JMIR Publications

ABSTRACT

Background:

Web-based methods can be used to collect data from hidden populations, including people who use drugs (PWUD). These methods might be especially advantageous among young adult PWUD in rural areas, where transportation barriers are prevalent, stigma may heighten concerns about confidentiality, and internet access is improving. However, online research with PWUD can be challenging, especially in verifying eligibility. Administering “quizzes” to verify residential and substance use eligibility could prove valuable in online research among PWUD, yet the utility of this approach is currently unknown.

Objective:

This protocol describes the implementation of online eligibility quizzes about the local community to verify residence in the target study area, and about drug dose, appearance, and price to verify opioid misuse.

Methods:

To be eligible, individuals had to live in one of five Eastern Kentucky counties; report using opioids to get high in the past 30 days; and be aged 18-35. Participants recruited from August 2017 to July 2018 were asked questions about their opioid use, followed by a quiz about drug dose, appearance and price to verify substance use eligibility. Residential eligibility was verified with five-question quizzes assessing knowledge of the county where they reported living. Questions queried knowledge about towns, festivals, and landmarks; local school mascots and colors; and presence of certain retail stores, restaurants, and facilities (eg, jails). A subsample who reported using opioids in the past 24 hours were randomly selected to complete urine drug testing (UDT). Non-parametric tests were performed to explore differences across demographic sub-groups.

Results:

Of the 410 entries assessed for eligibility, 39.3% (161/410) were ineligible due to reporting no substance use, being outside of the age range, or living outside of the study area. Of the remaining 249 who met eligibility criteria based on age, residency, and opioid misuse, 94.0% (234/249) “passed” the eligibility quizzes. Among those who passed the heroin quiz, 99.4% (167/168) recognized the image of powdered heroin, 94.6% (159/168) answered the cap size (i.e. the purchase unit) question correctly, and 97.0% (163/168) answered the street price question correctly. Among those who passed the drug quiz for prescription opioids, 94.7% (36/38) answered the dose question correctly and 81.6% (31/38) selected the correct image. In a random sample of participants who completed UDT within three days of their online screening, 73.5% (25/34) tested positive for an opioid.

Conclusions:

This study demonstrated the utility of using online eligibility screening quizzes to verify opioid misuse and residence. Participants accurately recognized heroin and prescription opioid doses, prices, and images and correctly answered questions about features of their county. Online quizzes to screen and enroll PWUD hold promise for future research as an alternative to more time- and resource-intensive approaches that could offset the advantages of web-based methods.