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10.1017/cts.2020.5
Running Head: FACEBOOK ADVERTISING FOR RURAL AUDIENCES
Communication Strategies for Designing Facebook Advertising Campaigns to Recruit Rural
Participants to Develop Healthcare Delivery Interventions
Elizabeth Flood-Grady, Ph.D. 1,2
Deaven Hough, M.A. 2
Rachel E. Damiani, M.A. 1,2,3
Nioud Mulugeta Gebru, M.P.S. 2,4
David A. Fedele, Ph.D., ABPP 6
Robert F. Leeman, Ph.D. 4,7
Janice L. Krieger, Ph.D. 1,2,3,8
1 STEM Translational Communication Center, University of Florida, Gainesville, USA
2 Clinical and Translational Science Institute, University of Florida, Gainesville, USA
3 Department of Advertising, College of Journalism and Communications, University of Florida,
Gainesville, USA
4 Department of Health Education and Behavior, College of Health and Human Performance,
University of Florida, Gainesville, FL USA
5 Department of Public Relations, College of Journalism and Communications, University of
Florida, Gainesville, USA
6 Department of Clinical and Health Psychology, College of Medicine, University of Florida,
Gainesville, USA
7 Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
8 Department of Health Outcomes and Biomedical Informatics, College of Medicine, University
of Florida, Gainesville, USA
The authors do not have any conflicts of interest.
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Abstract
Background: Little is known about designing research recruitment campaigns that connect with
underserved, geographically-isolated rural populations. A theoretically-informed process is
needed to assist researcher teams and practitioners in their evaluation of Facebook’s feasibility as
a recruitment tool and development of online materials for recruiting rural adults into healthcare
delivery intervention development studies.
Methods: We drew from research and theory in communication and incorporated process
analysis techniques to develop replicable procedures for designing and evaluating Facebook
campaigns for rural recruitment. We describe our process and illustrate using two case studies.
Results: Campaigns received approximately 1,000 link clicks from the target rural demographic
and successfully enrolled participants using Facebook as a primary method of recruitment. The
rural tobacco intervention development study received a total of 477 link clicks, cost only
$155.80, and enrolled three (23%) of its 13 participants from Facebook. The rural mental health
intervention development study received a total of 518 link clicks, cost only $233.28, and
enrolled 178 participants.
Conclusions: Our process yielded two successful recruitment campaigns. Facebook was an
affordable and efficacious strategy for enrolling adults in behavioral research studies on tobacco
and mental health. Future work should apply these theoretical techniques to additional study
topics and evaluate specific message features associated with recruitment.
Key words: Communication, Facebook recruitment, rural health, healthcare delivery intervention
development, elaboration likelihood model, message targeting
Word count: 6,422 excluding the abstract, references, tables, figures
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Social media channels, such as Facebook, offer billions of users the unique opportunity to
access and exchange important health information1,2. Individuals living in rural areas, who have
higher rates of a myriad of preventable diseases3, who are as likely their urban counterparts to
use the Internet4, actively use social and digital media to obtain health information5. As a leading
social networking site, Facebook can minimize social and physical distance often experienced by
rural adults. Moreover, its expansive reach makes it particularly useful for disseminating
opportunities to participate in intervention development studies – research that actively engages
potential recipients of interventions in research development – to geographically-isolated,
underserved rural populations. Facebook provides online tools to identify prospective rural
audiences to participate in research and gives researchers the unique advantage of simultaneously
recruiting for a study and evaluating recruitment campaign efficacy (e.g., metric evaluation).
This dual recruitment and monitoring approach can facilitate effective recruitment and adapt to
rural populations to enroll them in healthcare delivery intervention development studies.
However, challenges communicating with rural audiences about research participation
can impede recruitment. Many adults who reside in rural locations and adults with low health
literacy find it difficult to comprehend – and may misinterpret – common language used to
describe research participation. For instance, rural adults perceive the metaphor “randomization
is like flipping a coin” as akin to gambling with one’s health, making them less likely to
participate in research studies 6,7. In addition, rural audiences emphasize independence and self-
sufficiency in their definitions of health, and their overall health attitudes and beliefs differ from
adults living in urban areas8. Thus, the messages and information commonly used to
communicate with individuals about health research opportunities may not capture the attention
of rural audiences and may adversely affect participation.
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Developing advertising campaigns that communicate messages that resonate with rural
audiences is critical to engaging and recruiting underserved, rural populations to participate in
healthcare delivery intervention development studies. Leveraging Facebook’s expansive reach to
disseminate research opportunities to rural audiences has the potential to reduce discrepancies in
clinical enrollment between rural and urban audiences9. However, it remains unclear how to
design and evaluate Facebook recruitment campaigns that connect with underserved, rural
populations. Drawing from research and theory in communication, we describe a process – that
worked for our institution – for evaluating the feasibility of Facebook as a study recruitment tool
and developing theoretically-informed materials for recruiting rural audiences into healthcare
delivery intervention development studies. We use two case studies on rural Facebook
recruitment to describe and illustrate this process.
Methods and Procedures for Developing Facebook Advertising Campaigns for Rural
Recruitment
Despite Facebook’s potential to revolutionize study recruitment, the tangible steps for
designing, implementing, and evaluating Facebook research recruitment campaigns are unclear.
Our theoretically informed process for engaging rural individuals in research studies through
Facebook recruitment is contextualized, in part, through an explanation of the recruitment
services provided by our institution’s Clinical Translational Science Institute (CTSI) Recruitment
Center and two case studies wherein interdisciplinary teams used Facebook advertising to recruit
rural audiences into healthcare delivery intervention development studies.
CTSI Recruitment Center Consultations
Research teams who are interested in recruitment services, including Facebook
advertising, complete an online form through the CTSI Recruitment Center website describing
the nature of their study and recruitment needs. The form is emailed directly to the Recruitment
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Specialist (the center’s RS), who assesses the study needs and schedules an initial recruitment
consultation with the team. Prior to the consultation, research teams may be asked to provide
additional study information (e.g., eligibility criteria, previous recruitment efforts). During the
initial consultation, the center’s RS provides research teams with an overview of the suite of
available recruitment services, as teams may be unaware of the resources available at the
university or have uncertainties trying new recruitment methods. Services include a consent to
recontact registry, a community-based registry, a university-approved social media channel, and
access to national research registries. Research teams are counseled as to which recruitment
services are the best match for their study. If a team is interested in using Facebook recruitment,
they receive an overview of Facebook advertising (e.g., how it works) and our institutional
account (i.e., University of Florida [UF] Studies), which is led and managed by the CTSI
Recruitment Center.
Step 1: Assessing Facebook Recruitment Feasibility
To determine Facebook’s potential as a recruitment tool for a particular study, the
center’s RS conducts a feasibility assessment. Feasibility assessments evaluate the potential of
conducting a study in a specific location—given a particular population—and successfully
completing the project in terms of timelines, prospective targets, and cost10. To determine
Facebook recruitment feasibility the center’s RS completes a mock query for the study. The
mock query identifies the number of prospective participants who are active users on the site,
who fit the selected targeting criteria for the study, and who may ultimately see11 and potentially
engage with the advertisements (i.e., reach) in the geographic area where the study is conducted.
Prospective participants (i.e., active users on Facebook) for research recruitment are
identified based on their demographics and interests. Targeting by demographics includes
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identifying users by age or age groups (e.g., adults age 65+, 18-44 years of age), gender (e.g.,
men, women), and lifestyle information as indicated by users personal Facebook account, such as
relationship status (e.g., married). Demographics also includes targeting individuals by their
geographic location. For UF Studies, we typically set campaigns to appear within a 50-mile
radius of the city/location in which the study is being conducted (often Gainesville, Florida, the
location of our main campus). The 50-mile radius encompasses a number of rural areas. We use
demographic and location targeting in mock queries to determine the potential reach and link
clicks–an estimate for the number of clicks the advertisement will receive on a daily basis11, for a
given study.
Interest targeting is crucial to identifying and recruiting individuals into health research
and is used to determine feasibility. Interest targeting permits research teams to use key words on
Facebook and users’ involvement in certain groups or organizations (e.g., as denoted by liking
certain pages, involvement in groups) to further identify audiences within the previously set
demographic criteria. For instance, interests like “AARP” and “DIY Everywhere” could be used
in a mock query to evaluate the reach for a study on adults ages 50-65+. Interests targeting also
uses key words that relate to a specific disease, health topic, or condition, such cancer, diabetes,
and nutrition, to identify users by their health interests. The center’s RS may use the Audience
Insights tool from Facebook12 to identify interests for a wider range of targeting criteria. This
tool may be helpful for identifying and recruiting hard to reach populations or individuals whose
interests are not easily identified, such as healthy volunteers. These interests may include local
grocery store brands, sports teams, and restaurants. Multiple interests are included to
accommodate for the potential of low reach and low link clicks.
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Ad placement is also specified during the mock query. Per our institutional guidelines for
using social media in research recruitment13, ads can appear in users right-column and main
newsfeed. Facebook’s Right-column advertisements appear exclusively on desktop computers,
whereas advertising that appears in Facebook users’ main newsfeeds can be viewed from
desktop computers and mobile phones. Because advertising placement influences potential reach,
it is essential to include in the mock query.
Facebook recruitment feasibility is largely determined by the potential reach and
estimated link clicks for a particular study, based on the targeting parameters, and ad placement.
Previous studies that have used the UF Studies for recruitment also used as a benchmark to
determine if a study should proceed with Facebook advertising.
Recruitment Case Studies
Rural Tobacco Intervention Development Study, Case Study 1. The goal of this study
was to explore rural tobacco users’ perceived barriers and motivators to participating in research
and smoking cessation and to use the qualitative findings to help connect researchers with rural
tobacco users. Individuals who were over the age of 18 years old, current tobacco users (i.e.,
used tobacco products, including cigarettes, electronic-cigarettes [e-cigs or vapes], and dry
tobacco [e.g., snus and dip] on some days or everyday), and lived in a rural county in Florida
were eligible to participate in the interview study. The team initially implemented “on the
ground” recruitment approaches by utilizing their campus network to establish contact with
citizen scientists, representatives from local government extension offices, and county
department heads in the four rural counties where the team was recruiting. Individuals helped the
team identify locations and events (e.g., Amvets Sunday Funday) for recruitment. Limited
success with this initial recruitment approach led the study team to work with the CTSI
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Recruitment Center to implement additional recruitment strategies, including i2b2 queries to
identify prospective participants and Facebook paid advertising to promote the study. Individuals
who participated in the study were remunerated with a $25 Walmart gift card.
Rural Mental Health Communication Intervention Development Study, Case Study
2. The goal of this study was to identify and recruit rural parents with at least one adolescent to
participate in an online survey about parent-child mental health communication and to provide
feedback on existing web-based mental health resources. The data collected in this study served
as the foundation for a larger pilot project aimed at engaging rural parents and adolescents to
participate in the development of a web-based mental health intervention program for rural
youth. Participants who were over the age of 18, lived in a rural county in Florida, and had at
least one adolescent (i.e., a child between 10-17 years of age) were eligible to participate in the
study and were recruited through Facebook paid advertising. Individuals who participated in the
study were remunerated with $10 e-gift card.
Rural Facebook Recruitment Feasibility. Identifying prospective participants by study
demographics (e.g., age, gender) and strategies that are specific to identifying and recruiting
rural audiences for a particular study, such as using rural zip codes to identify and target
individuals who reside in rural areas, are used to determine rural Facebook recruitment
feasibility. Rural audiences are also targeted by study-related interests and interests that may
resonate with people who reside in rural areas, as described below.
Rural Facebook Recruitment Feasibility, Case Study 1: We used several targeting
strategies to evaluate the feasibility of Facebook for recruiting rural adults to participate in the
development of tailored tobacco intervention development. First, individuals were identified by
their age and gender. Second, zip codes were used to identify and target individuals living in the
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north Florida rural counties of Bradford, Columbia, Levy, and Union. For this study, a county
was considered ‘rural’ if it was classified as rural by the Florida Department of Health (i.e., the
county has 100 persons or less per square mile), the United States Department of Agriculture
(USDA) (i.e., county is nonmetro-urban with a population of 2,500 to 19,999, adjacent to a
metro area or Nonmetro-Urban with a population of 20,000 or more, adjacent to a metro area),
the Centers for Disease Control and Prevention (i.e., county is classified as micropolitan, with a
population of 10,000-49,999 or noncore - counties are considered nonmetropolitan and do not
meet criteria for micropolitan), and our institution’s classification (i.e., county is classified as
small town/rural). Thus, rural recruitment feasibility was determined, in part, as Facebook users
living in north Florida within a 50-mile radius of the cities/zip codes in the four rural counties.
Second, interests and key words pertaining to the study were included to assess
feasibility. A total of 13 Facebook interests related to tobacco use, such as cigar, smoking, and
vapor, were added to the query to identify prospective participants and determine reach (see
Table 1). The Facebook “Audience Insights” tool provided a list of interests deemed relevant to
rural adults living in the north Florida geographic region (e.g., Walmart, Tim Tebow, Universal
Orlando, Publix), though these were not used to target individuals for this study (See Table 1 for
full targeting criteria). Using these demographic and interest criteria, the potential reach for this
campaign was 19,000 Facebook users.
Rural Facebook Recruitment Feasibility, Case Study 2: Multiple targeting strategies
were used to evaluate the feasibility of Facebook for recruiting rural parents of adolescents into
the mental health communication intervention development study. First, individuals were
targeted by their age and gender. Second, zip codes were also used to identify and target
individuals living in rural counties across the state of Florida. For this project, a county was
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considered ‘rural’ if it was classified as rural by the 2010 census (i.e., counties with 50,000
residents or less were considered rural). Thus, rural recruitment feasibility was determined, in
part, as Facebook users living in the state of Florida who resided within a 50-mile radius of the
cities/zip codes in the 31 rural counties.
Second, interests and key words pertaining to the study were included to assess
feasibility. A total of three Facebook interests pertaining to parental status, including ‘parents
with adult children (18-26 years),’ ‘parents with preteens (8-12 years),’ and parents with
teenagers (13-18 years)’ were added to the query to identify prospective participants and
determine reach (See Table 1 for full targeting criteria). Because our goal was to understand how
– if at all – parents of adolescents communicate with their child about mental health and to
receive feedback on existing web-based mental health resources, individuals were not identified
and targeted using key words and interests pertaining to mental health. Linguistic considerations
pertaining to mental health were accounted and are described in the section on Developing
Content for Facebook Advertising. Using these demographic and interest criteria, the potential
reach for this campaign was 2,600,000 Facebook users.
Additional Steps and Considerations. Research teams complete a recruitment
walkthrough with the center’s RS. Facebook’s Ads Manager14 business tool, which is the
interface where the center’s RS sets up (i.e., selects/sets the criteria for identifying, targeting
prospective participants), launches recruitment advertisements, and monitors Facebook
advertising campaign progress (i.e., budget, clicks, reach, and impressions). A recruitment
walkthrough via the Ads Manager provides a visual for how campaigns work, allows teams to
see examples of previous study campaigns including the target audience, campaign results, and
budget, and demonstrates how the center’s RS monitors and reports ad metrics. Research teams
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only have access to the Ads Manager – and previous campaigns – when they complete the
recruitment walkthrough with the center’s RS. Completing a recruitment walkthrough is critical
to demonstrating the work and effort involved in developing, managing, and monitoring the
recruitment campaigns, especially since the next item discussed is service fee.
The center’s RS reviews and confirms the fees associated with Facebook advertising
(e.g., campaign cost) and Recruitment Center services (e.g., time and cost to developing ads,
managing campaign progress). Research teams are advised to budget $250 a month for
recruitment advertising on Facebook, though teams may commit to spending as much or as little
they are comfortable with. Recruitment Center fees are not adjusted or waived based on
campaign costs. Research teams receive a post-consultation email with notes from the
consultation, next steps, and if applicable, details on Facebook recruitment feasibility.
Step 2: Designing Recruitment Materials for Facebook Advertising Campaigns
If Facebook is deemed an appropriate channel for study recruitment, and the study team
agrees to the costs, teams collaborate with the CTSI Recruitment Center on a comprehensive
Facebook recruitment plan for submission and approval from the Institutional Review Board
(IRB). Using standardized templates developed as part of the larger initiative at the university to
establish procedures surrounding the use of social media in research recruitment, the plan
includes a description of the UF Studies Facebook account, how the recruitment campaign will
managed by the CTSI Recruitment Center13, the targeting criteria used to determine feasibility,
including additional targeting criteria identified by the center’s RS after the consultation. The
plan also includes creating content for recruitment materials, including the ad text, headlines, and
images that may be used in advertisements (See Table 2 for descriptions).
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Investigators receive assistance creating theoretically-informed recruitment messages.
The center’s RS creates study recruitment plans that can be used for several ad sets, developing a
minimum of six variations of text, headlines, and images for each study campaign. Including a
variety of text and visual options increases the likelihood that advertising text will adhere to
regulatory specifications used by IRBs to approve materials and ensures teams have enough
content to continue running recruitment campaigns for several months. Because Facebook uses
an algorithm to approve recruitment advertisements, developing multiple ad sets also accounts
for potential issues that may arise with approval on social media. Developing content for
multiple ad sets also provides our Recruitment Center with enough content to evaluate high and
low performing ads and ensures the team has additional IRB-approved options if performance is
low on a particular ad (i.e., if there are low link clicks). Using the standardized templates,
research teams are responsible for submitting the CTSI Facebook recruitment plan with materials
to the IRB for approval, making additional edits to the materials as needed, and submitting final
copies of recruitment advertisements to IRB.
Theoretical Considerations for Developing Facebook Recruitment Materials. There
are important theoretical and practical considerations to designing effective recruitment
advertisements on Facebook. The elaboration likelihood model (ELM) contends that audiences
attend to messages actively or passively and (in)attention to message content is influenced by
participant’s involvement with the message topic15. Audiences who perceive messages as
personally relevant actively seek out and process this information16,17, whereas uninvolved
audiences (i.e., those who have little involvement or interest in a topic) passively attend to the
same information with little awareness, comprehension, or evaluation15,17. Thus, a primary goal
of designing Facebook recruitment materials is to highlight the relevance of the study and
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participation to prompt active processing and message engagement among active and passive
members of the target audience.
Identity roles. It is important for messages to resonate with the identities and social
group membership of the target audience18. To ensure messages resonate with intended
audiences on Facebook, ads should be customized and incorporate language and visuals that
align with multiple aspects of the target audience’s identity. Primary identities often stem from
people’s membership in large social groups, such as ethnic19 and age identities20. These identities
often apply, more broadly, to larger social groups. Secondary identities reflect people’s
identification with certain behaviors or with groups associated with a set of behaviors21, such as
identifying with exercising and healthy living. Tertiary identities are unique to the individuals
being targeted in advertisements and reflect the extent to which people identify with their
position in the social group and the labels used to describe membership afflilation21, such as
being a cancer survivor, parent of an adolescent, or a local sports fan.
Understanding and highlighting target audience identities are important to developing
recruitment materials. When designing ads, we include as much about the study population and
highlight identities that may be salient to target audiences. For instance, rather than describing a
research opportunity as “A study seeking adult participants,” advertisements would highlight the
primary identity characteristics of the intended target audience, such as their age (e.g., adults
65+) and tertiary identity roles (e.g., caregivers). A recruitment advertisement describing that
same opportunity as “Adult caregivers between the ages of 65-80 needed to participate in a
study” should increase message relevance among prospective participants.
Ad images can also be used to emphasize prospective participants’ primary, secondary, or
tertiary identities. For instance, if recruiting older adults (e.g., adults 55+) into a study on
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physical, images should capture older individuals from diverse backgrounds (e.g., women, men;
African Americans, Latinx). Ad images can also be used to demonstrate prospective participants
enacting secondary identities relevant to the study (e.g., engaging in physical activity, such as
walking or swimming). Healthy volunteer studies and those with broad eligibility criteria should
incorporate images with individuals of all ages, races, and genders.
Additional theoretical considerations. For advertising messages, different information
and appeals may be effective for different audiences15. According to ELM, attitudes of audience
members with low involvement with an advertisement are positively influenced by appeals not
directly related to the ad topic, such as the attractiveness, credibility, and structural features of
the ad 15. In other words, members of the Facebook target audience who were identified using
interests and key words but may have little interest in participating healthcare delivery
intervention development studies, are likely to engage the ads because of information not directly
related to the study. To account for these individuals, we consider additional message features
when designing Facebook recruitment materials, including credibility, intrinsic and extrinsic
appeals, calls to action (CTAs), and diversity. Features are reflected in both the content
(information presented in the text and headlines) and visual (photos) aspects of materials.
Credibility. This refers to the trustworthiness of the source22 communicating a message.
Medical experts are widely considered as credible sources of health information23, and may be
perceived as credible sources of information about recruitment. Variability in perceptions of
source credibility across social groups25,15 suggests that how the source is presented visually
(e.g., doctor vs. lay person; female vs. male; African American vs. Caucasian) and linguistically
in messages (e.g., student with background in nutrition vs. medical research institution) may
influence message engagement and recruitment. Credibility is presented in multiple ways to
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account for variability in audience perceptions, including an emphasis on the institution (e.g.,
“University of [name]”) and/or researcher conducting the study (e.g., “Researchers at
[institution]”). If applicable, ads may also demonstrate a personal connection between the
researcher and target audience.
Intrinsic and extrinsic appeals. A recent study found that medical research institutions
communicate with prospective participants about research online using intrinsic (i.e., internal
factors; e.g., interest in advancing science, helping a loved one) and extrinsic (i.e., external
factors; e.g., time, transportation, compensation) message appeals26. Institutions emphasized
intrinsic non-monetary motivations for participating in research, such as the desire to advance
science and to help oneself26 on their websites. Extrinsic appeals, such as study incentives, were
also described on institution websites. Thus, intrinsic and extrinsic appeals are included in
recruitment messages. Non-monetary motivations highlighting internal factors for participating
are included – and vary – across ad text (e.g., “By participating, you can help advance the future
of science.”). Extrinsic factors that could encourage participation, such as offering compensation
(e.g., “You will receive an e-gift card”) or highlighting the time needed to participate (e.g.,
“Participating will take 30 minutes”) are also included – and vary – across ads.
Calls to action. Calls to action (CTAs) encourage specific action on the part of the
individual seeing the ad and are reflected in the ads by describing active steps individuals can
take to learn more about the study (e.g., “Click here to access the study website”) or to
participate (e.g., “Click here to be directed to the survey”). CTAs may motivate members of a
target audience who do not identify with the individual, group, or behaviors depicted in ad to
interact with or engage in additional behaviors pertaining to the study.
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Diversity. Clinical research routinely fails to adequately enroll minority and underserved
populations into studies27. Thus, diversity is among the most important considerations for
designing Facebook advertisements. Diversity is reflected in the images selected and language
used to describe research studies and activities in the recruitment advertisements. In the content,
we use numerous words and phrases to describe a study and identities of participants, to
highlight credibility, to explain intrinsic and extrinsic appeals and calls to action. Diversity is
reflected in images by representing individuals of as many ages, races, and genders as possible –
as they fit with the study population. See Table 3 for descriptions of themes and examples.
Advertising Text. Also described as “ad or post text,” advertising text refers to the
content presented in the body of the Facebook advertisement. Identities (e.g., “Smokers,”
“parents”), credibility (e.g., “Medical researchers”), intrinsic and extrinsic appeals (e.g.,
compensations provided”), and CTAs (e.g., “Learn more”) are included in the text of
advertisements (see Table 3 for additional examples). Ad text must also adhere to regulatory,
institutional guidelines, and Facebook guidelines. For instance, Facebook permits up to 125
characters in the post text. Similar to offline advertisements (e.g., flyers), Facebook
advertisements cannot target audiences by health or illness conditions. Language used in high
performing ads (e.g., ads with high clicks) and how words or phrases may be perceived by the
target audience are also considered when developing text of recruitment materials.
Advertising Headlines. With a 25-character limit for ad headlines, it is important to
succinctly summarize the study for participants and for mobile optimization. Similar to the post
text, information about the target population and specific aspects of the study are included in the
headlines. Due to space constraints, we choose key words and interests that best reflect the study
and represent the identities of prospective participants. For instance, if recruiting men who meet
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men online to participate in a study testing online dating applications, we would include the
primary (e.g., men) or tertiary group identities (e.g., online daters) in the headlines. Credibility is
also incorporated into the headline, often by using a common abbreviation for our institution and
health system (See Table 3 for additional examples). Intrinsic and extrinsic appeals are not
included in headlines.
Advertisements are required to include a “learn more” button, which is embedded in the
ad and directs users to a space outside of the social media site. Per our institutional guidelines,
the “learn more” button directs prospective participants to a secure channel outside of Facebook,
such as a url for a university study, an IRB-approved website created by study team, or a
Qualtrics or REDCap survey, for additional information about the study. Ad images function
similarly to the “learn more” button, and direct individuals to the separate, secure channel for
study information.
Images. Including images that reflect diverse populations and that represent the context
of the study is crucial to recruitment. In addition to selecting images that represent the study
population, we choose images that appear “realistic” (i.e., are not visibility or highly modified),
represent diverse individuals (e.g., people who are non-White and White) in everyday settings
(e.g., talking on the phone), and have performed well in previous UF Studies recruitment
campaigns. Images are selected from the website Shutterstock, and the watermarked images are
copied and pasted into the recruitment plan for submission and review from the IRB.
Special Considerations for Designing Messages for Rural Audiences. Rural
communities have unique resources, needs, health concerns, demographic variation, and
economic resources.28 Like all cultural groups, rural communities are not monolithic. However,
it is important for message designers to be aware that rural cultural values may be distinct from
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other populations. For example, research suggests that rural individuals are more likely to
prescribe to traditional norms and conservative values29. In addition, rural individuals may
experience health differently than non-rural populations.8 Rural attitudes and beliefs about health
emphasize independence, self-sufficiency, and ability to perform social roles and perceived
obligations8.
Rural audiences also hold distinct views of healthcare and caregiving. For instance, some
rural adults are skeptical of outsiders and distrusting of medical professionals, in particular30. In
rural communities, family members are also central to caregiving31, and parents are crucial to
teens and children’s ability to access care, especially in the context of mental health28.
Incorporating the themes and identities consistent with rurality and rural audience’s health
perceptions should help to facilitate recruitment of rural adults into health research studies.
Limited trust in healthcare systems, coupled with an emphasis on family members as caregivers,
further emphasizes the need to engage rural audiences in the participation and development of
healthcare delivery interventions. Thus, highlighting rural identity, independence and self-
sufficiency, and emphasizing other salient social identity roles of rural adults are crucial to
designing recruitment messages for rural audiences.
Developing Facebook Recruitment Materials for Rural Audiences, Case Study 1: To
recruit rural adults into the tobacco tailored intervention development study, ads incorporated
rural identity and framed study participation around independence and giving individuals agency
to participate in their healthcare. Rural identity was incorporated into ads by using key words and
phrases emphasizing rurality, such as “rural” and “Floridians who live in rural communities.”
Participation in the study was framed around independence and ability, and we used language
that conveyed the importance of participant input and individual experiences in helping
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researchers understand their health decisions (e.g., “You can help researchers at UF understand
how rural Floridians use tobacco products”).
The institution and researchers were highlighted as sources of credibility (e.g., “UF
tobacco study”), intrinsic (i.e., internal factors, e.g., the desire to help oneself or to advance
science) and extrinsic (i.e., external factors, e.g., “compensation provided”) messages, and calls
to action (e.g., “Click here to visit the study website”) were also included to increase message
appeal. Key words reflecting the content of the study, such as tobacco, tobacco products, and
tobacco use, were also incorporated into recruitment advertisements (See Table 4 for examples
of rural language considerations).
Rural settings are not culturally homogenous.8 Thus, it was important to select photos
with diverse individuals and images of people in rural settings. Images with individuals looking
at the camera were selected for this recruitment plan. These types of images performed well in
previous campaigns and reinforced cultural values of independence. Photos depicted individuals
whose demographics were consistent with individuals living in the four North Florida counties
(e.g., photos included individuals from African American, White, non-White, Hispanic
backgrounds). Photos with individuals in green, outdoor spaces were selected to represent
rurality whereas city settings with skyscrapers and landscapes that were dissimilar to North
Central Florida (e.g., a desert, beach) were excluded.
Developing Facebook Recruitment Materials for Rural Audiences, Case Study 2: To
recruit parents of adolescents into the mental health communication intervention development
study, ads highlighted the role of parental identity and framed participation in ways that offered
parent participants agency to inform the development of future healthcare efforts for their
children. Tertiary identities were incorporated into ads by using key words and phrases
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emphasizing parental identity roles, such as “Parents of adolescents.” Participation was framed
around parental identity and caregiving; ad language1 positioned parents as important caregivers
whose individual perspectives were central to understanding mental health (e.g., “Researchers
want to understand parent adolescent communication about mental health and illness”).
The institution and researchers were highlighted as sources of credibility (e.g.,
“Researchers at UF”). Ads also emphasized parental credibility, intrinsic (e.g., “Opportunity for
Florida parents”) and extrinsic appeals (e.g., “e-gift card provided”), and calls to action (e.g.,
“Click on the link to see if you qualify”) were also included to increase message appeal. Images
depicting a diverse selection of parents and adolescents – talking and engaging with technology –
were selected for the recruitment plan as parents of adolescents were the target audience of this
study. Thus, images demonstrated prospective participants enacting parental identities.
We also considered the potential for mental illness stigma to influence recruitment.
Mental illness stigma--public, perceived, and self--is a significant barrier to rural participation in
mental health-related services (e.g., treatment, research, etc.)32. To account for the stigma that
could preclude or deter parental participation, mental illness communication was framed in
multiple ways (e.g., communication about social and behavioral health) (See Table 4).
Step 3: Tracking Facebook Advertising Campaigns and Study Recruitment
Tracking Facebook study recruitment is a joint effort between the center’s RS and the
research teams. The center’s RS sends teams weekly updates documenting campaign progress
(i.e., total ad clicks, reach, comments), remaining budget, and how many weeks remain in the
campaign. Screenshots of user comments are also included in weekly updates, as necessary2.
1 Although “rural” was inadvertently left out in the creation of the advertisements for Case Study 2, the campaign
highlighted identities salient to recruiting rural adults into health studies and was successful in terms of recruitment.
2 If a potential participant commented that they were trying to reach the study team, the RS would take a screenshot
of this comment and send it to the team to follow-up.
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This regular monitoring allows the center’s RS and teams to make adjustments, as needed, to
maximize recruitment. At the end of the campaign, teams also receive a final summary with their
total metrics and suggestions for future campaigns.
To track the efficacy of Facebook recruitment, research teams include an item in their
survey, in-take or screener, asking participants how they heard about the study, and include
Facebook as a response option. Research teams are also expected to respond to weekly updates
with data on the number of participants who inquired about the study/filled out a screening
survey and enrollment. Inquiries are defined as phone calls and emails from potential participants
to the study team. Completion of online screeners (for surveys) are also considered inquiries.
Enrollment is the number of individuals who passed screening, consented, and participated in the
study. Teams are aware they will be asked to report on metrics before the campaign begins.
Because participants may continue to inquire about the study after campaigns have ended,
research teams also update the center’s RS on inquiries and enrollment after the study is
officially closed. As an incentive for reporting timely recruitment data, researchers may be
invited to participate in future manuscripts on recruitment.
Results
Facebook Advertising Campaign, Case Study 1: A total of 12 ads (two ad sets) were
disseminated over three weeks. This campaign received a total of 477 link clicks and cost
$155.80. The highest performing ad received 233 link clicks (see Figure 1). Sixteen individuals
who saw the advertisements on Facebook inquired about the study, three of which enrolled (See
Table 4 for full metrics).
Facebook Advertising Campaign, Case Study 2: A total of six ads (one ad set) were
disseminated over four weeks. This campaign received a total of 518 link clicks and cost
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$233.28. The highest performing ad received 340 link clicks (See Figure 2). Four hundred and
thirty-five participants inquired about the study 178 of which enrolled (See Table 4 for full
metrics).
Discussion
Evaluating the Recruitment Process
In this paper, we described a theoretically-informed process for evaluating Facebook’s
feasibility as a study recruitment tool and developing materials for recruiting rural adults to
participate in the development of healthcare delivery interventions. Engaging multiple theoretical
strategies to develop recruitment advertisements for dissemination on Facebook that target – and
appeal to – prospective participants is important to prompting active processing and message
engagement among active and passive members of a target audience. Using Facebook’s online
tools to select and set criteria to target prospective participants for study advertisements were
useful to determine the potential reach for the studies. However, incorporating message targeting
strategies (i.e., identifying group level characteristics of a target audience (e.g., demographic,
geographic, cultural, risk cognitive factors))33,34 and customizing the content of recruitment
advertisements to address the identities, information needs, and preferences of prospective
participants likely increased message relevance among prospective participants. Thus, rural
recruitment success may be attributed to the dual targeting approach to identifying rural
audiences through the social media channel and strategically communicating with rural adults
about research participation through carefully designed messages about recruitment.
Lesson Learned, Recommendations, and Next Steps
We learned several important lessons as we developed Facebook advertising campaigns
for rural recruitment and offer recommendations and next steps based on our experience. Some
recommendations are specific to rural recruitment whereas others apply more broadly to
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Facebook recruitment. First, metrics tracking through Facebook provides the Recruitment Center
and teams with valuable information on recruitment. Through metrics tracking, teams learn
which ads are high and low in terms of performance. Ad metrics also provide information
regarding the language, text, and visual depictions teams should include in future recruitment
materials. Knowledge gleaned from metrics, specifically which language and visuals work best
with the target population, can inform other aspects of the research design. For instance, if
advertisements with individuals in informal clothing (e.g., jeans) perform better than those with
individuals dressed to fit a certain role (e.g., doctor, researcher), when meeting with participants,
teams can use this information to tailor their clothing to match the individuals depicted in the
high performing ads. Thus, as a communication channel, Facebook advertising facilitates study
recruitment and the metrics offer insight regarding how to communicate and establish rapport
with participants.
Second, linking Facebook advertisements to a landing page or website affiliated with the
institution conducting the study may increase perceptions of study credibility. Health websites
with certain structural features (e.g., organizational information, such as a physical address) are
perceived as credible by online users32,35. Directing individuals to an institution-sponsored study
listing page may enhance study credibility by presenting prospective participants study
information on a page hosted by a reputable institution. Indeed, linking study advertisements to a
secure survey screener (e.g., REDCap) can be effective at recruiting and screening prospective
participants (the rural mental health study linked ads to a secure screener), however, online
consent forms and screeners may be less likely to include the visual heuristic cues (e.g.,
institution logo) that may enhance study and team trustworthiness.
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Third, we recommend running ad campaigns in one-month increments to establish a
baseline for which images, text, and headlines work best with the target audience for use in
campaigns. This timing also works well if teams need to “pause” or temporarily stop running ads
(e.g., if a team receives more inquiries than they can reasonably manage) without major
disruption. Fourth, consulting with investigators, designing theoretically-informed recruitment
messages, launching and monitoring campaigns, and tracking recruitment requires a considerable
amount of time. This process works best if teams collaborate with the center’s RS in advance of
study deadlines and provide timely recruitment data. Because tracking recruitment can be
difficult and time-consuming, future efforts should explore options to integrate with existing data
infrastructure at the institution to track recruitment and enrollment.
Strengths, Limitations, and Conclusions
Our paper is limited by its descriptive evaluation of two Facebook recruitment
campaigns. However, our process for developing theoretically informed recruitment materials for
engaging rural individuals in healthcare delivery intervention development studies through social
media is the first of its kind and a crucial step to understanding the efficacy of Facebook as a
recruitment tool. Future studies should evaluate the themes presented in the content of Facebook
recruitment messages to understand how ad themes relate to enrollment. This paper is also
limited by its use of plain text and static images in recruitment ads. Future campaigns should
include multiple message features (e.g., statistics, testimonials) and formats (e.g., videos,
images) in recruitment campaigns and evaluate their efficacy in terms of metrics and enrollment.
In sum, our theoretically-informed process for developing recruitment materials and engaging
rural individuals in healthcare delivery intervention development studies yielded two successful
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recruitment campaigns, and Facebook was an efficacious strategy for enrolling adults in research
studies on tobacco and mental health.
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Table 1. Targeting criteria and examples of language considerations for designing recruitment campaigns for rural audiences
Facebook Targeting Criteria Message Considerations
Demographics Interests Identity Credibility
Intrinsic and
extrinsic
appeals
Participation and illness
framing
Rural tobacco
intervention
development
study, Case
Study 1
Men and
women; adults
over the age of
18; 50-mile
radius of four
rural counties
in Florida
Camel (cigarette),
cigar, cigarette,
cigarette pack,
electronic cigarette,
Marlboro (cigarette),
nicotine gum,
smoking, snuff
(tobacco), tobacco,
tobacco pie, vapor,
vaporwave
Rural; rural
communities;
Floridians who
live in rural
communities;
Participants who
live in rural
Florida; North
Florida rural
communities
Researchers
at UF; UF
tobacco
study; Rural
tobacco
study
You can
contribute to
research
Compensation
provided
The importance of participant’s
unique input and individual
experiences: Researchers are
seeking input from Floridians
who live in rural communities
and who use tobacco products;
You can help researchers at UF
understand how rural Floridians
use tobacco products.
Rural mental
health
communication
intervention
development
study, Case
Study 2
Men and
women; adults
over the age of
18; 50-mile
radius of rural
counties in
Florida (full list
of rural
counties
available on
request)
Parents with adult
children (18-26
years), Parents with
preteens (8-12
years), Parents with
teenagers (13-18
years)
Parents; Parents
of adolescents;
Florida Parents
of adolescents
Researchers
at UF;
Opportunity
for Florida
parents;
Florida
parents have
the
opportunity to
play an
important role
in mental
health
research
e-gift card
provided
Parents as important caregivers
whose individual perspectives
were central to understanding
mental health: Parents of
adolescents are invited to
participate in an online survey
about social and behavioral
health
Mental illness stigma:
Communication about mental
health and illness; online
survey about social and
behavioral health; mental
health research
UF, University of Florida.
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Table 2. Key areas and descriptions included in the Facebook recruitment plan
Content Area Description
Campaign
Overview
Description of the UF Studies Facebook account, how the
page is managed by the CTSI Recruitment Center, and ad
placement (i.e., where the ads will be seen by
participants).
Targeting Criteria Options for targeting prospective participants including
demographics, interests, and location (such as city, general
area, or specific zip codes).
Adverting
Content
Ad text
Ad Headlines
Ad photos
Summary of the study highlighting a diverse selection of
key words describing identity features of the target
population, calls to action and steps to participation, study
credibility, and intrinsic and extrinsic appeals, in a
maximum of 125 characters.
Concise description of the study, highlighting the study
population, topic of the study, and institutional credibility
in a maximum of 25 characters.
Diverse selection of at least six Shutterstock photos.
Shutterstock photos are included in the Facebook
advertising account and in the cost the Recruitment Center
charges to investigators.
CTSI, Clinical Translational Science Institute; UF, University of Florida
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Table 3. Themes, descriptions, and examples of theoretical considerations included in recruitment materials
Theme Description Examples
Identity Reflect individual’s membership in
various social groups through an
explanation of their primary,
secondary, and tertiary group
memberships.
Age (e.g., adults 65+), race (e.g., African Americans, Hispanics), gender
(e.g., women, men, non-binary) (primary)
For a physical activity study, language describing types of physical activity
(e.g., walking, running) and images demonstrating individuals engaging in
physical activity (secondary)
“Parents, Guardians”; “Caregivers, Patients”; “Teens, adolescents”;
“Smokers “vs. “Tobacco users” (tertiary)
Credibility Describe the trustworthiness of the
source communicating a message. The
credibility of the institution and/or the
researcher conducting the study are
emphasized in recruitment messages.
“Medical Researchers”; “Researchers at [name] institution”; “Researcher
who has personal experience with adoption”; “Physician researchers”
Calls to
Action
Encourage specific action on the part
of the individual seeing the ad by
describing steps individuals can take
to learn about the study or to
participate.
“Click on the link to see if you qualify”; “Click here to be directed to the
survey”; “Click here to access the study website”; “Learn more”
Intrinsic and
extrinsic
appeals
Reference internal factors (e.g.,
interest in advancing science) and
external factors (e.g., time,
transportation, compensation) that
may motivate participation.
“You have the power to help us fight obesity!”; “By participating, you can
help advance the future of science”; “By participating, you can help the
health of your community” (intrinsic)
“Compensation provided”; “Participating will take 30 minutes” (extrinsic)
Note. Diversity is reflected in the language used to describe studies in recruitment materials, including numerous words and phrases to
describe the study and identities of participants, to highlight credibility, to explain intrinsic and extrinsic appeals and calls to action.
Diversity is reflected in images by representing individuals of as many ages, races, and genders as possible.
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Table 4. Metrics for rural Facebook recruitment campaigns
Total
Potential
Reach
Actual
Reach
Link
Clicks
Enrollment Campaign
Cost
Rural tobacco intervention
development study, Case
Study 1
16,000 4,940 477 13 $155.80
Rural mental health
communication
intervention development
study, Case Study 2
2,600,000
12,536 518 178 $238.28
Note. Enrollment for Case Study 1 reflects the total participants enrolled in the study, which
includes the three participants who were enrolled from Facebook.
https://doi.org/10.1017/cts.2020.5
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Figure 1.
Highest performing ad from Case Study 1
UF, University of Florida
Highest performing ad from Case Study 1
32
https://doi.org/10.1017/cts.2020.5
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Figure 2
. Highest performing ad
. Highest performing ad
from Case Study 2
33
https://doi.org/10.1017/cts.2020.5
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