Challenges in Recruitment of Young Adults Engaging in Sexual Behaviors and Alcohol Use

Abstract

Background

Young adults are at increased risk of negative outcomes, such as sexually transmitted infections and unintended pregnancies, due to alcohol use during sex, condomless sex, and inconsistent contraceptive use. We seek to adapt a brief intervention to address these health behaviors, which requires formative research with young adults engaging in alcohol use during sexual activity. Recruitment of young adults in research studies can be challenging. We examined the recruitment approaches used in this formative study to gain a deeper understanding of the challenges encountered in the recruitment of young adults for a sexual health and alcohol study to improve strategies and overcome obstacles.

Methods

The goal of recruitment for the formative study was to identify eligible participants through a screening survey and invite them to participate in a focus group. Inclusion criteria for the formative study were young adults aged 18-25, not in a monogamous relationship, had inconsistent contraception use or condomless sex, alcohol use during sex in the past month, and had Texas residency. The research team used several recruitment strategies: flyers, emailing community stakeholders to share materials, social media, and monetary incentives. We used the Plan Do Study Act (PDSA) cycle to examine our recruitment approaches in three cycles and reflect on the effectiveness of our recruitment methods. The effectiveness of each cycle was measured by the number of surveys that were completed, the number of eligible participants identified, and the number of resulting focus group participants. The research team reflected on challenges in each cycle.

Results

There were three recruitment cycles identified. Cycle 1 (January-February 2022) primarily focused on distributing flyers and contacting partner organizations to share materials with their clients; challenges included logistics, locations, and the ability to track this strategy. This cycle resulted in 253 surveys completed, 23 eligible potential participants, and 10 focus group participants. Cycle 2 (February-June 2022) incorporated social media advertising (e.g., Twitter, Craigslist, TikTok, and Reddit) to reach large audiences, but introduced issues such as social media platform policies, inauthentic survey results, and increased recruitment costs. This cycle resulted in 475 completed surveys, 10 eligible potential participants, and 1 focus group participant. Cycle 3, where inclusion criteria were broadened to increase the eligible population is preparing to launch to address these challenges.

Conclusions

Many challenges were identified in recruiting young adults engaging in condomless sex, ineffective contraceptive use, and alcohol use during sex to participate in this research study. Each recruitment strategy came with unique issues but a large discrepancy between audiences reached, and successful participants was constant in all strategies. Direct recruitment through partner organizations was effective but required considerable effort to ensure that the study was adequately advertised to potential participants. Social media marketing was effective in reaching large audiences but was complicated by platform advertising policies, false and repeated survey responses, and did not yield a cost-effective number of successful participants. These results suggest that broadening the inclusion criteria may increase the number of eligible participants.