# Access to translated invitations online increases involvement of linguistically diverse households in a population-based study: a cluster randomized controlled study

## TL;DR

Providing translated study invitations online increased participation from linguistically diverse families in a German health study.

## Contribution

A multilingual digital recruitment strategy improved involvement of non-German-speaking households in a population-based study.

## Key findings

- The flyer increased participation odds but not active response rates.
- In medium-social-level schools, flyer use increased participation by 2% per percentage point of non-German-speaking households.
- The flyer had inconclusive effects in low- and high-social-level schools.

## Abstract

This double-blind cluster-randomized controlled study examined the effectiveness of a multilingual physical-digital recruitment strategy to increase the involvement of linguistically diverse households in the German sub-survey of the World Health Organization European Childhood Obesity Surveillance Initiative. Students in primary schools received German study invitations either alone or with a supplemental flyer containing a QR-code for accessing translations online. A total of 114 classrooms (2306 students) received the flyer, while 115 classrooms (2276 students) served as control group. Main outcomes were active of responses to invitations and study participation. Response proportions were 48% overall, 48.6% in the flyer and 47.4% in the control group. Participation proportions were 26.7% overall, 27.8% in the flyer and 25.4% (571/2251) in the control groups. The flyer increased the odds of participation (14.9, 95% CI 1.003–1.315), but not the odds of active responses. In medium-social-level schools, response and participation proportions in the flyer group rose by 1.5% (ROR 1.015, 95% CI 1.003–1.027) and by 2% (ROR 1.020, 95% CI 1.005–1.034), respectively, for each percentage point increase in the proportion of non-German speaking households per classroom. The flyer’s effect in low- and high-social level schools was inconclusive. Although modest in magnitude, the addition of the flyer increased overall participation and, in particular, the involvement of linguistically diverse households in medium-social-level schools.

The online version contains supplementary material available at 10.1038/s41598-025-12092-6.