Pediatric recruitment stalling? Needle fear may be the barrier you’re overlooking.¹

Needle fear impacts youth avoidance of medical procedures.  More than half of children and even more than 20% of teens and adults are afraid of needles.¹

What does this mean for you? If your research protocol includes blood draws, injections, or IV procedures, you may be fighting an uphill battle, because you are recruiting from a fear-sensitive population.

Needle fear is a predictable, measurable barrier to enrollment in research, but it’s also addressable. DigiKnowIt News is a website built for and with youth that reduces emotional barriers to research participation before consent discussions begin.

The DigiKnowIt News website educates youth about research and medical procedures that may be included in clinical trials, including needle procedures.

In peer-reviewed evaluations, DigiKnowIt News significantly outcomes related to clinical trial participation in youth including:

• Knowledge
• Positive attitudes toward participation
• Confidence in participating^2,3

When customizing your DigiKnowIt News website, you can choose to include from a library of highly interactive, engaging, developmentally-appropriate, web-based learning activities designed to help children and adolescents learn what to expect if the research protocol includes one or more needle procedures as a means of mitigating their fears about participating.

Unlike many traditional methods of educating youth about needle procedures in clinical trials, DigiKnowIt News provides youth with comforting graphics showing the process of participating in a needle procedure, information about needle procedures that are developmentally understandable to them, and relatable testimonies from other youth who have participated in needle procedures.

Mitigate needle-related enrollment barriers before your next recruitment cycle. Explore and purchase DigiKnowIt News at digiknowit.com.

1. McLenon, J., & Rogers, M. A. M. (2019). The fear of needles: A systematic review and meta-analysis. Journal of Advanced Nursing, 75(1), 30-42.
2. Parker, A. E., Scull, T. M., & Morrison, A. M (2021). DigiKnowIt News: Educating youth about pediatric clinical trials using an interactive, multimedia educational website. Journal of Child Health Care, online: DOI: https://doi.org/10.1177/13674935211003774
3. Parker, A. E., Scull, T. M., Green, J., & Stump, K. N. (2025). Evaluation of an interactive, educational website developed for adolescents to learn about pediatric clinical trials: DigiKnowIt News. Journal of Pediatric Health Care, 39, 335-345.

If you are trying to recruit youth to participate in your study, DigiKnowIt News, a customizable website that educates young people about research, is the ideal tool to use as part of your recruitment plan. The website was designed with input from youth, so that it would be developmentally appropriate, understandable, and optimally engaging for both children and adolescents. Sharing this website with potential participants, once you have customized it for your study, can help boost your recruitment and retention rates.

How does the child version engage children?

The child version of DigiKnowIt News was created with and for 8 – to 11-year-old children.

The multimedia designs in the child modules use bright colors, playful fonts, and simple, custom illustrations. Activities included in the child modules give children an audio option in which they can choose to have content read to them instead of choosing to read it on their own.

The pedagogical styles in the child modules are highly engaging and entertaining presented in interactive investigative learning activities and digital comic books.

The language used throughout the child modules was designed to be understandable for 8- to 11-year-olds. New vocabulary words and concepts are introduced and explained in simple, clear language and short sentences.

How does the teen version engage adolescents?

The teen version of DigiKnowIt News was created with and for adolescents.

The multimedia designs used in the teen modules reflect the request of adolescents who were involved in program development to include more complex content to read, fewer illustrations, fewer game-like learning activities, and more videos than the child modules.

The pedagogical styles used in the teen modules also include many informative, YouTube-style videos that contain concise and complex content, focusing on topics related to research participation, as well as interesting facts about research and medical procedures. In addition, the comic books included in the teen modules contain more information and fewer interactive elements than the comic books in the child version.

The teen version includes additional content beyond what is included in the child version. For example, it includes content specific to different types of medical procedures used in clinical trials (e.g., sedation and anesthesia; organ testing). It also includes a module designed to help young people understand the process that occurs between adolescents and their parents when they are deciding about whether to participate in a research project.

How do I customize DigiKnowIt News for recruiting the age group of my potential participants?

Once you have purchased DigiKnowIt News, you will have the opportunity to customize the website to reflect the measures and procedures your participants will experience in your study. If your study includes a measure or procedure that is not part of the existing website, then you can contract with us to create new modules to fit your study’s needs that can be incorporated into your website.

First, you can choose to show your participants the child version or the teen version of the website. Alternatively, you can let your potential participants choose which version they would like to view.

Second, within the version of the website you choose, you can select which modules, including investigations, comics, or spotlight videos, you want to include based upon your study’s protocol.

The software will guide you through making these decisions and building your custom website.

To review all content available for you to include in your custom DigiKnowIt News website for children and adolescents, click here.

If you are planning to apply for grant or contract funding to support your pediatric research projects, it is important to develop a clear strategy to include in your proposals for how you will recruit participants. When reading your proposal, reviewers will look to see if it is realistic and feasible to recruit the number and types of people you want to participate in your study. In other words, your research proposal should not only include who you plan to recruit, but also how you plan to recruit and retain participants. Carefully strategizing and writing your recruitment and retention plan is particularly important for pediatric studies, because children and adolescents have unique needs when engaged in participant education in order to feel comfortable about choosing to participate, as we discussed in a previous blog.

One strategy to include in your proposal is to use an evidence-based, developmentally-appropriate recruitment website that is both interactive and customized to reflect your study protocol. DigiKnowIt News provides a low-cost, effective solution to fill this need.

Including use of DigiKnowIt News as part of your recruitment plan in your proposals will demonstrate to reviewers that you have a thoughtful plan for recruiting and retaining participants.

How DigiKnowIt News can strengthen your proposal.

The National Institutes of Health (NIH) have outlined various questions and points to consider when applying for a research grant (NIH, n.d.). Below, we describe how using DigiKnowIt News can help you address many of these points and increase your proposal’s competitiveness.

What mechanisms will you use to encourage recruitment?

The NIH recommend acknowledging multiple mechanisms for participant recruitment and retention in your grant application. While reaching potential participants and their families through flyers, advertisements, and digital marketing is an important first step in the recruitment process, reviewers also will look to see that you have a strategy that bridges the gap between attracting interest and obtaining assent. DigiKnowIt News offers that bridge by providing trustworthy, developmentally-appropriate education about study participation.

Have you designed your informational and study materials for your intended audience? Do you have realistic recruitment and retention strategies for all populations?

DigiKnowIt News was designed specifically to help researchers recruit and retain child and adolescent participants for research. It can be customized for children or adolescents based upon their developmental stage and learning preferences. The website features avatars and characters of diverse ages, genders, and races, helping all potential participants feel represented and included.

What are the barriers to participation? How will you prepare to address each of these barriers?

The NIH recommend thoroughly considering and addressing the specific barriers to participation for your unique target participant population when planning recruitment methods. Reviewers know that it is challenging to recruit children and adolescents for studies, particularly clinical trial studies that involve medical procedures, because young people may not fully understand what participation entails or may feel anxious about experiencing medical procedures. DigiKnowIt News helps overcome these barriers by providing education on various topic related to research participation and undergoing medical procedures to address the most significant barriers to youth participation in research including: lack of information, misinformation, mistrust, and fear about research.

Will study materials including consent forms and study instruments account for different literacy levels and cognitive abilities? Have you considered the language requirements and literacy of your proposed participants?

Including DigiKnowIt News in your proposal can help you stand out to reviewers, because, unlike materials commonly used to educate children and adolescents about research, the web application accounts for young people’s developmental abilities and preferred learning methods. With DigiKnowIt News, you can offer participants interactive activities and videos that use language that is easy for them to understand, so they can develop a better understanding of the purposes and methods included in your research project. In addition, DigiKnowIt News includes two separate versions of many interactive components that are designed specifically for children versus adolescents in order to increase engagement and accessibility across age groups.

What are the benefits to enrolling in your clinical research study from the perspective of your potential research participants?

Understanding the benefits of participating in research, in general, is a key motivating factor for children and adolescents making the decision about whether to participate. This is why DigiKnowIt News presents information using a variety of methods including interactive eLearning modules, video testimonials from former child and adolescent research participants, and digital comic books, in order to that allow young people to explore how participating in research might benefit them using the method that they find most appealing.

How will you retain participants?

DigiKnowIt News describes the potential risks of participating in research, how to communicate with research staff and ask questions, and what specific medical procedures may be like when participating. This information can help potential participants form realistic expectations for participating in research which may decrease the chances that they leave your study early when met with discomfort or challenges.

Are you aware that some communities are mistrustful of medical research? How do you plan to address these concerns?

A central goal of DigiKnowIt News is to reduce the fear and mistrust that potential participants have towards research, medical professionals, and/or researchers, which can be a barrier to participation. Its activities and video testimonials from real pediatric research participants are designed to empower children and adolescents to ask questions, teach them their rights as a participant, help them understand assent and consent, and remind them that they are able to remove themselves as a participant at any point in a study. In doing so, DigiKnowIt News can foster trust, autonomy, and confidence to help young people feel comfortable deciding whether to participate.

Next steps.

DigiKnowIt News was created by researchers and has been shown to increase youth knowledge, positive beliefs, and self-efficacy related to clinical trials participation. Our team can provide you with research findings and additional information about DigiKnowIt News that you can include in your proposal to demonstrate to reviewers that you have an evidence-based strategy for recruiting and retaining participants for your research.

If you would like use to provide you with some text or information about DigiKnowIt News to include in your proposal, email us at info@irtinc.us.

National Institute of Mental Health. (n.d.). Points to consider about recruitment and retention while preparing a clinical research study. U.S. Department of Health & Human Services. https://www.nimh.nih.gov/funding/grant-writing-and-application-process/points-to-consider-about-recruitment-and-retention-while-preparing-a-clinical-research-study

Are you struggling with low participation rates or high attrition in your study, but you are not sure what to do about it? Maybe you spent time creating recruitment materials or a procedure to educate children or adolescents about your study, so they might assent, but it is just not cutting it.

Our team created DigiKnowIt News to give researchers like you a tool that was designed to reduce the barriers that may be impacting youth participation in research. DigiKnowIt News is evidence-based and can help you recruit and retain more young people for your clinical trial or research study.

Evidence that shows DigiKnowIt News’ usefulness for your research.

DigiKnowIt News was evaluated in two randomized controlled trials, including one conducted with children and one with adolescents and their parents. Findings from both studies point to the usefulness of DigiKnowIt News for educating young people about research which can, in turn, help researchers combat low participation rates.

Some of the most common barriers to youth participation in research are lack of information, misinformation, mistrust, and fear about research. DigiKnowIt News was found to help alleviate these barriers by increasing child and adolescent knowledge, positive beliefs, and self-efficacy related to clinical trials participation. Below, read some of the important findings from the DigiKnowIt News evaluation studies:

1. DigiKnowIt Newsmade children more knowledgeable about clinical trials. Youth who used the website had more correct answers on the clinical trials knowledge quiz at posttest compared to youth in the control group.
2. DigiKnowIt News made children and families feel more positively about clinical trials. Children, adolescents, and parents reported more positive beliefs about clinical trials after using DigiKnowIt News than those that did not.
3. DigiKnowIt News increased youth self-efficacy for participating in clinical trials. Both children and adolescents felt more confident in their knowledge about clinical trials after using the website.
4. DigiKnowIt News helped families feel more familiar with clinical trials. Adolescents and their parents who used the website reported more familiarity with clinical trials than those who did not.
5. Children, adolescents, and parents had high levels of satisfaction with DigiKnowIt News. Most young people who used the website reported that they learned new information, could use information they learned to make a decision about clinical trials participation, enjoyed using the website, and would tell a friend who wanted more information about clinical trials about the website.

A usability study was also conducted on DigiKnowIt News with children to analyze the website’s ease of use by people. DigiKnowIt News received very positive ratings with respect to the website’s content, format, and usability.

By using DigiKnowIt News, you stop playing the guessing game when it comes to addressing low participation in your research and figuring out whether you are using effective tools for recruitment and participant education. By using the website, you can start feeling more confident that the method you are using to educate youth about your research will actually impact youth outcomes that have been found to be related to increased participation. In addition, you can ensure that you are educating young people about your research in ways that are understandable, usable, and relatable to them, so they may feel more comfortable when deciding whether or not to participate in your research.

If you would like more information on research findings from this study, visit https://digiknowit.com/research-findings/ or contact us. Email us at info@irtinc.us, if you would like to discuss how you can use DigiKnowIt News for your study or to try a free demo of the website.

If you are trying to recruit and retain an adequate number of participants for your pediatric research study, you probably already know how important it is for children and teens to understand what it means to participate in your research. When young people understand what they may be asked to do as a participant in your study and have realistic expectations for their participation, they will feel more comfortable deciding whether or not to assent, and may be less likely to leave your study early if they are met with any discomfort or challenges.

DigiKnowIt News is a particularly effective tool for educating young people about your research and helping them feel more comfortable when deciding to participate because, unlike common methods of educating potential child or teen participants, it harnesses their imagination, curiosity, interest in stories, eagerness to explore, and fascination with the web as a means of engaging them to learn about your study. Through its highly interactive activities that are strategically designed to capture young people’s attention, DigiKnowIt News gives children and teens a thorough understanding of what it means to be a participant in your research study, what their rights are as a participant, the medical procedures included in your study, and more.

In our most recent blog, we outlined how DigiKnowIt News’ interactive Investigations take advantage of children’s and teen’s curiosity for solving mysteries and exploring new topics to teach them about research and medical procedures commonly used in clinical trials. Digital Comic Books are another technique that DigiKnowIt News uses to pique the interest of children and teens to motivate them to learn about your study.

Most children enjoy an entertaining story, especially when they are transported to new situations and narratives where they will use their imagination to immerse themselves in the story they are being told. That is why thousands of life lessons have been taught to children in the form of books, plays, movies, and television shows. DigiKnowIt News’ Comic Books harness young people’s fascination with storytelling to teach them about research. The interactive Comic Books allow children and teens to choose a character to follow through adventures experienced while participating in a clinical trial. Like traditional comic books, DigiKnowIt News’ digital Comic Books contain storylines that are meant to entertain and teach young people. As each story unfolds, young people may feel the thrill, nerves, excitement, or uncertainty of participating in a clinical trial along with their character, which can prepare them for the different feelings they may experience if they choose to participate in your study. Plus, these activities are designed to hold their attention, so they are more likely to retain the information they are learning from the story which will help them make a decision about whether or not to assent to participate in your study.

Each frame within each Comic Book allows young people to listen to the story while reading along, as different characters chat and explore topics such as research participation, discuss participant rights, and weigh the benefits and costs related to participating. For example, The Chronicles of the Clinical Trial is a four-part Comic Book that allows children and teens to follow their character through the entire lifecycle of participating in a clinical trial. They watch as their character is introduced to a study by a doctor; discusses with their parents both the good and not-so good things about participating in the trial; asks a researcher questions about the study; signs the assent form; completes research tasks; and finishes the study.

DigiKnowIt News also contains Comic Books that allow young people to follow along as their character takes part in medical procedures as part of a clinical trial. As their character calms their feelings of nervousness when receiving a blood draw or an MRI scan, children and teens see what participating in a medical procedure may be like and more importantly, they learn strategies for handling discomfort or fear. This experience can help them feel more prepared to decide whether or not to participate in your study, especially if the study includes medical procedures. These Comic Books are optional for researchers to include in their custom DigiKnowIt News website, so you can choose to include the Comic Books that will be most helpful to your potential participants, based upon the medical procedures your clinical trial does or does not include.

To make these activities even more intriguing to young people than traditional Comic Books, DigiKnowIt News’ Comic Books are web-based and interactive. Young people today are constantly interacting with digital media and modern technology, so DigiKnowIt News was designed to immerse children and teens in an interactive, web-based environment that they are already comfortable and familiar with to learn about your study. Since most young people are used to and enjoy interacting with computers, tablets, and mobile phones on a daily basis, web-based tools like DigiKnowIt News may feel like a more familiar and entertaining way to learn about research than simply reading brochures or other paper documents, viewing presentations, or having conversations with researchers. DigiKnowIt News’ Comic Books not only interest young people in fun narratives, but also give young people opportunities to interact with different elements on the screen of a computer, tablet, or mobile device. Young people can click on different images in the digital Comic Books to dive deeper into the story and explore the topic, or just simply entertain themselves. The Comic Books also contain colorful and developmentally-appropriate illustrations and graphics that are meant to “catch the eye” of children and teens.

DigiKnowIt News’ Comic Books were strategically designed to be optimally effective at helping researchers enhance their recruitment and informed assenting process for their research. By educating children and teens about your study using DigiKnowIt News, you can feel confident that your potential participants are sufficiently engaged to learn and retain information about your study, so they may be more likely to decide to participate and be less likely to leave your study prematurely, once participating.

To explore one of DigiKnowIt News’ interactive, digital Comic Books for yourself for free, visit http://digiknowit.com/free-version/.

Typical methods of participant recruitment in clinical trials can be dull and off-putting to children and teens. For example, reading documents with information about your study and participating in long informed assent meetings can leave young people feeling even more confused and overwhelmed about deciding whether or not to participate in your study, as was described in an earlier blog. Contrary to typical methods of participant recruitment, DigiKnowIt News uses a unique approach to capturing the curiosity and interest of young people to motivate them to learn more about your study. Its customization capabilities allow for your DigiKnowIt News website to reflect the goals and methods of your specific study while also piquing the interest of potential participants. By engaging young people with information about clinical trials in an engaging and understandable way, DigiKnowIt News may help young people to feel more comfortable when making a decision about whether or not to participate in your study, which should ultimately improve your participation rates.

One type of online activity used in the DigiKnowIt News website to engage and excite youth is interactive Investigations, where children and adolescents can explore a variety of different topics that are relevant to participation in your clinical trial in developmentally relevant ways.

How do DigiKnowIt News’ Investigations engage children and teens with information about clinical trials?

Children have very different interests than adolescents when they interact with websites. For example, children like digital comic books, animations, and graphic illustrations, whereas teens like videos, more text-based interactive elements, and informational graphics such as charts and graphs. For these reasons, DigiKnowIt News’ Investigations for children are delivered in a highly interactive, game-like format, while the Investigations for teens are briefer and contain more complex topics, videos, definitions, and facts. The website was designed so that researchers can customize their version of the DigiKnowIt News website to reflect the recruitment needs of their clinical trial, and so that it will be interesting and developmentally appropriate for children (aged 8 to 12 years) or for adolescents (aged 13 to 18 years).

Because of these developmental differences in learning preferences, each Investigation for children includes an assignment to gather information about a clinical trials-related topic by having them become an “investigative journalist.” These Investigations involve completing several different activities such as role-playing interviewing a researcher, hearing testimonies from other children who have participated in a clinical trial, completing an interactive activity, or watching animated videos. Their goal in gathering information through these activities is to write a fake blog that they believe would help other children when they are deciding whether to participate in a clinical trial. Children earn points for completing activities to motivate them to complete the Investigations.

In contrast, each Investigation for teens includes six different types of activities, and teens can choose to interact with one or more of the activities. One example of an activity is the “DigiKnowThat” section, where teens click on attributes within infographics to reveal interesting facts about clinical trials as well as learn answers to frequently asked questions about clinical trials. A second type of activity included in the Investigations is called “DigiTube” where teens learn about clinical trials from entertaining videos. “DigiTube” was created because many teens enjoy watching videos on YouTube to entertain themselves or learn more about a specific topic. A third type of activity is the “DigiSearch” which is designed to look like a search engine that teens can interact with to learn definitions for commonly used terms in clinical trials, types of procedures used in clinical trials, and roles of people involved in clinical trials. During each activity in the Investigations, teens can choose to click an icon that will save information from the activity to their digital notepad, so they can refer later to information they learned from the activity.

In addition to the unique activities in the website that are designed for different age groups, there are also some features that are universal across age groups. For example, both the child and adolescent versions of DigiKnowIt News include videotaped scenarios, called “Human Interest Stories,” with examples of real-life situations that can happen in clinical trials. The scenarios that are included in the website had been suggested by youth during the development of DigiKnowIt News. Examples of some scenarios include having a conversation with a parent to weigh the benefits and risks of participating in a trial, asking questions to a nurse before getting an IV as part of a clinical trial, and asking a researcher questions as they review assent forms together. While watching each scenario, children and teens are presented with opportunities to choose what happens next in the scenario, which allows them to practice their decision-making skills about potential research participation in the future.

What do children and teens learn from DigiKnowIt News’ Investigations?

One barrier to recruiting children and teens for clinical trials is that they do not understand what it means to participate in a clinical trial. Therefore, there are four Investigations that focus on essential information related to participating in a clinical trial that are included as options in both the child and teen versions:

1. The Mystery of the Clinical Trials/Clinical Trials 101: When presented with the opportunity to participate in a trial, many young people do not understand what a clinical trial is or why they are important. In this Investigation, youth learn facts, definitions, and concepts related to participating in a clinical trial, and why it is important to participate in them. The child version of this Investigation is called “The Mystery of the Clinical Trials,” and the teen version is called “Clinical Trials 101.”
2. Know Your Rights: Some young people may be hesitant to participate in a clinical trial if they think that they might become unsafe or uncomfortable during a trial and have no way out. In this Investigation, youth learn about their rights and safety when participating in a clinical trial, and what is informed consent and assent. There are two separate versions of this Investigation for children and teens.
3. Good and Not So Good/Benefits and Costs: Some young people may choose to not participate in a trial if they think they will not benefit from their participation or if they are not sure what sacrifices they will have to make to participate. In this Investigation, youth learn about the potential benefits and costs of participating in a clinical trial. The child version of this Investigation is called “Good and Not So Good,” and the teen version is called “Benefits and Costs.”
4. Who to Talk to/Communication is Key: Young people may feel hesitant to participate in a trial if they think that they will be alone in their experience or will have no help to navigate their confusion or challenges during their participation. In this Investigation, youth learn the different roles of people involved in conducting clinical trials, and how to communicate about the trial with parents, researchers, and medical professionals. The child version of this Investigation is called “Who to Talk to,” and the teen version is called “Communication is Key.”

DigiKnowIt News also contains several other Investigations that researchers can include in their custom website to educate potential participants about specific medical procedures that are commonly used in clinical trials:

1. Needles: When deciding whether to participate in a clinical trial that includes receiving IVs or injections as part of participation, children and teens may feel afraid that the procedures may be painful or not understand what the procedure entails. In this Investigation, youth learn about needle procedures such as blood draws. There are two separate versions of this Investigation for children and teens.
2. Scans: Participating in a trial that includes getting an MRI or CT scan may be nerve wracking for young people who have fears of small spaces or loud noises or for young people who have not received a scan before. In this Investigation, youth learn about scans such as MRIs. There are two separate versions of this Investigation for children and teens.
3. Sedation and Anesthesia: Young people may feel hesitant to participate in a trial that includes receiving sedation or anesthesia because some children and teens may feel uncomfortable with the idea of being unconscious or experiencing symptoms when recovering from sedation or anesthesia. In this Investigation, youth learn about different types of sedation and anesthesia such as local and general anesthesia and sedative and anti-anxiety medication. This Investigation is only available in a version for teens.
4. Organ Testing: Some young people may feel nervous about participating in a trial that includes receiving organ testing procedures because these procedures may be unfamiliar or uncomfortable for them. In this Investigation, youth learn about different tests of organ functioning such as spirometry, pulse oximetry, electrocardiogram (ECG), urinalysis, and biopsies. This Investigation is only available in a version for teens.
5. Behavioral Treatments: Behavioral treatments may also be unfamiliar to young people, which may make them feel hesitant to participate in a clinical trial that includes receiving behavioral treatments. In this Investigation, youth learn about clinical trials that use interventions that do not include drugs or medicines. These trials examine how behavioral treatments improve health behaviors (e.g., sleep, nutrition, exercise). This Investigation is only available in a version for teens.

These Investigations target youth fears about certain medical procedures that may be unfamiliar to them. By knowing what to expect from participating in specific medical procedures, children and adolescents may not feel as apprehensive about participating in a clinical trial that involves medical procedures.

DigiKnowIt News’ Investigations are highly appealing to active learners who learn best from visual, auditory, kinesthetic, and reading/writing activities. The Investigations contribute to DigiKnowIt News’ ability to appeal to and engage a variety of youth, so each research study can recruit their target participant population.

To view a free demo of DigiKnowIt News’ Investigations and explore how DigiKnowIt News may be useful for your study, complete the form at https://digiknowit.com/free-version/.