Challenges of ‘Imposter participants’ in patient and public involvement

The term “imposter participants” has been proposed to characterise individuals who, for the purpose of participating in research, provide false identities and experiences [1-4]. The term ‘Inauthentic participants’ is a broader term which describes individuals or technologies that engage in fraudulent or disingenuous practices to participate in research and includes ’bots’ which complete automated tasks [5]. 

Emerging literature has focused on recruitment for predominantly qualitative studies involving online interviews, particularly when reimbursement is offered for participation. Some authors have characterised “red flags” for identifying ‘imposter participants’ who are offering to participate in an online research study, particularly those posing as multiple individuals. These include a combination of factors including large volumes and strange timings of email responses and unlikely demographic characteristics, and request for reimbursement, at the time of recruitment. When an interview or focus group is conducted a preference for non-visual participation, short or vague responses, fixation on monetary compensation, and inconsistencies in reported demographics and personal characteristics [6]. A number of strategies have been proposed to combat this problem such as providing proof of location or eligibility during recruitment and data collection, examining email and consent form patterns, and comparing demographic data with regional statistics [6]. The researcher is faced with a dilemma when data has been generated which may have been contributed by a suspected imposter participant [7]. How has the researcher judged that the participant is inauthentic? What should be done with these data – should the data be included in the analysis or not? If the data are not used and the participant was not an ‘imposter’, what ethical concerns are raised? This is a threat to data integrity.

These discussions are ongoing in research teams conducting research which involves online participation of people with lived experience of illness, and teams are aware of the challenge. Less well described is the phenomenon of ‘imposter participants’ in patient and public involvement and engagement (PPIE) activities. We report the work generated for a researcher aiming to recruit people with lived experience of Long Covid to an online PPIE meeting.

Katie reflects: “I recently supported with the organisation of an online meeting for people with lived experience of Long Covid. The purpose of the meeting is for lived experience experts to help researchers consider impact of their ongoing research into Long Covid and discuss how to ‘Keep Long Covid on the Agenda’. The flyer advertising the meeting included mention of reimbursement but did not specify an amount.

The poster for the meeting was circulated to our People and Communities team for circulation, and external partners, including Long Covid charities, and Primary Care Networks. The flyer was also added to a number of social media platforms. I received requests to attend the meeting from 11 people in the first hour of my working day. By the end of the day (Friday) I had received 25 expressions of interest from people wanting to join the event. This was accompanied by a steady stream of emails coming into my Junk folder: 48 in total. At first, I could not believe that the event was so popular in such a short amount of time, and was pleased by the level of interest shown, but the more I read through the emails the more I became suspicious of their authenticity.

Some of the emails contained what appeared to be legitimate stories of lived experience of Long Covid. However, a large number of emails contained the same subject line ‘interested’ and all had the same email body ‘Please send me the link for the webinar’. Out of the 48 emails in my Junk folder, 40 of them contained this exact content. The other 8 appeared slightly different, for example, they had different email subjects, but the layout of the emails exactly was the same (including the same typos), with just one word or one sentence being slightly different. I also noticed that all the email addresses were the first name and surname of the ‘person’ with four numbers afterwards. I spent the afternoon going through all of the emails in both my Junk and Inbox folders and judged that only 20 responses were legitimate.

But that was not the end, by 9am on Saturday I had received a further 20 expressions of interest; by 10.30am this has increased to 48 in my Inbox and a further 16 in my Junk folder….. In total, I received 137 emails in a little over 24 hours. I do not typically work weekends, so at this point I felt it was best to put on an automatic reply to advise that the event was now closed to registration.

When I returned to work on Monday, it took me approximately four hours to sort through the emails (7 hours in total including the work on Friday). I judged that only around 40-45 emails were from legitimate people. The remaining emails were either human imposters or ‘bots’. Some of these were obvious, using names such as ‘Keanu Reeves’ and ‘Chris Evans’. Others were more difficult to determine, so I had to keep cross referencing with similar emails to check them, and low and behold they were same layout and content as the day before.”

So, following Katie’s experience, what is our advice to research teams recruiting people with lived experience to online PPI meetings?

• Use a registration form such as MS teams, rather than an individual’s email address, and ask for some demographic details on this form – and with a puzzle that demands a human to demonstrate ‘you are not a robot’.
• Consider whether (or not) to mention reimbursement on the initial advertisement for the meeting.
• Avoid use of social media to advertise PPI meetings – stick to known networks and links.
• Share the work out – so that sorting through registrations does not fall to one person.

Finally, advice to senior researchers who say, sometimes flippantly, “could you just set up this meeting” – consider the potential workload for your research team members that your simple request will generate.

References

[1] Chandler, Jesse J., and Gabriele Paolacci. "Lie for a dime: When most prescreening responses are honest but most study participants are impostors." Social Psychological and Personality Science 8, no. 5 (2017): 500-508.

[2] Pozzar, Rachel, Marilyn J. Hammer, Meghan Underhill-Blazey, Alexi A. Wright, James A. Tulsky, Fangxin Hong, Daniel A. Gundersen, and Donna L. Berry. "Threats of bots and other bad actors to data quality following research participant recruitment through social media: Cross-sectional questionnaire." Journal of medical Internet research 22, no. 10 (2020): e23021.

[3] Roehl, Jacqueline M., and Darci J. Harland. "Imposter participants: Overcoming methodological challenges related to balancing participant privacy with data quality when using online recruitment and data collection." The qualitative report 27, no. 11 (2022): 2469-2485.

[4] Ridge, Damien, Laurna Bullock, Hilary Causer, Tamsin Fisher, Samantha Hider, Tom Kingstone, Lauren Gray et al. "‘Imposter participants’ in online qualitative research, a new and increasing threat to data integrity?." Health expectations: an international journal of public participation in health care and health policy 26, no. 3 (2023): 941.

[5] Teitcher, Jennifer EF, Walter O. Bockting, José A. Bauermeister, Chris J. Hoefer, Michael H. Miner, and Robert L. Klitzman. "Detecting, preventing, and responding to “fraudsters” in internet research: ethics and tradeoffs." Journal of Law, Medicine & Ethics 43, no. 1 (2015): 116-133.

[6] Sharma, Pakhi, Steven M. McPhail, Sanjeewa Kularatna, Sameera Senanayake, and Bridget Abell. "Navigating the challenges of imposter participants in online qualitative research: lessons learned from a paediatric health services study." BMC Health Services Research 24, no. 1 (2024): 724.

[7] Martino, Alan Santinele, and Arielle Perrotta. 2025. “Imposter participants challenge research integrity in the digital age.” The Conversation. January 14, 2025. Accessed June 20, 2025. https://theconversation.com/imposter-participants-challenge-research-integrity-in-the-digital-age-246126.