Gaining access to underresearched populations in women's health research

Sexual Violence Against Men in Conflict and Post-Conflict Settings: A Qualitative Research Methodology

Sexual violence against men in conflict and post-conflict settings is under-researched. Men’s reluctance to talk about their experiences in conflict and post-conflict settings has contributed to the subject being a difficult area of inquiry. This article describes the research design and the strategies employed by the first author, who conducted qualitative research with South Sudanese male refugees who were survivors of sexual violence and have resettled in two communities in Uganda since the onset of the 2013 South Sudan conflict. The qualitative research is a part of a mixed-method program of research for the first author’s doctoral research that focused on sexual violence perpetrated against men in conflict and post-conflict settings. Based on the learnings during the fieldwork in this complex research setting and by drawing on best practices in qualitative research, this article proposes guidelines that can assist researchers who conduct qualitative research with vulnerable populations (across multiple disciplines) on sensitive topics such as sexual violence. The guidelines include five key steps: spending time in the community before participant recruitment and data collection, fostering a trust relationship with stakeholders, using appropriate gatekeepers, making participants feel at ease throughout the research, and using the snowballing sampling technique. The key steps are interdependent and can be adapted to suit the research context. These guidelines can be useful across multiple disciplines and subject areas.

Experience and lessons learned from multi-modal internet-based recruitment of U.S. Vietnamese into research

Background

Asian-Americans are one of the most understudied racial/ethnic minority populations. To increase representation of Asian subgroups, researchers have traditionally relied on data collection at community venues and events. However, the COVID-19 pandemic has created serious challenges for in-person data collection. In this case study, we describe multi-modal strategies for online recruitment of U.S. Vietnamese parents, compare response rates and participant characteristics among strategies, and discuss lessons learned.

Methods

We recruited 408 participants from community-based organizations (CBOs) (n = 68), Facebook groups (n = 97), listservs (n = 4), personal network (n = 42), and snowball sampling (n = 197). Using chi-square tests and one-way analyses of variance, we compared participants recruited through different strategies regarding sociodemographic characteristics, acculturation-related characteristics, and mobile health usage.

Results

The overall response rate was 71.8% (range: 51.5% for Vietnamese CBOs to 86.6% for Facebook groups). Significant differences exist for all sociodemographic and almost all acculturation-related characteristics among recruitment strategies. Notably, CBO-recruited participants were the oldest, had lived in the U.S. for the longest duration, and had the lowest Vietnamese language ability. We found some similarities between Facebook-recruited participants and those referred by Facebook-recruited participants. Mobile health usage was high and did not vary based on recruitment strategies. Challenges included encountering fraudulent responses (e.g., non-Vietnamese). Perceived benefits and trust appeared to facilitate recruitment.

Conclusions

Facebook and snowball sampling may be feasible strategies to recruit U.S. Vietnamese. Findings suggest the potential for mobile-based research implementation. Perceived benefits and trust could encourage participation and may be related to cultural ties. Attention should be paid to recruitment with CBOs and handling fraudulent responses.

Considerations for employing intersectionality in qualitative health research

Intersectionality theory has recently emerged in the health sciences as a critical theoretical and methodical approach. Though some scholars have outlined explicit guidelines for applying intersectionality in research using quantitative methods, others have cited epistemological concerns and additive thinking to advocate for the analysis of intersectionality with qualitative methods. Thus, there remains a need for additional guidance and support for utilizing and applying intersectionality theory throughout the qualitative research process. With the goal of demystifying the process of utilizing intersectionality as a methodological approach in qualitative research in the health sciences, this paper provides researchers with recommendations, specific examples, and important considerations for incorporating intersectional approaches into study conceptualization, participant recruitment, data collection, and data analysis. Additionally, this paper reviews challenges that researchers may experience in conducting research using intersectional approaches and offers suggestions for overcoming challenges. This paper offers timely and relevant information that can be used to strengthen the theoretical and methodological rigor of qualitative health research, especially studies that seek to advance health equity.

Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands

Background

There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands.

Methods

We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis.

Results

The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies.

Conclusions

The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.

Lessons learned from recruiting socioeconomically disadvantaged smokers into a pilot randomized controlled trial to explore the role of Exercise Assisted Reduction then Stop (EARS) smoking

BACKGROUND

Research is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit.

METHODS

Smokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants.

RESULTS

We randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting.

CONCLUSIONS

Mailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective.

TRIAL REGISTRATION

ISRCTN identifier: 13837944 , registered on 6 July 2010.

Self-reported depressive symptoms in women hospitalized for acute coronary syndrome

The purpose of this cross-sectional observational study was to explore depressive symptoms, among 377 women, during hospitalization for acute coronary syndrome (ACS). Women were screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II). Pearson chi-squared tests for independence were used for comparisons between categorical variables and t-tests for independent samples were used for comparisons between continuous variables. Tukey's honestly significant difference test along with one-way anova test was used to conduct multiple comparisons between the three defined age groups ranging from 29-49, 50-64 to ≥65 years. A total of 118 women screened positive for depression (BDI-II score ≥ 14). The percentage of women that met the criteria for a positive depression screening was significantly different between the three age groups. The proportion of depressed women who reported feelings of sadness, past failures, punishment, self-dislike, agitation, worthlessness, sleep disturbances and irritability varied significantly by age group. Study findings indicate that symptom experience and severity may differ across a lifetime. These results support the need to understand the complexity of depressive symptoms experienced by women. The ability to understand and recognize depressive symptoms in women, with ACS, may assist healthcare professionals with the management of a modifiable cardiovascular risk factor.

What do women want? Experiences and reflections of women after prenatal diagnosis and termination for anomaly

It is difficult to hear the voices of women describing their experiences of perinatal health care in the United States. This article reports results from interviews with 30 women about their experience of pregnancy termination for fetal anomaly (TFA) and their encounters with the medical system during the diagnosis through the aftermath of termination process. The ways researchers inadvertently silence women's voices are analyzed. Themes emerged from the interviews, including the role of preparedness, access and barriers to care, and the importance of empathic compassion by the provider. Additionally, women give relatively unprocessed advice and feedback to the varied disciplines of the medical care team.

Lessons learned and challenges in building a Filipino health coalition

In recent years, community-based coalitions have become an effective channel to addressing various health problems within specific ethnic communities. The purpose of this article is twofold: (a) to describe the process involved in building the Kalusugan Coalition (KC), a Filipino American health coalition based in New York City, and (b) to highlight the lessons learned and the challenges from this collaborative venture. The challenges described also offer insights on how the coalition development process can be greatly affected by the partnership with an academic institution on a community-based research project. Because each cultural group has unique issues and concerns, the theoretical framework used by KC offers creative alternatives to address some of the challenges regarding coalition infrastructures, leadership development, unexpected change of coalition dynamics, and cultural nuances.

Community-academic research on hard-to-reach populations: benefits and challenges

In this article, the authors examine some of the benefits and challenges associated with conducting research on hard-to-reach/hidden populations: in this instance, sex workers. The population studied was female and male sex workers working in different sectors of the sex industry in a medium-size Canadian metropolitan area. The authors describe the need for close community-academic cooperation, given the hidden and highly stigmatized nature of the target population that was investigated and the local context in which the research project was embedded. The authors discuss the main benefits and challenges of the research collaboration for the various parties involved, including the community partner organization, indigenous research assistants, and academic research team. They conclude with a discussion of strategies to help overcome the main challenges faced during the research endeavor.

Accessing the community: gaining insider perspectives from the outside

Accessing participants for research projects is often treated as unproblematic. However the experience outlined here of negotiating access to participants within a community setting illustrates the inherent difficulties of recruitment. The authors describe the techniques used and practical challenges faced when accessing participants within a socially deprived community for a qualitative research project on social capital. They used a number of different strategies to generate a diverse sample including advertising, snowballing, accessing gatekeepers, and street surveys. The value of a stakeholder analysis is described alongside issues surrounding the use of gatekeepers. Rather than acting as outsiders seeking participants at every available opportunity, a more fortuitous strategy involved the ethnographic approach of "being there" as active contributors to community life. Here, the cornerstones of credibility and trust were addressed in a process of continually negotiating access from a semi-insider position.

[A research partnership in a multiethnic setting]

The objective of this paper is to describe a research partnership endeavour with five community organizations focusing their work on facilitating the integration of immigrant populations in the Montreal area. Survey data were collected in order to obtain a sociodemographic picture of recent immigrant women (n = 254), their knowledge of Info-Santé CLSC services and their use of those services. Focus group discussions were also carried out to explore the needs of these women with regards to the various services offered by Info-Santé CLSC (n = 44). Among these women, some had previously used the services and others not. The community organizations were the main crafters of this research partnership across the various stages from its inception to evaluation. The success factors of such a partnership are discussed according to human, professional and organizational dimensions.

Incorporating cultural diversity in randomised controlled trials in midwifery

The randomised controlled trial is currently the 'gold standard' that guides health-care practices. The implementation of new models of midwifery care often relies on results from randomised controlled trials. However, many randomised controlled trials exclude women who do not speak English or are designed in such a way that cultural diversity is not facilitated. This can mean that the sample is not representative of the population from which it was drawn or to which it will be applied. Culturally diverse representation can be achieved through a number of strategies. These include utilising health-care interpreters, ensuring materials are translated into common community languages and engaging the local community. These strategies can be used to ensure that the sample in a randomised controlled trial is culturally and linguistically diverse, and representative of the community. We have conducted a randomised controlled trial of a community-based model of midwifery providing continuity of care in a culturally diverse population. A number of issues in the conduct of a trial within a culturally diverse society are discussed in this paper. The trial will be used to illustrate some of the strategies used to ensure that the sample represented the population from which it was drawn.