JMIR Publications

ABSTRACT

Background:

US overdose death rates continue to exceed 77,000 per year, the majority of which involve opioids. One evidence-based response to this crisis is overdose education and naloxone distribution (OEND). There is a large, national (US) network of citizens and first response agencies connected through an app called PulsePoint Respond who are engaged in facilitating rapid layperson CPR administration in cases of public emergencies. Our goal is to recruit these first response agencies to provide targeted messaging about OEND to the large subpopulation of motivated layperson responders. This study focuses on the first step: the feasibility of our national efforts to recruit first response agencies to participate in our project.

Objective:

First, we identified whether more first response agencies were successfully recruited using materials that included preemptive correction of misperceptions about overdose and naloxone than with standard recruitment materials. Second, we investigated the recruitment parameters observed when agencies were successfully recruited.

Methods:

The overall study was a randomized, controlled trial in which we randomly sampled 180 first response agencies from the total set of agencies subscribing to PulsePoint (n=773). Agencies were randomly allocated to three study arms (1:1:1) with stratification for rural status. Arm 1 received standard recruitment materials, arm 2 received similar materials that directly addressed common misperceptions about overdose and naloxone, and arm 3 was recruited to serve as a control arm for later parts of the study. The primary analysis of recruitment approaches used logistic regression contrasting arms 1 and 2. Exploratory analyses included descriptive statistics and other logistic regression models.

Results:

A total of 39 agencies signed memoranda of understanding to participate in the project (22.2% of the total sample; 25.8% of the agencies where a point of contact had been established). We did not find evidence that the messaging contained in arm 2 significantly affected recruitment success (OR=0.754, 95% CI = 0.298 – 1.904, p = .550). Likewise, arm assignment (3-way comparison) did not significantly affect the likelihood of an agency agreeing to participate. The recruitment process took an average of 160.15 days (SD: 105.88 days) per agency, and involved 8.41 e-mails, 2.03 voicemails, 0.85 phone calls, and 1.23 video calls.

Conclusions:

Recruiting first response agencies that subscribe to PulsePoint for participation in a national-level OEND project appears feasible, with an anticipated participation rate between 22% and 26% of agencies solicited. Successful recruitment timelines can be lengthy and involve extensive correspondence. Since the language used in our different study arms did not have a significant effect on agency recruitment, other factors (such as individual citizen responses to messaging) could reasonably be used to select the overall language used in subsequent project recruitment materials. Clinical Trial: OSF Registries; https://osf.io/egn3z