Representation is power: traditional, hybrid, and digital recruitment results from a non-randomized clinical trial engaging adolescents

Clinical trials support the iterative advancement of modern medicine. However, challenges in achieving population-representativeness or participant sampling commensurate with the burden of disease can limit the generalizability and reproducibility of trial results. Here, we present the recruitment strategies and cohort profile of the Engaging Adolescents in Decisions about Return of Genomic Research Results non-randomized clinical trial (NCT0448106), where traditional, targeted hybrid, and digital recruitment methods were implemented with quota sampling to enroll diverse adolescents (ages 13-17) and young adults (ages 18-21). The largest proportion of participants enrolled through digital strategies (39.1%), followed by traditional (34.2%), and targeted hybrid strategies (23.2%). Despite lower enrollment, targeted hybrid recruitment, involving letters and text messages, had the largest proportion of participants from groups historically underrepresented in research (87.5%), compared to traditional (48.5%) and digital (32.3%) methods (p < 0.001). Our findings demonstrate a model for achieving both recruitment targets and inclusive trial participation to counteract overrepresentation of participants of European descent in clinical research.