One of the major questions facing those interested in veterans' behavioral health is how do we reach veterans who need care but do not receive it?
RAND research suggests that about half of recent veterans struggling with behavioral health concerns, such as posttraumatic stress disorder (PTSD) and depression, do not seek care for such concerns. However, reaching veterans to understand more about their care-seeking poses a conundrum. Clinical settings are typically where veterans are recruited for studies, and therefore the population of interest — those not seeking care — is not represented. Researchers have struggled with ways to find veterans outside of clinical settings using newspapers, TV and radio ads, and bulletin boards. With the advent of the Internet and social media, it makes sense to use these means to reach veterans for research efforts so we can better understand what their needs are and how best to meet them.
A team of RAND colleagues and I recently conducted a study to see if we could recruit young adult veterans aged 18 to 34 from the social media website Facebook for a research study. The strategy succeeded — we obtained 1,023 veterans in just over three weeks. We found that the recruited sample matched closely with the young adult veteran population in several key areas, such as age, gender, marital status, income, and education level; which tells us that Facebook can be used to recruit representative samples of veterans and not just a selective subsection of the population. Perhaps most important, about half of the veterans we reached through Facebook were struggling with PTSD, depression, anxiety, and heavy alcohol use; yet only half of these participants had received any behavioral health care in the past year. This tells us that Facebook may be a viable method to reach young veterans in the community who need care but are not receiving it.
Our next step is to answer questions about how we can use Facebook and other social media to promote initiation and maintenance of behavioral health care among those that might benefit from such care. This includes designing programs intended to motivate veterans to seek care at the VA or elsewhere in the community, as well as stand-alone programs that can be delivered over the Internet to directly address behavioral health problems among this group in need of care.
While our Facebook recruitment was quick and relatively inexpensive, there is still much to consider when designing social media recruitment for studies. We learned much from the process of the study and recommend the following to those using social media to reach veterans and other groups.
Have a plan for managing misrepresentation by participants. If incentives are involved, there will likely be those on the Internet who will attempt to misrepresent themselves as members of your target population. We found that 200 people gave responses in our survey that suggested they may not have actually been veterans and another 216 accessed the survey but did not meet our eligibility criteria (for example, they were too old or still on active duty service). It is important to make eligibility criteria clear up-front to screen out those who do not fit criteria, but also to have a system of checks to weed out misrepresenters.
Budget appropriately. Our strategy was cheaper than some other Facebook studies, but these others have ranged from no cost per adolescent recruit up to $20-$30 per recruited adult with depression or PTSD. Costs may vary based on the population you are targeting and the advertisement strategy you are using.
Learn how to reach veterans and other at-risk groups that do not have Facebook accounts. We learned that 102 of the veterans we reached learned about the study through a friend and 34 veterans completed the survey on a public computer or someone else's phone or computer. Reaching peers or family members to help recruit those with limited Facebook/Internet access is an area of important future research work.
Expand beyond one-time survey research studies. Our study contained a one-time survey that veterans could complete in one sitting online and earn a $20 incentive for doing so. Much is to be learned about how social media can be used to keep participants involved in lengthy outreach programs or in research studies where participants are asked to complete repeated surveys over time.
Make Internet-based studies and programs available via mobile devices and tablets. About two-thirds of the veterans in our study completed the survey on phones or tablets. Given the utility of these devices and ease of access, programs and studies should consider mobile-capability to maximize the number of people reached.
Eric R. Pedersen is a behavioral scientist at the nonprofit, nonpartisan RAND Corporation.
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