virtual recruitment was establishing trust with research participants. Our
studies involved sensitive topics such as weight, aging, food insecurity, addiction and finances.
Originally, many of us planned to spend time in clinics, homeless shelters, and other community
sites to engage with potential participants and develop a sense of familiarity. Without this
opportunity, most participants did not see our faces until the virtual interview which may have
affected who was willing to participate.
Solutions implemented: To compensate for the loss of in-person recruitment, many of us
utilized intermediaries such as physicians, mentors, caseworkers, school administrators, and
clinical administrators to communicate with potential participants. This strategy helped to
generate participant trust. In one project that recruited medical professionals, participant
invitations that did not include an intermediary led to a 40 percent participation rate, while
invitations including a faculty mentor or previous participant recommendation yielded
participation rates of 64 and 80 percent, respectively. We noted that trust and familiarity gained
by introductions and recommendations from intermediaries led to an increased likelihood of
Although effective, this strategy also presented challenges. Relying on intermediaries for
recruitment placed a greater burden on our community partners, who were asked to complete
additional tasks. This also may have slowed the research process because the schedule of the
intermediary dictated recruitment. Finally, trust was placed on the intermediary to recruit a
representative sample which may have introduced sampling bias.
● All community engagement projects should have a network of intermediaries who have
established trust with participants prior to beginning research.
● Community engagement projects conducted during COVID-19 require enhanced
relationships with these networks in order to increase participation rates and create more
Challenge 2: LEVERAGING RECRUITMENT TECHNOLOGY
At the outset of many of our projects, we used a common outreach method (such as
email) for all subjects. Due to virtual recruitment constraints and variable subject familiarity with
technology, many of us found that personalizing outreach methods led to more successful
participant engagement and recruitment.
Solutions Implemented: Virtual recruitment proved to be increasingly population-
dependent and customized. Those in academic settings were more active on email and were
familiar with online meeting platforms. In contrast, working parents and senior groups were
more receptive to phone calls. The likelihood of phone pick-up was improved by masking
unfamiliar phone numbers and displaying familiar clinic numbers with a telephone number
masking application (e.g. Doximity Dialer). In one study, school administrators sent study
recruitment information through a specialized school-specific parent interface, allowing
recruitment materials to reach just over 1,800 families. Without utilizing these population-
specific avenues, recruitment and resource dissemination would have been significantly
Adding new strategies to improve virtual recruitment outcomes came with significant
challenges. Submitting IRB amendments specifying recruitment protocol changes delayed
project benchmarks. Additionally, we recognize the choice of recruitment technology might
influence the study population. For example, benefits of online meeting platforms were most
apparent when the recruitment pool consisted of educated professionals frequently using these
platforms. Email-based recruitment methods also could have altered study outcomes, by limiting
participants to those with access to the Internet.
● Personalize outreach methods to a study population.
● Administer communication preferences survey during recruitment in order to confirm
preferred communication method.
● Begin recruitment using multiple methods in order to efficiently eliminate unsuccessful
Future research conducted remotely should be guided by themes of building trust and
leveraging recruitment technologies. While we focused on recruitment, it is important to
acknowledge the impact that COVID-19 will have on project outcomes. Given that our studies
included interviews, participants’ responses typically reflected their current situation, many of
which had been altered by COVID-19.
We are grateful for the support of Dr. Leslie Ruffalo and Dr. Bryan Johnston from the
Department of Family and Community Medicine at Medical College of Wisconsin. Research
reported in this publication was supported by the National Institute On Aging of the National
Institutes of Health under Award Number T35AG029793, the Department of Family and
Community Medicine at MCW, and the Wisconsin Medical Society. The content is solely the
responsibility of the authors and does not necessarily represent the official views of these
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