Hailey N. Miller

Background: Lack of knowledge about clinical trial (CT) research may perpetuate poor engagement of underrepresented populations. The rise of internet use may improve CT knowledge, and internet-based recruitment modalities might differentially benefit recruitment if internet users have higher baseline CT knowledge. We seek to bridge these gaps by assessing the relationship between internet use, access to health information, and CT participation. Objective: This study aimed to determine the association between internet use and CT knowledge among US adults. Methods: The Health Information National Trends Survey (HINTS) 5 cycle 4 is a cross-sectional, nationally representative survey of US adults. Participants self-reported internet use (yes or no) and knowledge of CTs (dichotomized as none or little vs higher). Logistic regression estimated odds ratios (ORs) for higher CT knowledge by internet use, adjusting for sociodemographic and health factors. Analysis was stratified by internet use modalities, exploring variations in knowledge. Results: Among a weighted sample of 249,896,898 participants (mean age 46, SD 17.0 years; 1471/2616, 50% women), 88% (n=2233) were internet users. No knowledge or only a little knowledge of CTs was reported among 97% (361/383) of internet nonusers and 89% (2233) of internet users. There were significantly greater odds of higher CT knowledge among internet users than among nonusers in the fully adjusted model (OR 2.62, 95% CI 1.30-5.33; P =.009) . Stratified analyses demonstrated a positive association between combined mobile phone and home-based internet use and higher CT knowledge in the fully adjusted model (OR 2.69, 95% CI 1.34-5.37; P =.006). Conclusions: Internet use is associated with greater CT knowledge. Thus, internet-based recruitment modalities may augment conventional engagement methods to identify US adults potentially interested in CT participation.

Background: Influencer marketing (paid promotion by individuals with large, engaged social media followings) has become a major commercial advertising strategy, projected to reach US $32 billion globally in 2025. Clinical trials increasingly recruit through digital channels such as social media advertisements and patient portal messages. However, to our knowledge, influencer marketing has not been described as a clinical trial recruitment modality, and no practical guidance exists for investigators who wish to use it. Objective: We provide a step-by-step tutorial describing how we developed and deployed a social media influencer recruitment video for the GoFreshSE (Groceries for Residents of Southeastern USA to Stop Hypertension) trial, a decentralized pilot randomized trial of home-delivered Dietary Approaches to Stop Hypertension–pattern groceries for adults with elevated blood pressure in Florida, Georgia, and Tennessee. We also provide a reusable preparation framework for other study teams. Methods: Using Cameo Business, an online marketplace where public figures record short promotional videos, we filtered candidates by audience location (Atlanta, Miami, and Nashville), follower count (≥100,000), and price (US <$3000) and then selected an influencer on the basis of audience demographics relevant to our recruitment priorities. We transcribed the influencer’s sample videos to characterize his speaking style, drafted a study script, and used a large language model (GPT-4o) solely to adapt the script’s tone; the adapted script was reviewed by the study team and approved by the institutional review board before use. After the influencer recorded the video, we corrected gaze and adjusted pace using openly available tools, added framing and captions, and deployed the advertisement on Facebook and Instagram through Meta’s advertising platform. Results: A qualifying pool of 57 influencers met our follower and cost thresholds. The selected influencer delivered a high-quality video 4 days after booking. The total Cameo cost was US $660, including a 75-day license and service fee, and the elapsed time from script development to a live advertisement was less than 2 months. The final 47-second video was rendered to satisfy Meta and TikTok placement and aspect ratio requirements while retaining the platform-required watermark. We report each step (marketplace search, booking request, script adaptation, ethics review, video editing, and deployment) in sufficient detail to be reproduced. Conclusions: Social media influencer marketing through Cameo Business is a rapid, low-cost mechanism for producing clinical trial recruitment videos and is feasible within typical trial timelines and budgets. To our knowledge, this is the first tutorial to document the procedure end to end, and it surfaces practical, ethical, and authenticity considerations, including governance of generative artificial intelligence and the limits of permissible video editing, that investigators should weigh before adopting this modality. The comparative effectiveness of influencer-based recruitment will be evaluated separately.

Background: Black and Latino adults in the United States experience a disproportionate burden of cardiometabolic conditions due to interacting behavioral, social, and structural drivers of health. Less is known about the impact of integrating digital health tools into CHW-led interventions to improve cardiometabolic health. This trial evaluates a multilevel community–digital health promotion model delivered by CHWs to improve service utilization, health behaviors and cardiometabolic health among Black and Latino adults. Methods: This community-partnered trial uses a randomized delayed-control group with a phased recruitment design. Four cohorts (N = 664) are enrolled through three community-based organizations (CBOs). Eligible participants are ≥18 years who self-identify as Black or Latino, and have prediabetes/diabetes, hypertension, or overweight/obesity. Participants are allocated to either (1) a multilevel intervention consisting of CBO and CHW capacity building combined with individualized CHW-led lifestyle coaching and group activities supported by digital tools, or (2) a delayed control group receiving SMS-only cardiometabolic health education. Data collected at baseline, 6, 9, and 18 months include surveys and health metrics. Qualitative data are collected from participants and community partners to assess intervention acceptability, implementation facilitators and barriers, and sustainability. Results: The primary outcome is health service utilization at 6 and 9 months. Secondary outcomes include health behaviors, health metrics, and social determinants of health. Sustainability of health behaviors and health metrics is assessed at 18 months. Conclusions: Findings will provide evidence to inform scalable, sustainable community-digital health models for CHW-supported cardiometabolic health interventions in underserved communities. Trial registration: Prospectively registered at ClinicalTrials.gov ( NCT06607341 ) on May 23, 2025. Sponsor name and contact: National Institute of Health/National Heart, Lung and Blood Institute 9000 Rockville Pike, Bethesda, Maryland 20892 Phone: (301) 402-9612; Email: kimberly.durkin@nih.gov

UNSTRUCTURED Social media influencer marketing is a digital advertisement strategy that is growing in popularity. Its use has been documented in consumer purchasing behavior but is yet to be described for clinical trial recruitment. In this tutorial, we describe the steps we followed to develop and deploy a social media influencer advertisement for the recruitment of participants into the Groceries for Residents of Southeastern USA to Stop Hypertension (GoFreshSE) trial. We also provide a preparation framework for other studies who would like to use this modality for their own clinical trial recruitment. We used Cameo Business to identify potentially relevant influencers to hire by selecting influencers who were popular in the 3 geographic areas from which GoFreshSE is recruiting. We narrowed down the list of possible influencers by selecting those with ≥100,000 followers on their respective social media platforms (for a wide reach) and charged a cost of ≤$3,000/video. We ultimately selected a former football coach, who provided a high-quality video of him reading an institutional review board-approved script 4 days later. We utilized open source, commercially available tools to edit the video and deployed the 44-second-long video on Facebook and Instagram using Meta’s Advertising platform. Social media influencer marketing through the Cameo Business platform is a rapid mechanism to develop clinical trial influencer recruitment videos.

Background: Black and Hispanic adults in the United States face a disproportionately high burden of cardiovascular disease (CVD). Digital health literacy (DHL) may influence CVD prevention and management, yet its role in these populations is not well understood. Objective: This study aimed to examine associations between DHL and cardiovascular-related lifestyle behaviors, CVD, and CVD risk factors among Black and Hispanic adults. Methods: This was an exploratory analysis of survey data from a cross-sectional study among adults in Maryland; Virginia; and Washington, DC (March 2024-June 2024). DHL was measured using items from the Digital Health Literacy Instrument, and outcomes included self-reported CVD and risk factor diagnoses and lifestyle behaviors (physical activity and fruit-, vegetable-, and sugar-sweetened beverage intake). Multivariable regression models were used to assess associations, adjusting for sociodemographic and health literacy factors. Results: Among 1221 participants, the mean age was 44 (SD 16) years; most were female (n=766, 62.7%), insured (n=1065, 87.2%), and non-Hispanic (n=840, 68.8%) and identified as Black or African American (n=778, 63.7%). Higher DHL was associated with greater vegetable intake (incidence rate ratio 1.08, 95% CI 1.01‐1.15). Contrary to our hypothesis, DHL was positively associated with sugar-sweetened beverage consumption (incidence rate ratio 1.13, 95% CI 1.10‐1.25). DHL showed a significant nonlinear association with fruit intake ( P =.01). No significant associations were observed with CVD or its risk factors. Conclusions: The relationship between DHL and cardiovascular-protective behaviors was mixed, suggesting that DHL may not be sufficient to promote consistent health-protective behaviors. The findings highlight the need for interventions that strengthen DHL while also addressing broader contextual and structural factors such as targeted digital marketing of unhealthy food and beverages, as well as environmental barriers. Longitudinal and experimental studies are needed to clarify causal pathways and inform equitable CVD prevention strategies.

BACKGROUND: Targeted, digital recruitment strategies such as tailored websites using motivational themes may improve recruitment in clinical trials, but their effectiveness remains unclear. We hypothesized that themes emphasizing community well-being, personal health benefits, or access to perks would increase engagement and prescreening sign-ups compared with a standard contribution to science message in a clinical trial focused on Black adults. METHODS: We implemented A/B testing of website themes for recruitment in two randomized trials testing the dietary approaches to stop hypertension diet intervention on blood pressure among Black adults. Website themes were derived from predeveloped motivational categories and included (1) contribution to science (control group), (2) community well-being, (3) personal blood pressure improvement, and (4) access to perks (groceries or cash). A/B randomization directed visitors to a theme randomly between June and December 2024. Using an open-source Web analytics platform, we captured data on 2 primary outcomes: (1) sign-up rate defined as the proportion of unique visitors who completed the trial’s prescreening form and (2) engagement defined as (a) mean pageviews per session and (b) mean time spent on site per session. We compared themes using the Welch t tests with statistical significance assessed as 2-tailed P P P 0.05 for all comparisons). There were no statistical differences noted across the 3 alternative motivational themes for these outcomes. CONCLUSIONS: Tailored websites with digital messages emphasizing community well-being, personal health benefits, and access to perks significantly improved engagement and prescreening sign-up rates, demonstrating that they may enhance recruitment within cardiovascular research. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT05393232 and NCT05121337.

Background Mobile health (mHealth) applications are promising tools for managing chronic conditions such as hypertension and diabetes. However, disparities in access and use, often described as the digital divide, may limit their benefits for vulnerable populations Objective To assess the prevalence of mHealth app use among U.S. adults with hypertension or diabetes and examine sociodemographic, technological, and health-related factors associated with digital engagement. Methods Data were drawn from the 2024 Health Information National Trends Survey (HINTS 7). Respondents with self-reported hypertension or diabetes (n=3,172) were included. The outcome was self-reported mHealth app use. Independent variables included sociodemographic characteristics, technological access and health-related factors. Survey-weighted log-binomial regression estimated adjusted prevalence ratios (RRs) and 95% confidence intervals (CIs). Results Significant disparities in mHealth app use were observed. Adults aged 65–74 (RR=0.70, 95% CI: 0.56–0.88) and 75+ years (RR=0.50, 95% CI: 0.35–0.71) were less likely to use apps than younger adults. Males (RR=0.85, 95% CI: 0.74–0.97) reported lower use than females. Higher income (≥$100,000: RR=1.39, 95% CI: 1.06–1.81) and education (college+: RR=1.42, 95% CI: 1.17–1.73) were associated with greater use. Smartphone non-ownership (RR=0.42, 95% CI: 0.24–0.75), never using the internet (RR=0.07, 95% CI: 0.01–0.46), lower digital confidence (RR=0.74, 95% CI: 0.56–0.97), and high frustration with technology (RR=0.61, 95% CI: 0.43–0.87) were strong barriers. Health-related factors were not significantly associated. Conclusion Persistent disparities in mHealth use among adults with hypertension and diabetes underscore the need to address digital access and literacy to promote equitable engagement with digital health tools.

Background: Long-term adherence to weight loss behaviors is challenging, as most individuals who achieve significant weight loss regain 1-2 kg per year. Financial incentives can reinforce weight-loss initiation and maintenance behaviors, but optimal strategies remain unclear. Objective: This paper describes the design, technical architecture, and operational workflow of Log2Lose, a 5-year, multisite randomized controlled trial testing different financial incentive strategies to promote weight loss and maintenance. We detail the platform’s integration with external devices, automated data collection, and adaptations to maintain intervention fidelity in the context of evolving technology and regulatory requirements. Methods: The Log2Lose platform collects daily weight and dietary data from cellular scales and fitness tracking applications, calculates weekly incentive eligibility, and sends automated feedback and motivational text messages. We summarize the technical adaptations, message delivery performance, data completeness, and the balance between automation and manual support required to ensure data integrity. Results: By the end of the study, 706 participants recorded 181,285 weights and 114,144 daily calorie entries. The platform sent 126,283 text messages and calculated 35,187 incentive payments, with 99.4% (34,976/35,187) processed automatically. Adaptations addressed device integration changes, application programming interface discontinuations, and new text messaging regulations. Despite automation, ongoing technical support was essential for resolving delivery errors, device issues, and data anomalies. Conclusions: Log2Lose demonstrated that large-scale, fully remote weight loss interventions can be implemented using consumer technology paired with a robust, adaptable platform. Success depended on flexible software design, continuous monitoring, and responsive technical support to navigate regulatory and technological changes. Log2Lose offers a practical model for processing remotely collected longitudinal dietary and weight data, providing valuable guidance for researchers, health care providers, and employers developing similar digital health interventions. Trial Registration: ClinicalTrials.gov NCT04770909; https://clinicaltrials.gov/study/NCT04770909