Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and Feasibility Study

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Abstract
Background: US overdose deaths 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 cardiopulmonary resuscitation administration in cases of public emergencies. Our goal is to recruit these first response agencies to provide targeted messaging about OEND to this 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: This study aimed to determine 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 and to investigate 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 3 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 40 agencies signed memoranda of understanding to participate in the project (n=176, 22.7% of contacted agencies; n=151, 26.5% 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 (odds ratio 0.754, 95% CI 0.298‐1.904; P =.55). Likewise, arm assignment (3-way comparison) did not significantly affect the likelihood of an agency agreeing to participate. The recruitment process took a mean of 159.08 (SD 104.74) days per agency and involved 8.38 emails, 1.98 voicemails, 0.83 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 23% and 27% 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.

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