Table 1 Recruitment strategies used in the ACCESS trial

1. Patient contact by health care providers

 a. Pharmacies: Several large Canadian pharmacy chains, along with hundreds of independent pharmacies across Alberta, were approached by the ACCESS trial team to be a part of the recruitment process. They were asked to display posters and/or hand out brochures to patients. Pharmacists had considerable autonomy to decide how to recruit patients, with some only having posters displayed, others handing out brochures, and others directly targeting individuals they felt would be appropriate for the study. Regardless, pharmacists did not enroll patients directly but simply provided the number for the study survey unit

 b. Health professionals: Throughout the study, we distributed posters and brochures to specialist and family physician offices as well as hospitals throughout Alberta. This category included participants who saw the posters and/or brochures at these locations and participants who were told about the ACCESS trial by medical or allied health professionals (physicians, nurses, and dieticians) other than pharmacists

2. Paper mail

 a. Census-based Canada Post mail-out: Brochures were mass mailed to targeted communities identified by Canada Post as having a preponderance of residents who were over the age of 65 and had lower incomes, based on census data. A total of 122,000 brochures were sent out in three separate mailing cycles

 b. Coronary angiogram registry: All consenting Albertans who undergo cardiac catheterization for diagnostic or therapeutic purposes are entered into a patient registry called the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) [21]. Those who are found to have coronary artery disease are asked to consent to being contacted to hear about future clinical studies. We used the list of those consenting individuals to contact those with demographics suggesting potential eligibility for ACCESS. These individuals were directly mailed a letter about ACCESS. Everyone on the mail-out list was then called by our survey unit to confirm interest and eligibility. A total of 4780 individuals received letters and phone calls over 11 months

 c. Targeted mail-out after hospital discharge: Patients who were discharged from an Alberta Health Services (AHS) facility (the single health care provider in Alberta) who met study criteria (based on age and previously known health conditions) were contacted by mail by AHS, inviting them to call the survey recruitment line if they were interested in participating. A total of 50,042 letters were sent over 11 months

3. Media

 a. Paid radio advertisements: Three local radio stations in Calgary and nearby areas were selected on the basis of having a large audience with the correct target demographic to play 30-s commercials up to 42 times a week for 2 weeks. The radio commercial included instructions on how to enroll and a brief summary of the study, highlighting that eligible individuals would have a 50% chance to receive free medications

 b. Facebook: A paid Facebook ad was designed to recruit participants (disseminated to Alberta seniors and a separate Facebook ad to younger individuals—noting the potential relevance to their parents and grandparents) and was displayed on the pages of targeted groups for a few months

 c. Hospital programming channel: A professionally produced 90-s TV commercial aired on televisions in select physicians’ offices, community laboratories, and some AHS facilities throughout Alberta for 6 months in 2016/2017

 d. Transit advertisements: Advertisements were placed at transit stops and stations as well as inside the trains and buses in Calgary, Edmonton, Medicine Hat, and Lethbridge for 11 months

 e. Paid print media: Included anyone recruited from paid print advertisements. This included advertisements placed in general and senior-specific newspapers and newsletters throughout the province

 f. Unpaid media: Included free social media advertising from personal, university, and charitable organizational accounts on Twitter and Facebook. Press releases were sent from the University of Calgary in March 2016 and from AHS in September 2016. A variety of coverage arose from this—predominantly radio stories and interviews. Two news stories featuring the ACCESS trial were broadcast on local TV stations during the evening local news. Various other free stories and articles in papers and newsletters across Alberta arose from a variety of other contacts. Anyone who claimed to see any print, online, or aired media within 3 weeks of the release dates was categorized under “unpaid media”

4. Seniors outreach

 a. Seniors’ homes: The ACCESS team traveled to and contacted various seniors’ homes and apartments to give presentations and drop off brochures and/or posters. Many rural locations were contacted by phone, and if managers were interested in recruiting, posters and brochures were sent directly to the seniors’ homes. Some seniors' homes posted the materials in common areas, while others put brochures directly in mailboxes or under residents’ doors

 b. Seniors aid resources: Seniors aid resources included social workers, help centers, food banks, and health care or social care service coordinators. Advertising to these places/people consisted of word of mouth and the distribution of brochures to institutions and providers. Any presentations or booths set up by the ACCESS team at events, fairs, or centers were also included in this category

5. Word of mouth: This strategy was established as the study became more well known. Many study participants told their family members and/or friends about the study and gave them the enrollment phone number. As this strategy became more successful, we further encouraged it by periodically sending enrolled participants recruitment brochures to distribute to those who might be eligible and interested