Letter to the Editor Regarding “Clinical Trial Recruitment and Retention of College Students with Type 1 Diabetes via Social Media: An Implementation Case Study”: A Commentary on Wisk et al (2019)

We read with interest the article written by Wisk et al¹ that was recently published in the Journal of Diabetes Science and Technology.¹ We recognize the value of testing the reliability of Internet recruitment of hard-to-reach populations, such as adolescents, in a research protocol. In the study by Wisk et al,¹ Facebook appears to be an important source of recruitment for adolescents and young adults. In the literature, scientific data have shown that young people who commit to participating in health actions via the Internet are satisfied with this type of approach.² Thus, implementing health education actions via social networks seems to us to be particularly relevant in daily care programs for adolescents with diabetes as long as the programs are tested and adjusted to the needs of adolescents with diabetes.³ We would therefore like to thank Wisk et al for their scientific contribution. However, we would like to highlight some methodological limitations that may affect the study’s conclusions.

The title of the article states that the proposed design was an implementation case study, but the described method does not seem to have been based on case study results.⁴ Moreover, the authors mention that their study was a comparative test conducted prior to a larger study.⁵ This leads us to question the study design. It seems to us that the work presented by Wisk et al¹ was instead a pilot study that was implemented to assess the feasibility of a study protocol before moving on to a larger study.⁵

Four issues regarding the representativeness of participants could be raised: (1) the selection of the population through Internet recruitment only does not allow for reliable control of the respondents’ identity or the reliability of the inclusion criteria; (2) the $20 remuneration given to the participants creates a high risk of double or false participation; (3) non-Internet users were excluded, even though the literature reports that 93% of adolescents use the Internet for school programs or entertainment;^2,6 and (4) the authors specify that 39.2% of responses were excluded. Thus, the representativeness of the population does not seem to be guaranteed. In view of these issues, a pilot study involving a control arm with direct recruitment during a medical consultation would make it possible to adequately compare recruitment methods for people who are difficult to include in a scientific study.

Finally, the second objective of the study presented by Wisk et al¹ was to test the influence of a concurrent educational intervention on diabetes self-management and alcohol consumption behaviors in 2 groups: Group 1, in which the information was provided by an endocrinologist, versus Group 2, in which the information was provided by peers. It seems that the authors have chosen not to present the results collected in relation to this second objective, which frustrates the reader.

Considering the points raised above, it seems premature to conclude that Internet recruitment is reliable for scientific studies involving a complex and difficult-to-recruit population.