Over the years I’ve worked in patient recruitment, there’s been something of a shift in terms of what the main bottlenecks are. Awareness has always been, and remains, the biggest problem – that is, potential participants not being aware there is a trial they could take part in.

But things have moved on somewhat since the days when people were completely unaware that such things as clinical trials actually exist. Primarily, I think, a result of the whole world becoming aware of a clinical trial for one particular issue a few years ago – Covid. (Interestingly, I was approached at the time by several organizations to help them recruit for Covid vaccine trials, but ended up providing minimal advice. As I said to them at the time – “you’ll have no problem recruiting for this. It’s on the TV every ten minutes, so lack of awareness is certainly not an issue here.”)

Does that mean we’ve solved the problem, then, and all clinical trials are able to recruit sufficient participants easily and quickly? Far from it. The industry still suffers with many challenges – two of which I’m going to address in this article: Finding patients, and getting them into the system quickly to solidify their interest and commitment.

Digital Outreach: Finding and Engaging Patients Where They Are

In today's world, the internet is often the first place people turn to for information about their health. Platforms like Meta, Google, and Instagram have become powerful tools in connecting people with relevant clinical trials, enabling researchers to target potential patients through highly specific demographic and behavioural criteria. Digital outreach is a cost-effective and efficient way to capture the attention of a wide audience. However, to make the most of it, a deep understanding of digital advertising, targeting, and messaging is essential.

Meta Advertising

Meta vast user base and sophisticated ad-targeting tools make it an ideal platform for reaching potential trial participants. (Indeed, I have written a book about how to make the most of this particular platform for patient recruitment). Ads can be tailored to target users based on age, location, interests, health conditions, and behaviours, ensuring their message reaches the people who are most likely to qualify for a study.

Elements that help make Meta advertising successful:

• Personalised Messaging: Ads should speak directly to the patient's experience, using language that resonates with their needs, emotions, and concerns. Avoid generic phrases in favour of specific, patient-centric language that builds curiosity and empathy.

• Visual Appeal: Meta ads with compelling visuals - such as photos or videos featuring relatable people or narratives - can capture attention quickly. High-quality, realistic imagery tends to perform better than stock photos, as they build trust and relatability. It’s also worth testing non-realistic images (e.g. cartoon or drawings) as these can sometimes perform best.

• Clear Call to Action (CTAs): A direct and easily understandable CTA is crucial. Phrases like “See if You Qualify” or “Sign Up Today for More Information” may help guide potential participants toward the next step without overwhelming them. Though the CTA button on the ad that has consistently worked best is a simple ‘Learn more’.

• Test Everything: Despite what I say above about avoiding generic phrases, I still see plenty of successful ad campaigns based on a template style ‘We’re looking for patients with XYZ condition to take part in a clinical trial’. Testing each element against a variation is the key to achieving continuous improvement.

Google Advertising

Google Ads can capture the attention of people actively searching for health information. For example, someone Googling ‘clinical trials for diabetes’ could see an ad directing them to a relevant study, making Google an effective way to engage people with immediate interest. (Though this will be a small proportion of the overall potential audience).

Some things to focus on for effective Google advertising:

• Keyword Strategy: Identify keywords specific to the trial’s target demographic and condition. Keywords need to strike a balance between specificity - to minimise irrelevant traffic - and volume - to ensure significant reach.

• Ad Copy and Landing Pages: Ad copy should be clear, concise, and compelling, addressing the user’s likely questions and concerns in as few words as possible. The landing page should then provide more detailed information and a simple, intuitive path to enable the potential participant to express their interest or apply.

• Geo-targeting: Since clinical trials are usually location-specific, ensure that ads are targeted geographically to reduce interest from those outside a travel distance radius of a participating research site.

Retargeting

Retargeting allows researchers to display ads to individuals who previously visited a trial’s website or interacted with an ad but didn’t convert (e.g. by submitting their information). This can help bring in more trial participants than without using it, as some people require multiple touchpoints before committing.

Strategies for retargeting include:

• Reminder Ads: After a person visits the site without converting, display ads that remind them of the trial’s benefits, such as contributing to new treatments or the comprehensive health check they will be getting.

• Dynamic Retargeting: Tailor the retargeting ads based on specific pages or ads the user interacted with, which can personalize the message and encourage further engagement. (This may be overkill, but could act as a reminder of the original media the person saw, thus helping orient them re: what the ad is about).

Follow-Up: Consolidating Interest Swiftly and Effectively 

Once a patient clicks “submit” on an interest form, the recruitment process is far from over. An effective follow-up system is essential for maintaining their interest and converting them into an actual trial participant.

Building a Rapid Follow-Up System

The longer the lag between submission and follow-up, the higher the risk of losing the participant’s interest or attention. This is especially true of people who have been attracted by online advertising, for whom immediacy is a baked-in element of the browsing process. A quick response will significantly increase the chances that they remember the trial and feel valued as a prospective participant. Here are some strategies to build an efficient follow-up system:

• Automated Responses: Set up automated confirmation emails or text messages that are sent immediately after form submission, acknowledging the prospective participant’s interest and outlining the next steps.

• Timely Outreach by Phone or Email: Within 24 hours of submission, a site representative should reach out via phone or personalized email. (Note: some in the industry suggest you will see a big drop-off in response rates even just 20 minutes after submission!) During this contact, you need to reiterate the purpose and potential benefits of the trial, address any questions, and look to schedule the first visit to a research site.

• Reminders and Reconfirmations: Schedule reminder calls, emails, or texts leading up to the initial visit to keep the appointment top-of-mind. These reminders reduce no-shows and help participants feel supported throughout the process.

Training Site Staff for Effective Engagement

Follow-up isn’t just about speed, it’s also about quality. Site staff should be trained to communicate empathetically, answering questions about the trial clearly and concisely. Common areas for training include:

• Communication Skills: Patients are likely to have questions and concerns. Site staff should be able to address these with empathy and clarity, reinforcing the patient’s sense of safety and trust.

• Knowledge of the Study: A deep understanding of the trial, including eligibility criteria, risks, and potential benefits, enables site staff to answer questions confidently, reducing ambiguity and increasing trust.

• Addressing Practical Concerns: Many patients worry about logistical issues, such as transportation, time commitments, or compensation. Empowering site staff to offer solutions, such as providing information about travel reimbursement or flexible scheduling, can reduce these barriers. (One suggestion here is to have research sites available for visits outside of working hours and at weekends, thus enabling more people to be able to access the trial).

Follow-Up Timing: The Importance of Momentum

Momentum is crucial in recruitment. After a potential participant expresses interest, each hour without a follow-up reduces the likelihood of their engagement. Digital ads capture participants at a moment of curiosity or motivation, but distractions can quickly redirect their attention. To sustain interest:

• Response Time Goal: Aim to contact participants within 24 hours at the latest. Automated systems can help kickstart the process, but a live person should follow up as quickly as possible.

• Timely Scheduling of First Visits: Where possible, schedule the initial visit within a week (maximum) of the participant’s submission. A quick start helps to maintain their motivation, reduces drop-offs, and initiates the participant in the trial process sooner.

Measuring Success and Refining the Approach

Regularly analyzing performance metrics for both digital outreach and follow-up activities can reveal bottlenecks or areas of improvement. Key metrics to monitor include:

Outreach Metrics

• Click-Through Rate (CTR): Measure how often people who see an ad click on it. A low CTR may indicate that the ad is not compelling or not targeted correctly.

• Conversion Rate: Track the percentage of people who submit their information after clicking an ad. If this rate is low, it could signal that the landing page needs refinement.

• Cost Per Acquisition (CPA): Calculate the cost of each successful lead. High CPA may indicate that ad spend is inefficient or that the targeting needs adjustment.

Follow-Up Metrics

• Response Time: Track the average time between a participant’s submission and the first follow-up contact. Reducing this time should improve levels of enrolment.

• Show-up Rate for Initial Visits: Measure the percentage of participants who attend the first visit after being scheduled. Low show-up rates may suggest the need for additional reminders or support.

• Participant Retention: Follow up with those participants who are enrolled in the trial after initial recruitment. Poor retention can signal the need for improved communication or support throughout the trial process.

Ongoing Optimization

Patient recruitment is not static; it requires regular optimization. Periodically review metrics, identify trends, and make adjustments as needed. Conduct split tests on ads to find the most effective messaging, and review follow-up protocols to identify any bottlenecks that require improvements in timing or approach.

Conclusion: The Foundation for a Successful Recruitment Process

Digital outreach and effective follow-up are two sides of the same coin when it comes to successful patient recruitment. Digital platforms such as Meta and Google provide powerful tools to engage potential participants at scale. But, without timely follow-up, interest can fade quickly. By creating a streamlined recruitment process that pairs targeted digital outreach with prompt, empathetic follow-up, we can reduce the bottlenecks and increase the number of participants in a trial.

About the Author

Ross Jackson is a well-known patient recruitment specialist and author of the industry standard books “The Patient Recruitment Conundrum” and “Patient Recruitment for Clinical Trials using Meta Ads.”

Having started out with digital marketing in 1998, Ross quickly developed a specialty in the healthcare niche, evolving into a focus on clinical trials and the problems of patient recruitment and retention.

Over the years Ross branched out from the purely digital and now operates in an advisory capacity helping sponsors, CROs, sites, solutions providers, and others in the industry to improve their patient recruitment and retention capabilities – having advised and consulted on over 100 successful projects.