JMIR Publications

ABSTRACT

Background:

Historically, recruiting research participants via social media facilitated access to people who use opioids (PWUO), capturing a range of drug use behaviors. The current rapidly-changing online landscape, however, casts doubt on social media’s continued usefulness for study recruitment.

Objective:

This study assessed social media recruitment for PWUO and describes challenges and potential solutions for effective recruitment.

Methods:

As part of a study on barriers to harm reduction health services, we recruited PWUO in New York City to complete a REDCap online survey using Meta (Facebook, Instagram), X (Twitter), Reddit, and Discord. Eligible participants must have reported using opioids (heroin, prescription opioids, fentanyl) for nonprescription purposes in the past 90 days and live or work in New York City. Data collection took place from August through November 2023. Including study purpose, compensation, and inclusion criteria caused Meta and X to flag our ads as “discriminatory” and “spreading false information.” Listing incentives increased bot traffic across all platforms despite bot prevention activities (e.g., reCAPTCHA, counting items in an image). We instituted a rigorous post hoc data cleaning protocol (e.g., investigating duplicate IP addresses, participants reporting use of a fictitious drug, invalid ZIP codes, improbable drug use behaviors) to identify bot submissions and repeat participants. Participants received a $20 gift card after post hoc data inspection.

Results:

There were 2,560 submissions, 93.2% (n=2387) of which were determined to be from bots or malicious responders. Of these, 23.9% (n=571) showed evidence of a duplicate IP or email address, 45.9% (n=1095) reported consuming a fictitious drug, 15.8% (n=378) provided an invalid ZIP code, and 9.4% (n=225) reported improbable drug use behaviors. The majority of responses deemed legitimate (n=173) were collected from Meta (n=79, 45.7%) and Reddit (n=48, 27.8%). X’s ads were the most expensive ($1.96/click) and yielded the fewest participants (3 completed surveys).

Conclusions:

Social media recruitment of hidden populations is challenging but not impossible. Rigorous data collection protocols and post hoc data inspection are necessary to ensure validity of findings. These methods may counter previous best-practices for researching stigmatized behaviors.