18.    Can participants be recruited through advertising? Advertisements are part of the informed consent and participant selection process. Samples of all advertisements, such as flyers, newspaper ads, radio and television announcements, bulletin board tear-offs, and posters, along with an explanation of other methods of recruiting participants, must be submitted to the IRB.

Advertisements should be submitted with the application or as soon as the principal investigator decides to use them. The content of advertisements should be limited to:

 Advertisements should not claim, explicitly or implicitly, that the research is treatment or is superior to any current practice. Extravagant attention-getting devices such as extremely large, bold typefaces and dollar signs are prohibited. Advertisements should not pressure readers into participating.

Snowball recruitment – often times researchers have an initial pool of contacts and they hope those people will "nominate" other qualified potential participants. This kind of sampling is commonplace in case study and qualitative psychological, sociological, and anthropological research.  However, it may be used also in genetic studies where it is necessary to recruit relatives of the proband for direct interviews and/or tissue sampling, etc. This recruitment procedure is sometimes inappropriately labeled "cold calling".
    The following excerpt from the Belmont Report regarding voluntariness compels IRBs to pay close attention to snowball recruitment procedures: "Unjustifiable pressures usually occur when persons in positions of authority or commanding influence---especially where possible sanctions are involved--- urge a course of action for a subject. A continuum of such influencing factors exists, however, and it is impossible to state precisely where justifiable persuasion ends and undue influence begins." For example, what if a highly respected individual in the community (say a local elected official, teacher, member of the clergy, or tribal elder) provided the name of a potential contact. When the nominee is contacted, the person might be unduly influenced to participate in the project because of the stature of the nominator.
    Consideration of minimal risk is likely to play an important role in IRB review of snowball recruitment procedures. For example, it would make a big difference whether the research involved extramarital affairs or substance use as opposed to family meal time routines or leisure activities. To "cold call" someone on sensitive topic issues places him or her in a potentially embarrassing situation, which should be avoided. Moreover, the original subject is being placed in the position of being asked to disclose information about a third party without that party's consent. One means of reducing the risks in snowball recruitment is for the researcher to gently ask subjects whether they would be willing to pass some information about the study they just completed to other potential subjects. The researcher may give the original subject an information sheet that they can give to people they think might be interested and qualified. Then these potential participants can contact the researcher if they are interested. The researcher must provide the IRB with a copy of the information sheet (which must include all of the same information that is in the initial recruitment script) he/she will give to the initial contact to distribute. If the potential subject were interested in study participation, they would be free to contact the researcher.
    Some reasons why snowball recruitment could be approved for minimal risk projects include:

    1. People cannot always be depended upon to make phone calls and contacts. Even with good intentions, they forget, become busy, etc.
    2. If participants have to contact others, they may have to use their time to make at least two phone calls (one to other potential subjects and one to the investigator). Participants shouldn't be required to do extra work if there is no practical risk involved.
    3. Participants might not accurately describe the research and its purposes or they might prep other participants to provide particular responses.

    The IRB recommends the following safeguard procedures if snowball recruitment is to be used:

    1.  Let subjects know that they will be asked to provide the names of other potential recruits, but that they have the right to decline to provide this information.
    2.  Revealing the name of the nominating source becomes complicated. Obtaining the subject's written permission to reveal their identity to subsequent contacts may be handled on the consent form provided there is an initialed check list item. That is, if the subject agrees to provide names of other possible contacts, they could initial a check box on the consent form that they agree to allow their identity to be revealed to the subsequent contacts. Not initialing the box would be interpreted as meaning the subject was unwilling to permit his/her name to be used when making the additional contacts, even if he/she supplied the names and contact information.
    3.  Researchers, including those doing phone interviews, should provide the IRB with a script detailing how the researcher will be obtaining the information for the snowball recruitment. The IRB may require adjustments to this script.