Tablet Versus Quick Response Code: Difference in Research Participation Rates?

Abstract

Conducting research with immunocompromised populations, especially within the context of a global pandemic, warrants consideration of alternative research methods and modes of administration to keep participants safe. Digital and internet-based research methods have been utilized to minimize the risk of harm with cancer patients; however, adolescents and young adults with cancer (AYAs) remain an under served and understudied population with high levels of unmet needs. The purpose of the current study was to examine differences in AYA research participation rates based on two digital survey administration methods (tablet versus QR code). AYAs were randomly assigned to complete an online survey using either a tablet or quick response (QR) code, and participation rates in each group were compared. The total participation rate was 22.9%, with 75% of completed surveys from the tablet group and 25% from the QR code group. While the use of a QR code allows for reduced costs for in-clinic recruitment and may be the most sanitary option during COVID-19, eligible patients in the current study showed trends of increased engagement using a sanitized tablet. It is important to consider how psychosocial research and electronic surveys are administered, as the method may impact recruitment and/or information obtained.

Background

COVID-19 has impacted many variables in the implementation of research studies, and researchers have adjusted by moving study administration and recruitment online (Saberi, 2020). Digital research techniques are particularly applicable to conducting research with immunocompromised populations, such as adolescents and young adults (AYAs) with cancer, who are at a higher risk of developing severe COVID-19 infections (National Cancer Institute, 2022). Given the need for intervention in the under-researched and underserved population of AYAs with cancer, as well as a historically low rate of research engagement and use of supportive interventions (Rosenberg et al., 2015), it is important to identify and utilize effective engagement methods in psychosocial research with AYAs (Psihogios et al., 2019; Saberi, 2020). However, there is currently a dearth of literature examining specific and best methodological practices for psychosocial research recruitment with this population. In the current study, AYAs were asked to complete an online survey that assessed cancer-related needs, and the purpose of this study was to examine differences in AYA participation rates based on survey administration method (tablet versus quick response [QR] code) with a sample of AYAs diagnosed with cancer.

Methods

This study was approved and determined exempt by the University of Texas Southwestern Medical Center institutional review board. Eligible patients included AYAs between the ages of 18 to 39 with a history of cancer, representing approximately 6.7% of the patient population at the recruitment site—a hospital-based cancer center. Over the course of 4 months, the research team screened weekly clinic schedules to identify eligible patients with upcoming, in-person, outpatient, oncology appointments. At the time of eligibility determination, each patient was randomly assigned to one of two methods of survey administration: (1) tablet or (2) QR code. Random assignment was generated using a randomization algorithm run by a statistical software program, and assignments were indicated in appointment notes on the clinic schedule used by front desk clinic staff. Upon appointment check-in, front desk staff informed patients of the study and provided them with their assigned administration method—a tablet preloaded with the online survey or a paper handout containing a QR code linked to the online survey. Both administration methods included a brief written introduction to the study, and patients were then able to either decline participation or access the survey. The survey included a participation information sheet detailing research aims, procedures, risks, benefits, confidentiality, and contact information, after which participants could indicate consent to participate and complete the rest of the survey. Demographic characteristics were collected, and the number of survey completions in each group was compared to assess for any differences in participation rates based on method of administration.

Results

A total of 35 patients were identified as eligible to participate in the study, with 18 patients assigned to the QR code administration method (51.4%) and 17 patients assigned to the tablet administration method (48.6%). A total of eight patients provided consent and participated in the study, resulting in an overall participation rate of 22.9%. Out of the eight participants, two were assigned to the QR code group (25.0%), and six were assigned to the tablet group (75.0%). Participant ages ranged from 22 to 37 years old, with a mean of 32 and a standard deviation of 6.14. The demographic characteristics of participants are presented in Table 1, and the distribution of the administration method is presented in Table 2.

Table 1.

Participant characteristics (n = 8)

Demographic variable	Frequency (N)	Percentage (%)
Gender assigned at birth
Male	5	62.5
Female	3	37.5
Racial identity
Black/African American	1	12.5
Native Hawaiian/Pacific Islander	1	12.5
White	4	50.0
Prefer not to answer	2	25.0
Ethnic identity
Hispanic/Latin(a/o/x)	3	37.5
Non-Hispanic/Latin(a/o/x)	5	62.5
Cancer diagnosis
Breast	1	12.5
Leukemia	1	12.5
Lymphoma	2	25.0
Testicular	2	25.0
Thyroid	1	12.5
Other	1	12.5
Stage at diagnosis
1	0	0.0
2	1	12.5
3	2	25.0
4	1	12.5
Unknown/not staged	4	50.0
Level of education
Some elementary/middle school	1	12.5
High school diploma/GED	1	12.5
Some college	3	37.5
College degree	2	25.0
Master’s degree	1	12.5

Table 2.

Administration method distribution for participants and non-completers

Administration method	Number of participants (%)	Number of non-completers (%)
QR	2 (25%)	16 (59%)
Tablet	6 (75%)	11 (41%)
Total	8 (100%)	27 (100%)

Discussion

The purpose of the current study was to examine differences in participation rates of an online survey using two different administration methods in a sample of AYAs diagnosed with cancer. Results from this pilot study showed trends in AYAs having higher rates of participation with in-clinic tablet administration compared to QR code. No study to date has examined the use of QR code versus tablet in recruitment rates. Although there is limited information on AYA preferences for administration methods, existing literature suggests AYAs have high levels of social media and internet usage (Hausmann et al., 2017) and prefer electronic modes of delivery for health-care related interventions (Bartholomew et al., 2021). While the use of a QR code allows for reduced costs for in-clinic recruitment and may be the most sanitary option during COVID-19, eligible patients in the current study showed trends of increased engagement using a sanitized tablet. These preliminary trends suggest that not all electronic modes of recruitment are created equal. The use of technology by AYAs may be an actual hypothesized barrier to QR code recruitment, as there is the potential for distraction to other tasks on a personal device. Using a tablet for research recruitment or survey administration may limit distractions away from the study, as no additional notifications appear on the screen while the participant consents and completes the information online. The current study highlights the importance of considering how psychosocial research and electronic surveys are administered within a clinic visit, as the administration method may impact recruitment and/or how much information is obtained.

Limitations

The primary limitation of the current study is the small sample size; researchers discontinued randomization efforts due to observed trends in participation rates between administration methods and a need to increase the sample size for a larger psychosocial implementation study. Therefore, the study does not have sufficient power to determine whether the findings are statistically significant. The generalizability of the data is also limited due to sampling from only one location, as different socioeconomic factors, such as income and educational attainment, have been shown to influence patients’ ability to engage in research (Zarghom et al., 2013). Another limitation of this study is that non-participating patient demographics could not be obtained; therefore, differences among demographic variables based on participation could not be presented for this study.

Future Directions and Clinical Implications

The current study resulted in a total participation rate of 22.9%, which is slightly lower than the 25 to 52% range suggested by existing psychosocial research with AYAs (Vlooswijk et al., 2022). It is important to consider the impact of COVID-19 on participation in psychosocial cancer research. One study examining psychological distress and resilience in AYAs with cancer during COVID-19 reported a response rate of 17.8% (Jacobson et al., 2022), which may suggest the pandemic negatively impacted research participation in this population. The current study purposely used a recruitment strategy that placed the least amount of burden on clinic and research staff. To increase participation rates, patients could be approached once roomed in the clinic so that participation is more accurately perceived as a clinically-meaningful activity rather than “just another” check-in task. Additionally, having research personnel approach patients to participate could help increase participation rates, as research personnel could describe the details of the study, answer questions, and engage with the patient about the benefits of participation. Lastly, this research study utilized methods believed to improve the quality of care with negligible risk to the participant. Another way to improve recruitment in the future could be to identify strategies for the study to transition into a quality improvement program that is implemented throughout the clinic without requiring consent. Integrating clinic staff into recruitment efforts during scheduled oncology appointments may be an effective way to engage AYAs in psychosocial research while limiting in-person contact and reducing the risk of infection.

This study shows that the administration method should be considered when conducting research, specifically with AYAs, and that providing a tablet at the time of recruitment may be an effective way of increasing participation in psychosocial research when compared to the administration of a QR code. Future research should focus on replicating this trend with a larger sample. If results are replicated, future studies could also explore underlying mechanisms influencing participation rates based on administration methods. This study has specific implications for researchers as they plan for recruitment, specifically with AYAs in an oncology setting. While QR codes may be more widely disseminated and cost effective, recruitment rates could be suffering, which may be even more costly to researchers. Although there are benefits to using electronic administration for research, it is important to understand the differences between electronic administration methods and the impact it can have on the ability to engage participants. Furthermore, more information is needed to determine if these results are also suggestive of how psychosocial interventions are best delivered to patients electronically.

Author Contribution

Brittany C. Hall, Haley S. Markwardt, and Sarah E. Taghavi contributed to the study conception and design, material preparation, and data collection and analysis. All authors contributed to original draft preparation, writing, reviewing, and editing. All authors read and approved the final manuscript.

Funding

Authors H.S.M., S.E.T., and B.C.H. received salary support from the Fort Worth Adolescent and Young Adult Oncology Coalition, a non-profit entity.

Data Availability

The data supporting the findings of this study are available within the article.

Declarations

Ethical Approval

Approval was granted by the University of Texas Southwestern Medical Center Institutional Review Board on July 14, 2020 (STU-2020-0505).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

The authors affirm that human research participants provided informed consent for publication of deidentified data collected for the study.

Competing Interest

Authors A.P.W., M.N.O., and P.R.M. have no relevant competing interests to disclose. Authors H.S.M., S.E.T., and B.C.H. received salary support from the Fort Worth Adolescent and Young Adult Oncology Coalition, a non-profit entity.