How Can "The Godfather Of Influence" Help Improve Clinical Trial Recruitment?

By Ross Jackson, consultant

Second in the series “Inspired Patient Recruitment – Taking Inspiration From Business Advice Bestsellers,” this article explores the ways concepts from  “Influence” by Robert Cialdini might be applied to patient recruitment and retention efforts. Cialdini, coined “The Godfather of Influence,” is a best-selling business book author who bases his approach on proven psychological principles of influence and persuasion.

Sticking with my previous strategy of presenting a positive and negative approach (using the theory of inversion to highlight bad practices that should be eliminated), I’ve again worked the content into an imaginary job interview featuring two candidates — one who “gets” the ideas in “Influence,” and one who sticks to the old-school way of doing things. The hope is that you will pick up ideas for your own recruitment and retention activities from the questions and answers below.

Candidate Interviews: Inspired By “Influence” Vs. Stuck In The Same Old

Interviewer: Looking at the principle of reciprocity, what initial value or benefit could you provide to potential participants before they commit to joining the trial? And what do you think about such things as free resources that could create a sense of obligation to participate?

Candidate One: I’d want us to provide potential participants with free health screenings related to the condition we’re studying, which would provide them immediate value. I’d also explore setting up educational webinars about the condition, which can not only help people feel informed but also create a sense of goodwill. Both would ultimately make them more likely to reciprocate by enrolling in a clinical trial.

Candidate Two: There isn’t really the time or inclination to offer much up-front aside from the standard trial brochure. What I’ve found is that if people are interested, they’ll join without needing any additional motivation. After all, the trial can benefit them and others, so that should be enough.

Sticking with this theme, how might you continue to deliver value throughout the trial? Do you think that small but regular gestures of appreciation could encourage participants to stay engaged?

Candidate One: I’d want to send regular, personalized updates to participants about the progress of the study, as well as broader health advice that they could apply in their daily lives. I’m also keen on such things as small but meaningful rewards, like gift cards or wellness kits, at key milestones in the study, which could help reinforce participants’ engagement.

Candidate Two: Once participants have enrolled, I haven’t seen the need to provide anything extra. In my experience, they’re here to get treatment or contribute to science, so there’s no real point in offering further updates or rewards. Fundamentally, once they’ve gone through the process of enrolling, they should be motivated enough to see the trial through to the end.

Another of the principles I’ve picked up from the book “Influence” is related to commitment and consistency. How might you obtain commitments from potential participants? And what about asking for smaller commitments?

Candidate One: During the recruitment process, I can see the advantage of asking potential participants to take small steps, like filling out a short survey or attending an informational session. This could help us gauge their interest and indicate that, once they’ve taken that first step, they’re more likely to join the trial.

Candidate Two: Due to the highly regulated nature of the industry, and based on how things always have been done before, it’s important to ask participants to read through the details in the consent form and agree up-front to attend multiple appointments. Coming from a clinical background, I believe that if a potential participant is serious about their commitment, they should be prepared to jump in fully from the start without first needing to take the kind of smaller steps you’re referring to.

And once a participant joins, how might you reinforce their commitment?

Candidate One: Once participants enroll, I’d suggest we remind them of their initial motivations for joining — for example, the desire to contribute to research that may benefit others. I also think we should encourage people to recognize their progress and personal milestones, which can help them see how their participation is making a difference for themselves and the wider patient community.

Candidate Two: Once people have enrolled, I’ve never seen the point of following up on why they joined or what their goals are, as I assume their initial decision will keep them motivated. Neither can I see any benefit in reminding them of their progress or achievements. With so much else to do, it would be difficult for our staff to spend time on this kind of activity, and participants should already be motivated enough to stay engaged.

Another area of interest is that of social proof. Taking issues of privacy and anonymity into account, do you believe it’s worthwhile to showcase stories from past participants?

Candidate One: I’ve seen great success in highlighting testimonials from past participants. At my previous organization, we made sure these testimonials were from people with diverse backgrounds, so potential participants could see people like themselves who have had positive experiences. Additionally, we showcased success rates and high satisfaction levels from past trials to provide tangible evidence that participation is worthwhile.

Candidate Two: I’d ensure we adhere to strict guidelines when it comes to privacy and participant blinding. I also don’t believe that participants need to know who else has participated or how well the trial has worked for others, as it could attract people with the wrong sort of motivation for taking part. If people are interested, the science should speak for itself, and that should be enough to convince them to join.

In the same area, what’s your view on leveraging social networks or communities in your recruitment strategy?

Candidate One: I’m a big fan of trying to engage patient advocacy groups and online forums where patients gather for support. Having individuals from these communities share their experiences with a trial can be an effective way to encourage others to participate, especially through hearing from someone they are more likely to trust.

Candidate Two: I’ve never seen any evidence of success when attempting to engage with patient communities or forums. As a result, I’d expect to rely solely on our advertising strategies to expect participants to come to us. Trying to involve external influencers or groups is a time-consuming and almost certainly fruitless exercise. If the trial is worthwhile, potential participants should be able to find out about it on their own.

People can often be influenced by those they perceive to be “in authority.” Would it be worthwhile to introduce the experts behind the trial?

Candidate One: I’d suggest our communications with potential participants should prominently feature the medical experts and researchers leading the trial. This should also include endorsements from any respected institutions that are partnering with us, as I’ve found that participants and potential patient referrers — such as other doctors in the field — are more willing to engage when they know the trial is backed by recognized experts.

Candidate Two: I certainly wouldn’t recommend going out of our way to showcase the experts leading the trial. Participants can read the names of the doctors involved on the trial website, and realistically, how likely is it they will recognize any of the names? On top of this, it’s well-known that the general public is likely to trust medical professionals, which negates the need for us to have to actively promote their credentials.

Would you consider alternative forms of authority? That is, beyond traditional experts such as medical practitioners.

Candidate One: I would involve influential voices from patient communities, health bloggers, and the like who are trusted by our target demographic. If they can share their insights on the trial in a relatable way, it can build trust among prospective participants who may be more skeptical about engaging with formal research institutions.

Candidate Two: Given the seriousness and intricacies of the subject matter, plus the risk of contravening regulations, I would never consider engaging non-medical influencers or patient community figures as part of the recruitment process.

Another aspect of the “influence” approach might be termed likeability or relatability. How would you communicate with potential participants? And how would you build rapport and trust?

Candidate One: I’d like to ensure that all our outreach is highly personalized. Instead of sending generic emails, we should tailor our messaging to each individual, for instance by referencing their specific condition and other details they’ve provided. My experience suggests that participants respond much better when they feel like they’re being spoken to as individuals, not just another statistic.

Candidate Two: To comply with regulations, as well as maximize our resources and efficiency, our communications would be pretty standard and automated. Sending out mass emails with the same content is a tried and tested method of reaching a wide audience.

Looking at this principle when it comes to patient-facing team members, what opportunities might participants have to interact with trial staff in a positive and friendly environment?

Candidate One: I’d train our clinical staff to be warm, empathetic, and responsive. It’s common sense that participants are more likely to stay engaged when they feel they have a personal connection with the research team. I’d be keen to introduce regular check-ins, where we acknowledge people’s contributions and thank them for their involvement, which should help with building good relationships.

Candidate Two: Given the nature of what we’re doing, I’d want any interactions with participants to be purely transactional. I certainly wouldn’t encourage staff to build personal relationships with participants, as everyone in the process should be aware they’re taking part in research, not attending a holiday camp. As long as the participants show up and complete their tasks, I really wouldn’t see the need to go beyond a formal tone or express much in the way of gratitude.

And finally, and again obviously bearing in mind the regulations and ethical implications, consider the principle of scarcity. Do you think you could emphasize any limited availability of spots or time-sensitive benefits?

Candidate One: This is obviously a tricky one, given the overarching principle to be non-coercive. However, I’ve always felt that you can be persuasive without crossing that line, so when recruiting, I’d suggest we might be able to emphasize that spots in the trial are limited and that — if appropriate — enrollment is closing soon. We should also always highlight the unique benefits participants receive by enrolling, such as access to ongoing high-quality medical checkups. Without breaking any ethical principles, I’d suggest it would be possible to imply a sense of urgency and encourage quicker decision-making for those contemplating taking part.

Candidate Two: Given the ethical implications you’ve alluded to, I certainly wouldn’t look to stress anything like urgency or limited availability. Indeed, in my experience, keeping enrollment open for as long as possible is the only way to fill the trial. And, as well as the ethical issues, there’s no point in rushing participants. If they want to join, they’ll make up their mind to do so.

Do you think there would be ways to utilize the idea of scarcity during the retention process?

Candidate One: Again, we’re getting into a bit of an ethical scenario here. To keep participants engaged, I’d suggest we could remind them of the exclusive nature of the trial, also possibly re-emphasizing that they have access to the type of ongoing health checks that are not available to others. I’ve also found that offering rewards for hitting certain milestones also can keep participants motivated to stay on track – another element they wouldn’t benefit from if they dropped out of the trial.

Candidate Two: Once participants are enrolled, it would be unethical to emphasize anything special about their involvement. They’re getting what they signed up for, and I don’t think it’s appropriate within the regulations to remind participants that they’re part of something unique or that they have access to resources others might not.

Who Is The Best Choice For The Job?

Naturally, taking the approach adopted by Candidate One will require some investment of time and resources. But this expenditure will pale in significance compared to the downsides and costs of not recruiting or retaining sufficient patients to complete your trial.

Reading “Influence” by Robert Cialdini might give you some additional ideas to those outlined above. And for more insights as gleaned from other business advice books, look back at “What's A Better Tactic For Patient Recruitment — "Unreasonable Hospitality" Or The Same Old?” and watch out for the next article in the series of “Inspired Patient Recruitment – Taking Inspiration from Business Advice Bestsellers.”

About The Author:

Ross Jackson is a patient recruitment specialist and author of the books “The Patient Recruitment Conundrum” and “Patient Recruitment for Clinical Trials using Facebook Ads.”

Having started out with digital marketing in 1998, Ross quickly developed a specialty in the healthcare niche, evolving into a focus on clinical trials and the problems of patient recruitment and retention.

Over the years Ross branched out from the purely digital and now operates in an advisory capacity helping sponsors, CROs, sites, solutions providers, and others in the industry to improve their patient recruitment and retention capabilities — having advised and consulted on over 100 successful projects.