Table 3.

Strengths and challenges of study recruitment methods.

Recruitment method	Strengths	Challenges
Facebook ads	Reach those not affiliated with the VAa or connect with wider audience Can target audience by some parameters to optimize reach Can adjust ads and targeting in real time, improves cost-efficiency, and can follow recruitment needs for specific subgroups Provides a variety of metrics to track performance, such as reactions to and engagement with ads	Takes experience to get audience parameters correct Negative comments need frequent monitoring; negative comments and hate speech can have negative impacts on study staff as well as on potential study participants Not able to reach those not on Facebook Little to no direct customer service if ads were deemed to violate Facebook policy Takes significant staff time to optimize Learning platform requires time and research Requires thoughtful budgeting due to varied and somewhat unpredictable costs and efficacy of ads
Community outreach	Reach those not affiliated with the VA or connect with wider audience Can reach those not on social media Establish trustworthiness and credibility with leaders of community organizations who hold closer personal relationships with organization members	Little control to how or when organizations shared study information High-volume surges of interested participants to manage; surges may cause recruitment bias by geographic region or demographic group May be biased toward those involved with community groups (eg, those who publicly identify as LGBTQ+b vs those who do not) Some organizations may be hard to reach or may not have up-to-date contact information Researching, compiling, contacting, and following up with organizations may require significant time and energy Some relevant local groups may be missed if study team is not connected or familiar with the region
Trialfacts or similar recruitment service company	Expertise and resources solely dedicated to recruitment and social media advertising Reduces burden on study staff Typically offers a recruitment number guarantee—will prorate a refund if numbers are not achieved Familiarity with institutional review board protocols Affordable or cost-efficient for this study Provides a tailored recruitment plan and study timeline	Can be expensive Less control over advertisements Requires establishing secure information exchanges with Trialfacts to meet all VA information security guidelines May lack content area expertise for specific populations, such as LGBTQ+ veterans Difficulty recruiting some subgroups Quality checks needed to review data or reports May overlap in reach if study is already conducting separate social media recruitment Not able to reach those not on social media

^aVA: Veterans Health Administration.

^bLGBTQ+: lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority.