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Background: The "Healthy and Active Fund" involved 17 community-based projects focused on the delivery of physical activity interventions, led by a variety of public and third sector organizations. As a novel, direct approach to capturing impact at this level, these organizations were encouraged to robustly evaluate and monitor their own project's outcomes, with core funds allocated to this process. This study aimed to explore project experiences of planning and completing evaluation activities, to better understand how to support community-based practice improvement. Methods: In-depth semistructured interviews were completed with individuals who had supported their project's evaluation. Reflexive thematic analysis was used to identify key facilitators and barriers associated with evaluation in this context. Results: Across 3 identified themes, participants (N = 15, 12 projects) referred to a need for greater organizational capacity and expertise, familiarity with evaluation methods, partnership-working, inclusivity, and flexibility, particularly when collecting data from project beneficiaries. Overarching program support (eg, case officers) was viewed as a valuable resource that was disrupted by COVID-19. Participants highlighted the resilience of their projects when engaging with evaluation processes and acknowledged wider learning across organization networks as a result of this success. Conclusions: This study shows that projects may benefit from closer support and external expertise for research and evaluation. There is willingness by third sector and public bodies to adopt research and evaluation methods into routine practice, but significant barriers persist. Future programs should continue to support adaptable approaches to evaluation at community-level, to better progress health and well-being goals for diverse populations. [ABSTRACT FROM AUTHOR]

This paper presents insights on conducting urban research amidst the COVID-19 pandemic, emphasizing the adoption of digital ethnography as an innovative and flexible approach. Drawing from an expanding body of literature on fieldwork among 'hard-to-reach' populations during crises such as the COVID-19 pandemic, we share our experiences from a study on the socio-economic impacts of mandatory lockdowns on poor urban residents in Harare, Zimbabwe. Our research highlighted several methodological benefits of digital ethnography, including its non-intrusive and non-intimidating nature, cost and time efficiency, ability to increase participant diversity, assurance of respondent safety, research flexibility, and the generation of impactful data. Unlike traditional immersive ethnography, digital ethnography proved adept at navigating the complexities of the 'global', 'local', and 'trans-local' dimensions of contemporary urban research subjects. However, this approach also presents several ethical challenges. These challenges include obtaining informed consent, ensuring confidentiality and anonymity, participants' potential misunderstanding of the research context, the risk of exacerbating stress during crises, and respecting privacy in digital spaces. Urban researchers must carefully consider these ethical issues before undertaking their studies. In conclusion, virtual environments have become integral to modern life and represent essential avenues for urban researchers, particularly during periods of limited physical interaction and when studying populations that are difficult to reach in person but more accessible online. Further, the adoption of digital ethnography, extends beyond the necessity imposed by the COVID-19 pandemic. It reflects an ongoing evolution in ethnographic practices, adapting to the realities of a digitally connected world. We suggest that urban researchers should think of digital ethnographic ethics from the point of view of reciprocal and mutual collaboration with participants. With this thinking, urban research subjects become co-participants and co-researchers rather than subjects of exploitation in the expanding and complex digital space. [ABSTRACT FROM AUTHOR]

Online communication tools are increasingly being used by qualitative researchers; hence it is timely to reflect on the differences when using a broad range of data collection methods. Using a case study with a potentially hard-to-reach substance-using population who are often distrustful of researchers, this article explores the use of a variety of different platforms for interviews. It highlights both the advantages and disadvantages of each method. Face-to-face interviews and online videos offer more opportunity to build rapport, but lack anonymity. Live Webchat and audio-only interviews offer a high level of anonymity, but both may incur a loss of non-verbal communication, and in the Webchat a potential loss of personal narrative. This article is intended for sociologists who wish to broaden their methods for conducting research interviews. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss the issues in studying hard-to-reach or dispersed populations, with particular focus on methodologies used to collect data and to investigate dispersed migrant entrepreneurs, illustrating shortcomings, pitfalls and potentials of accessing and disseminating research to hard-to-reach populations of migrant entrepreneurs. Design/methodology/approach: A mixed methodology is proposed to access hard-to-reach or dispersed populations, and this paper explores these using a sample of Brazilian migrants settled in different countries of the world. Findings: This paper explores empirical challenges, illustrating shortcomings, pitfalls and potentials of accessing and disseminating research to hard-to-reach populations of migrant entrepreneurs. It provides insights by reporting research experiences developed over time by this group of researchers, reflecting a "mixing" of methods for accessing respondents, contrasting to a more rigid, a-priori, mixed methods approach. Originality/value: The main contribution of this paper is to showcase experiences from, and suitability of, remote data collection, especially for projects that cannot accommodate the physical participation of researchers, either because of time or cost constraints. It reports on researching migrant entrepreneurship overseas. Remote digital tools and online data collection are highly relevant due to time- and cost-efficiency, but also represent solutions for researching dispersed populations. These approaches presented allow for overcoming several barriers to data collection and present instrumental characteristics for migrant research. [ABSTRACT FROM AUTHOR]

Background: Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM) are significantly less likely than white MSM to initiate pre-exposure prophylaxis (PrEP). A peer-driven intervention (PDI) may be an effective approach to addressing this disparity. In this study, we explored community member perspectives of a PDI to promote PrEP uptake among B/AA and H/L MSM. Methods: We conducted semi-structured interviews with B/AA and H/L HIV-negative MSM between August 2018 and October 2019 in Rhode Island, USA. Participants reported their perspectives and recommendations for a PDI. Data from participant responses were thematically analysed. Results: Of 15 MSM, the median age was 25 years (interquartile range: 22, 33). The majority identified as B/AA (53.3%), H/L (66.7%), and having a college education or above (53.3%). Most participants viewed a PDI positively and were willing to learn and promote PrEP among their peers. Participants identified and supported several potential intervention components, such as education about the benefit of PrEP, emphasising prevention-effective dosing, and clarifying no prevention effect towards other sexually transmitted infections. They preferred in-person meetings to electronic communication. Preferred characteristics of peer educators included compassion, good communication skills, and enthusiasm about PrEP. Conclusions: This in-depth qualitative interview suggested that a PDI approach is promising in promoting PrEP uptake, as it could deliver culturally appropriate education and encourage PrEP uptake via peer influence among B/AA and H/L MSM. Peer approach is effective in promoting health among hard-to-reach populations. This study aims to explore the feasibility of implementing a peer approach for improving pre-exposure prophylaxis (PrEP) use among Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM). Study findings will be used to develop a peer approach for a real-world implementation. Participants were interviewed for their perspectives on such a peer approach, including willingness to disseminate PrEP knowledge and potential barriers to initiating PrEP. [ABSTRACT FROM AUTHOR]

Background: Respondent-driven sampling (RDS) is a peer chain-recruitment method for populations without a sampling frame or that are hard-to-reach. Although RDS is usually done face-to-face, the online version (WebRDS) has drawn a lot of attention as it has many potential benefits, despite this, to date there is no clear framework for its implementation. This article aims to provide guidance for researchers who want to recruit through a WebRDS. Methods: Description of the development phase: guidance is provided addressing aspects related to the formative research, the design of the questionnaire, the implementation of the coupon system using a free software and the diffusion plan, using as an example a web-based cross-sectional study conducted in Spain between April and June 2022 describing the working conditions and health status of homecare workers for dependent people. Results: The application of the survey: we discuss about the monitoring strategies throughout the recruitment process and potential problems along with proposed solutions. Conclusions: Under certain conditions, it is possible to obtain a sample with recruitment performance similar to that of other RDS without the need for monetary incentives and using a free access software, considerably reducing costs and allowing its use to be extended to other research groups. [ABSTRACT FROM AUTHOR]

Background: Lung cancer represents the leading cause of cancer death for Pacific Islanders in the United States, but they remain underrepresented in studies leading to the lack of evidence-based cessation programs tailored to their culture and lifestyle. Objectives: This paper aims to describe the development of culturally tailored and community informed recruitment materials, and provide lessons learned regarding implementation and adaptation of strategies to recruit Pacific Islander young adult smokers into a randomized cessation study. Methods: Development of recruitment materials involved a series of focus groups to determine the cessation program logo and recruitment video. The initial recruitment strategy relied on community-based participatory research partnerships with Pacific Islander community-based organizations, leaders and health coaches with strong ties to the community. Results/Lessons Learned: While the recruitment materials were well received, initial strategies tapered off after the first 3 months of recruitment resulting in the need to revise outreach plans. Revised plans included the creation of a list with more than 200 community locations frequented by Pacific Islander young adult smokers, along with the hiring of part-time recruitment assistants who reflected the age and ethnicities of the desired cessation study participants. These materials and strategies ultimately yielded 316 participants, 66% of whom were recruited by the revised strategies. Conclusions: Community-based participatory research approaches not only inform the design of culturally tailored intervention recruitment material and strategies, but also result in innovative solutions to recruitment challenges to address the National Cancer Institute's gaps in science regarding small populations. [ABSTRACT FROM AUTHOR]

Background: Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an electronic survey to carry out RDS studies; there is currently no commercially available webRDS solution. We designed and developed a webRDS solution to support a research study aimed at estimating conflict-attributable mortality in Yemen. Our webRDS solution is composed of an existing survey platform (i.e. ODK) and a bespoke RDS system. The RDS system is designed to administer and manage an RDS survey cascade and includes: (1) an application programming interface, (2) a study participant client, and (3) an administrator interface. We report here on the design of the webRDS solution and its implementation. Results: We consulted members of the Yemeni diaspora throughout the development of the solution. Technical obstacles were largely the result of: WhatsApp's policies on bulk messaging and automated messaging behaviour, the inherent constraints of SMS messaging, and SMS filtering behaviour. Language support was straight-forward yet time consuming. Survey uptake was lower than expected. Factors which may have impacted uptake include: our use of consumable survey links, low interest amongst the diaspora population, lack of material incentives, and the length and subject matter of the survey itself. The SMS/WhatsApp messaging integration was relatively complex and limited the information we could send potential participants. Conclusion: Despite lower-than expected survey uptake we believe our webRDS solution provides efficient and flexible means to survey a globally diverse population. [ABSTRACT FROM AUTHOR]

Little research has been done on what motivates gender, romantic, and sexual minority (GRSM) couples to attend relationship wellness programs or what incentives they find appealing. For this study, 18 participants in dyadic partnerships responded to questions about their motivations to participate in a brief relationship wellness program as well as what financial incentives held the most appeal. All nine couples shared that they were motivated to do the wellness program to contribute to research for the GRSM community, suggesting that altruistic motivations are particularly relevant to GRSM couples. In regard to financial incentives, gifts that supported their relationship health, such as a gift card for a meal out together, held the strongest appeal. The results in this preliminary study may assist in refining incentives and other strategies to engage these often hard-to-reach couples. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the impact of different logistic regression estimators applied to RDS studies via simulation and the analysis of empirical data. Four simulated populations were created with different connectivity characteristics. Each simulated individual received two attributes, one of them associated to the infection process. RDS samples with different sizes were obtained. The observed coverage of three logistic regression estimators were applied to assess the association between the attributes and the infection status. In simulated datasets, unweighted logistic regression estimators emerged as the best option, although all estimators showed a fairly good performance. In the empirical dataset, the performance of weighted estimators presented an unexpected behavior, making them a risky option. The unweighted logistic regression estimator is a reliable option to be applied to RDS samples, with a performance roughly similar to random samples and, therefore, should be the preferred option. [ABSTRACT FROM AUTHOR]

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The authors investigated the effects of a collaborative after-school inclusive sports program on adolescents with disabilities and neurotypical students in underserved high schools. The program brought together a large urban school district and a private after-school program to provide a service on the school site. The goals were to provide a truly integrated sports environment for adolescents with disabilities and to provide underrepresented minority students an opportunity to gain service learning, improved social–emotional development, and greater self-perceived impact. The project was feasible and indeed continued well beyond the evaluation period. Quantitative results indicated that the neurotypical adolescents felt they had an impact on improving the responsibility of their peer athlete, and they felt they had better perspective taking after participating. Descriptive comments indicated that the children with disabilities enjoyed participation and that this inclusive program may have provided an additional avenue for a subset of the population to engage more in the activities of their school. Program details are presented to encourage further research and replication. [ABSTRACT FROM AUTHOR]

Vaccines prevent 4–5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often "hidden" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach "hidden" subpopulations. [ABSTRACT FROM AUTHOR]

Social scientists are increasingly using social media to conduct research and to recruit subjects for research studies. Prior research seems to suggest that using social media is particularly helpful when it comes to recruiting participants from hard-to-reach populations such as immigrants. In this study, we examine how social media platforms (i.e., Facebook and WhatsApp) were used to recruit participants for a study, which examined Kenyan immigrants' perceptions of the police. Within the context of criminal justice research, the inclusion of African immigrants in research is important as their experiences and perceptions of justice get muted when compared to the experiences of blacks in general. We found that when conducting research among this group of immigrants, social media was instrumental in facilitating the recruitment of participants. Moreover, we discovered that building rapport with the participants and clearly articulating the objectives of the study was important. Implications for research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Opioid-use disorder is related to premature death worldwide. Opioid-agonist treatment (OAT) is an effective treatment for opioid dependence. OAT delivery platforms may influence treatment access and outcomes, especially for the most vulnerable groups. The aim of this study was to determine the effectiveness and safety of low-threshold OAT compared to the standard treatment. Methods: Patients with diagnosed opioid dependence undergoing low-threshold OAT at the Bergen delivery platform in Norway were enrolled in a cohort study in 2014–2019. A national OAT cohort was the reference group. The main outcomes were treatment retention, the use of illicit opioids, non-fatal overdose, overdose death, and all-cause mortality during the first year following treatment initiation and the full treatment period. Additionally, healthcare utilization in the periods before and during OAT was investigated. Results: Compared to the reference cohort, the low-threshold cohort (n = 128, mean age: 38 years, women: 28%) showed treatment retention rates of 95% versus 92%, illicit opioid use of 7% versus 10%, non-fatal overdose of 7% versus 6%, and death at 1.0% versus 1.3%, respectively. The incident rate ratios (IRRs) for healthcare utilization increased substantially during the OAT period compared to the period before; the IRR increased by 3.3 (95% confidence interval (CI): 2.8, 3.9) and 3.4 (95% CI: 3.1, 3.9) for all in- and outpatient healthcare, respectively. Conclusions: Low-threshold OAT was at least as effective and safe as the standard OAT in terms of treatment retention, the use of illicit opioids, non-fatal overdose, and death. Healthcare utilization increased during the OAT compared to the period before. Lowering the threshold for OAT entrance within proper delivery platforms should be broadly considered to reduce harm and improve healthcare access among patients with opioid dependence. [ABSTRACT FROM AUTHOR]

Objectives: In response to the COVID-19 pandemic, much in-person data collection has been suspended or become tele-remote. However, tele-remote methods often exclude marginalized groups, including people who use drugs, many of whom lack the technology to participate. To inform future surveillance and research during the pandemic and other public health disasters, we report methods and lessons learned from an in-person survey of people who use opioids conducted by the New York City Department of Health and Mental Hygiene (DOHMH) during the COVID-19 pandemic. Materials and Methods: This public health surveillance was a component of the Centers for Disease Control and Prevention Overdose Data to Action initiative and aimed to inform overdose prevention efforts. Survey domains inquired about participants' drug use patterns, risk behaviors, overdose history, and service use. Results: From June 16 through September 9, 2020, DOHMH staff members conducted 329 surveys with participants from 4 syringe service programs (n = 148, 44.9%) and via street intercept (n = 81, 55.1%). To survey participants safely and effectively, it was important to build rapport upfront so that requests to maintain distance were not perceived as stigmatizing. DOHMH staff members offered all participants, regardless of survey eligibility, Narcan and hygiene products, including face masks and soap. Practice Implications: Surveys administered outdoors during the COVID-19 pandemic should be limited to 30 minutes. Although conducting in-person surveys poses unique challenges, this method should be considered so marginalized populations are included in data collection and public health responses. [ABSTRACT FROM AUTHOR]

This qualitative study explores the experiences of men who self-report victimization from a female intimate partner in four English-speaking countries. Forty-one men who reported any type of intimate partner abuse (IPA) from a female partner were recruited via targeted advertising in Australia, Canada, the United Kingdom, and the United States. Twelve online focus groups were conducted across countries using a phenomenologically informed design. Thematic analysis was carried out from an inductive and realist epistemological position and themes identified at a semantic level. This approach was taken to directly reflect the men's experiences and perspectives, ensuring the voices of this hard-to-reach and overlooked population were heard. Three themes were identified across the countries: an imbalanced experience of harm; living with sustained abuse ; and knowledge is power for men experiencing IPA. It was found that most participants underwent physical harm in the context of coercive control and experienced abuse over long periods of time. They were slow to recognize the magnitude of their partners' behavior and act upon it for a range of reasons that are described in detail. In addition, promoting knowledge about the victimization of men by women, using appropriate language and active learning, was found to be important in helping the men gain autonomy and agency to break the pattern of abuse and aid their recovery. The implications of the findings for developing male-friendly IPA policy, practice, and services are discussed, in addition to the need for innovative research methodology to access hard-to-reach populations. [ABSTRACT FROM AUTHOR]

We completed a scoping review to: (1) identify strategies that have been used to engage hard-to-reach populations in childhood disability research, and (2) synthesize information as to whether and how these strategies were evaluated. Systematic search of six electronic databases and grey literature to identify articles published in the last 10 years. Studies published in English, French, and Spanish reporting on strategies used to engage hard-to-reach populations in childhood disability research were eligible for inclusion. Out of 106 articles selected for full text review, 16 were included. Engagement was more common in earlier stages of research. The populations included in studies were children with disabilities and their parents. Engagement strategies were reported but rarely evaluated. Anecdotal outcomes of engagement were reported in 14/16 studies and included positive outcomes for the children and parents such as empowerment. The challenges with engagement included the increased time needed to engage children with disabilities or their parents. Our results can guide others who wish to engage a diverse group of children with disabilities and their parents in research. Research on how to engage other hard-to-reach populations within the childhood disability umbrella and evaluation of engagement strategies and outcomes is needed. • Service providers should be concerned when the research informing their practices does not include families that represent their clients (e.g., families who are low income, Indigenous, ethnic minority, or LGBTQI parents of children with disabilities). • Strategies used to include children with disabilities in research, such as offering varied response methods that include story telling or photography, may also be used to promote participation in clinical services. • Service providers and teachers may have a role in facilitating the recruitment of 'hard-to-reach' families in research and advising researchers on methods to create a comfortable environment with accessible means of data collection for children with disabilities. [ABSTRACT FROM AUTHOR]

Purpose: Opioid use disorder among women of childbearing age has reached epidemic proportions. In rural regions of the United States, recruiting perinatal women who use nonmedical opioids to participate in research is wrought with challenges, including barriers such as community stigma, lack of transportation, and time constraints. The current study describes our process and challenges of recruiting pregnant and postpartum women in rural Indiana consisting of women who misuse opioids and those who do not. Description: We employed multiple strategies to recruit participants. Methods included (1) sampling from healthcare facilities based on referrals from front-desk staff and frontline healthcare workers; (2) dissemination of flyers and brochures within healthcare facilities and the community, supported with onsite research assistant presence; (3) digital methods coupled with snowball sampling; and (4) local community talks that provided information about the study. Assessment: Our multiple recruitment efforts revealed that building relationships with community stakeholders was key in recruiting women who use nonmedical opioids, but that digital methods were more effective in recruiting a larger sample of pregnant and postpartum women in a short amount of time. Conclusion: We conclude by making several recommendations to enhance academic-community partnerships in order to bolster sample sizes for prolonged research studies. Furthermore, we highlight the need to destigmatize addiction in order to better serve hard-to-reach populations through research and practice. [ABSTRACT FROM AUTHOR]

Introduction: Administering patient-reported outcome measures (PROMs) by text message may improve response rate in hard-to-reach populations. This study explored cultural acceptability of PROMs and compared measurement equivalence of the EQ-5D-3L administered on paper and by text message in a rural South African setting.Materials and Methods: Participants with upper or lower limb orthopaedic pathology were recruited. The EQ-5D was administered first on paper and then by text message after 24 h and 7 days. Differences in mean scores for paper and text message versions of the EQ-5D were evaluated. Test-retest reliability between text message versions was evaluated using Intraclass Correlation Coefficients (ICCs).Results: 147 participants completed a paper EQ-5D. Response rates were 67% at 24 h and 58% at 7 days. There were no differences in means between paper and text message responses for the EQ-5D Index (p = 0.95) or EQ-5D VAS (p = 0.26). There was acceptable agreement between the paper and 24-h text message EQ-5D Index (0.84; 95% Confidence Interval (CI) 0.78-0.89) and EQ-5D VAS (0.73; 95% CI 0.64-0.82) and acceptable agreement between the 24-h and 7-day text message EQ-Index (0.72; CI 0.62-0.82) and EQ-VAS (0.72; CI 0.62-0.82). Non-responder traits were increasing age, Xhosa as first language and lower educational levels.Conclusions: Text messaging is equivalent to paper-based measurement of EQ-5D in this setting and is thus a viable tool for responders. Non-responders had similar socioeconomic characteristics and attrition rates to traditional modes of administration. The EQ-5D by text message offers potential clinical and research uses in hard-to-reach populations. [ABSTRACT FROM AUTHOR]

Member countries of the Asia Pacific Malaria Elimination Network are pursuing the regional goal of malaria elimination by 2030. The countries are in different phases of malaria elimination, but most have demonstrated success in shrinking the malaria map in the region. However, continued transmission in hard‐to‐reach populations, including border and forest malaria, remains an important challenge. In this article, we review strategies for improving intervention coverage in hard‐to‐reach populations. Currently available preventive measures, including long‐lasting insecticidal nets and long‐lasting insecticidal hammocks, and prompt diagnosis and treatment need to be expanded to hard‐to‐reach populations. This can be done through mobile malaria clinics, village volunteer malaria workers and screening posts. Malaria surveillance in the hard‐to‐reach areas can be enhanced through tools such as spatial decision support systems. Policy changes by the malaria programs will be required for implementing the strategies outlined in this article. However, strategies or tools may be suitable for some population groups but difficult to implement in other groups. [ABSTRACT FROM AUTHOR]

Background: The term 'last mile' has been used across disciplines to refer to populations who are farthest away, most difficult to reach, or last to benefit from a program or service. However, last mile research lacks a shared understanding around its conceptualization. Objectives: This project used a concept mapping process to answer the questions: what is last mile research in global health and, how can it be used to make positive change for health equity in the last mile? Methods: Between July and December 2019, a five-stage concept mapping exercise was undertaken using online concept mapping software and an in-person consensus meeting. The stages were: establishment of an expert group and focus prompt; idea generation; sorting and rating; initial analysis and final consensus meeting. Results: A group of 15 health researchers with experience working with populations in last mile contexts and who were based at the Matariki Network institutions of Queen's University, CAN and Dartmouth College, USA took part. The resulting concept map had 64 unique idea statements and the process resulted in a map with five clusters. These included: (1) Last mile populations; (2) Research methods and approaches; (3) Structural and systemic factors; (4) Health system factors, and (5) Broader environmental factors. Central to the map were the ideas of equity, human rights, health systems, and contextual sensitivity. Conclusion: This is the first time 'last mile research' has been the focus of a formal concept mapping exercise. The resulting map showed consensus about who last mile populations are, how research should be undertaken in the last mile and why last mile health disparities exist. The map can be used to inform research training programs, however, repeating this process with researchers and members from different last mile populations would also add further insight. [ABSTRACT FROM AUTHOR]

The value of social science research lies within the development and implementation of study designs that adequately address complex research questions. This not only relates to the sampling strategies employed, but also the quality and applicability of the research team and associated networks. In this paper, we demonstrate the importance of involving a diverse study team in our community-based participatory action research study on homelessness in Durban, South Africa. We focus specifically on the usefulness of involving advisory networks in our study, which consisted of stakeholders from diverse backgrounds. The diversity in our advisory networks emerged as critically important in the co-designing and implementation of our research. Each network offered unique contributions to the study design which enhanced the credibility of our study. We also found that the advisory networks facilitated cross-sector collaboration and knowledge sharing through the establishment of targeted task teams. Given this, the design and implementation of future studies with marginalised populations can be strengthened by involving advisory networks from the inception phase of the project. This paper thus expands the methodological scholarship on advisory networks, which can be transferred to all studies that are interested in adopting a multi-voiced approach to social science research. [ABSTRACT FROM AUTHOR]

Background: Migrant populations are among the hardest to reach for research purposes. Methods: An interdisciplinary research team piloted a modified version of Boal's simultaneous dramaturgy with Roma mothers in Belfast. Results: The technique, based on scripted performances, translations, and discussions, proved effective for engaging with this hard-to-reach population, despite low levels of literacy, high language barriers, and cultural separateness. The approach uncovered attitudes to pregnancy which reinforce health inequalities, and present significant challenges for improving the health of marginalized populations. Conclusions: This pilot underlines the importance of building trust through holistic approaches to working with hard-to-reach populations through the creative arts. [ABSTRACT FROM AUTHOR]

Individuals, particularly those considered "hard-to-reach," often engage well with assessment tools that involve active dialogue and the co-construction of knowledge. Strengths profiling is one such tool that enables a person-centered and autonomy supportive approach to the identification of character strengths. Strength profiling is an adaptation of performance profiling used in sport psychology, which has not yet been utilized in broader psychological research or clinical practice. Supporting an individual by raising awareness of their personal character strengths is an effective and growing mechanism for promoting psychological well-being. Strengths profiling involves several stages of exploring, defining, and assessing character strengths, leading to the identification of signature strengths and goals for future development. Informed by personal construct theory, the present study explored the experiences of homeless young people living in sheltered accommodation (N = 116), when using strengths profiling at the start and end of a 10-week, strengths-based intervention. Mixed-method data was obtained from the strengths profiles, questionnaires measuring resilience, self-worth, and well-being, and diary entries. Findings revealed a rich array of character strength terminology and individual meanings. Participants found strengths profiling to be highly engaging, particularly due to their active role in strength identification, which prompted interesting and meaningful reflections on character strengths that were pertinent to them. Participants felt their signature strengths were vital protective factors within their lives and strengths profiles were correlated with resilience, self-worth, and well-being. Character strengths and resilience were also significantly and meaningfully improved pre/post-intervention, providing support for the use of strengths profiling as a tool for monitoring change in character strength perceptions. Overall, this study demonstrates the utility and versatility of strengths profiling as a new method in the discipline of positive psychology and strengths-based research and applied practice. [ABSTRACT FROM AUTHOR]

Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effectiveness of different recruitment strategies used in a study aimed at eliminating/reducing second-hand smoke (SHS) exposure in Dutch children 0-13 years of age with a high risk of asthma.Methods: The different strategies include: 1) questionnaires distributed via home addresses, physicians or schools of the children; 2) cohorts from other paediatric studies; 3) physicians working in the paediatric field (family physicians, paediatricians and Youth Health Care (YHC) physicians); and 4) advertisements in a local newsletter, at child-care facilities, and day-care centres.Results: More than 42,782 families were approached to take part in the screening of which 3663 could be assessed for eligibility. Of these responders, 196 families met the inclusion criteria for the study. However, only 58 (one third) could be randomised in the trial, mainly because of no interest or time of the parents. The results showed that recruiting families who expose their children to SHS exposure is very challenging, which may be explained by lack of 'recognition' or awareness that SHS occurs in homes. The presence of asthma in the family, respiratory symptoms in the children, and even incentives did not increase parental motivation for participation in the study.Conclusions: The recruitment process for an intervention program addressing SHS exposure in children was considerably more challenging and time consuming than anticipated. Barriers at both a parents level and a doctor's level can be discriminated. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this research is to understand how low-income, ethnically diverse, Medicaid recipients read, interpret and use culturally tailored health communications, specifically health plan report cards and health intervention/wellness program recruitment materials.Design/methodology/approach The paper reports two exploratory studies on message design. Researchers considered 12 focus groups for Study 1, consisting of 51 African-American, Hispanic and non-Hispanic White men and women who were enrolled in Medicaid and had a behavioral health diagnosis and a chronic disease. Researchers considered 22 focus groups for Study 2, consisting of 102 Hispanic, African-American and non-Hispanic White women enrolled in Medicaid.Findings The paper provides qualitative insights into how underserved populations interpret the visual and verbal aspects of health communications. Key findings include problems with cultural tailoring and monetary incentives for health improvement program participation, message components that show respect and are more likely to be read, how visuals can expand verbal messages and provide symbolic models and specifics on the desired image content.Research limitations/implications Because of the qualitative approach, the research results may lack generalizability. Thus, researchers suggest conducting quantitative studies to test these findings.Practical implications The paper includes implications for the development of powerful verbal and visual messaging for underserved populations. Additionally, the findings suggest a need to include emotional response in health communication theories and to incorporate visual communication theories in message design studies.Originality/value Research on health communication with underserved populations is limited, yet these populations have higher incidences of death and disability from disease. This paper fulfills a need to discover best health communication practices with underserved populations. [ABSTRACT FROM AUTHOR]

Background Offenders on probation are considered to be 'hard to reach' by researchers because probation is a 'closed setting' and engaging offenders in research can be problematic due to issues such as return to custody and chaotic lifestyles. Aim To share learning about the challenges encountered when undertaking research with offenders on probation in the UK, strategies for overcoming them and the implications for research design and outcomes. Discussion The authors identify challenges in gaining and maintaining access; recruitment; ethics; data collection and analysis; and dissemination of findings. They also consider the implications of these challenges for research design and outcomes. Conclusion Engaging offenders in research takes time and effort to gain and maintain access. Researchers need to be persistent and flexible. The potential influence of gatekeepers on recruitment and outcomes is critical and constant communication needs to be maintained. When designing and resourcing projects, researchers must consider the transient nature of the population as well as the need to communicate any potential limits of confidentiality. Implications for practice The lessons learned will be helpful for future research in this field, which is needed to provide data for healthcare commissioners to inform the provision of patient-centred care for this vulnerable and hard-to-reach population. [ABSTRACT FROM AUTHOR]

Although research with hard‐to‐reach populations is necessary to deepen the social work knowledge base and improve services to these groups, recruiting members of hard‐to‐reach populations for research projects is often a challenging process. Frequently, non‐probability sampling is used to obtain participants. However, the difficulties and limitations associated with this process in quantitative research are rarely discussed in depth in the literature. Sampling issues can significantly impact a research project, delaying it, extending it or even causing the premature termination of a project. Challenges to recruitment can limit the type of research that is completed, impact the knowledge base or introduce threats to validity through sampling bias. Using a preliminary quantitative study on parental engagement with child protective services as an illustration for the discussion, the challenges of non‐probability sampling with a hard‐to‐reach population and the implications for research practice are explored and discussed. Implications for future research practice are considered. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the impact of a client-centered behavioral intervention (Brief Negotiated Interviewing) on mothers’ human papillomavirus (HPV) vaccine knowledge and vaccination initiation for their adolescent daughters. Methods. We randomized mothers to intervention (n = 100) and control (n = 100) groups, and followed them over 12 months. Electronic medical records were reviewed to determine vaccination status. The primary outcome was receipt of the first vaccine. The secondary outcome was HPV vaccine knowledge among mothers. Results. Brief Negotiated Interviewing intervention mothers demonstrated increased knowledge about HPV (pre/post mean score of 5 to 10 out of a possible 11; P < .001) and significantly higher mean knowledge scores (10 vs 6, P < .001) than control mothers. However, initiation and completion rates of the vaccine were not significantly different between groups. Conclusions. Increasing HPV vaccine knowledge did not translate into increased vaccine uptake or completion of vaccination series. Future intervention must explore vaccine reminders to increase HPV vaccination rates. [ABSTRACT FROM AUTHOR]

Collecting data from hard-to-reach populations is a key challenge for research on poverty and other forms of extreme disadvantage. With data from the Boston Reentry Study (BRS), we document the extreme marginality of released prisoners and the related difficulties of study retention and analysis. Analysis of the BRS data yields three findings. First, released prisoners show high levels of "contact insecurity," correlated with social insecurity, in which residential addresses and contact information change frequently. Second, strategies for data collection are available to sustain very high rates of study participation. Third, survey nonresponse in highly marginal populations is strongly nonignorable, closely related to social and economic vulnerability. The BRS response rate of 94% over a 1-y follow-up period allows analysis of hypothetically high nonresponse rates. In this setting, nonresponse attenuates regression estimates in analyses of housing insecurity, drug use, and unemployment. These results suggest that in the analysis of very poor and disadvantaged populations, methods that maximize study participation reduce bias and yield data that can usefully supplement large-scale household or administrative data collections. [ABSTRACT FROM AUTHOR]

Background: Significant progress has been made in reducing the malaria burden in the Asia Pacific region, which is aggressively pursuing a 2030 regional elimination goal. Moving from malaria control to elimination requires National Malaria Control Programmes (NMCPs) to target interventions at populations at higher risk, who are often not reached by health services, highly mobile and difficult to test, treat, and track with routine measures, and if undiagnosed, can maintain parasite reservoirs and contribute to ongoing transmission. Methods: A qualitative, free-text questionnaire was developed and disseminated among 17 of the 18 partner countries of the Asia Pacific Malaria Elimination Network (APMEN). Results: All 14 countries that responded to the survey identified key populations at higher risk of malaria in their respective countries. Thirteen countries engage in the dissemination of malaria-related Information, Education, and Communication (IEC) materials. Eight countries engage in diagnostic screening, including of mobile and migrant workers, military staff, and/or overseas workers. Ten countries reported distributing or recommending the use of long-lasting insecticide-treated nets (LLINs) among populations at higher risk with fewer countries engaging in other prevention measures such as indoor residual spraying (IRS) (two countries), spatial repellents (four countries), chemoprophylaxis (five countries), and mass drug administration (MDA) (three countries). Though not specifically tailored to populations at higher risk, 11 countries reported using mass blood surveys as a surveillance tool and ten countries map case data. Most NMCPs lack a monitoring and evaluation structure. Conclusion: Countries in the Asia Pacific have identified populations at higher risk and targeted interventions to these groups but there is limited information on the effectiveness of these interventions. Platforms like APMEN offer the opportunity for the sharing of protocols and lessons learned related to finding, targeting and successfully clearing malaria from populations at higher risk. The sharing of programme data across borders may further strengthen national and regional efforts to eliminate malaria. This exchange of real-life experience is invaluable to NMCPs when scarce scientific evidence on the topic exists to aid decision-making and can further support NMCPs to develop strategies that will deliver a malaria-free Asia Pacific by 2030. [ABSTRACT FROM AUTHOR]

Objective: Sex trafficking is a pressing issue in Ohio-a major node in national sex trafficking networks; however, no quantitative analysis of risk factors specific to Ohio victims has been conducted. Method: Using a survey conducted by the Ohio Human Trafficking Commission representing Ohio urban, street-based sex workers (N = 328), this study uses a life-course theory framework to identify and measure the effect of direct risk factors on domestic minor and adult sex-trafficking outcomes using multivariate logistic regressions. Variables of specific interest include peer influence, experiences during transience, prior minor victimization, and a lack of support while attempting to escape. Results: Survival sex and peer influence increase the odds of minor victimization, and a lack of available support and resources for victims while attempting to escape significantly increase the odds of adult victimization. Conclusion: This analysis produces a better understanding of risk factors facing Ohio's sex trafficking victims and provides broader insights about the determinants of domestic sex trafficking. In addition, these results have been used in a report to an Ohio Senate Caucus promoting a federal bill regarding missing children. [ABSTRACT FROM AUTHOR]

Long-haul truck drivers and members of their social networks in urban locales constitute a hard-to-reach population at risk for acquiring and disseminating STIs/HIV. This paper focuses on the unique logistical, methodological, and ethical challenges faced by population health scientists while studying long-haul truck drivers and members of their sexual networks in inner-city neighborhoods of a major US metropolitan center and the innovative strategies developed to overcome the challenges. Formative research and focus groups with several trucker-centered populations (N = 28) led to in-depth interviews and serologies with 60 truck drivers and 24 sexworkers. Various difficulties encountered by the research team are discussed, followed by strategies devised to overcome them. [ABSTRACT FROM AUTHOR]

Certain social groups are often difficult for researchers to access because of their social or physical location, vulnerability, or otherwise hidden nature. This unique review article based on both the small body of relevant literature and our own experiences as researchers is meant as a guide for those seeking to include hard-to-reach, hidden, and vulnerable populations in research. We make recommendations for research process starting from early stages of study design to dissemination of study results. Topics covered include participant mistrust of the research process; social, psychological, and physical risks to participation; participant resource constraints; and challenges inherent in nonprobability sampling, snowball sampling, and derived rapport. This article offers broadly accessible solutions for qualitative researchers across social science disciplines attempting to research a variety of different populations. [ABSTRACT FROM AUTHOR]

Time-location sampling (TLS), also called time-space sampling or venue-based sampling is a sampling technique widely used in populations at high risk of infectious diseases. The principle is to reach individuals in places and at times where they gather. For example, men who have sex with men meet in gay venues at certain times of the day, and homeless people or drug users come together to take advantage of services provided to them (accommodation, care, meals). The statistical analysis of data coming from TLS surveys has been comprehensively discussed in the literature. Two issues of particular importance are the inclusion or not of sampling weights and how to deal with the frequency of venue attendance (FVA) of individuals during the course of the survey. The objective of this article is to present TLS in the context of sampling theory, to calculate sampling weights and to propose design-based inference taking into account the FVA. The properties of an estimator ignoring the FVA and of the design-based estimator are assessed and contrasted both through a simulation study and using real data from a recent cross-sectional survey conducted in France among drug users. We show that the estimators of prevalence or a total can be strongly biased if the FVA is ignored, while the design-based estimator taking FVA into account is unbiased even when declarative errors occur in the FVA. [ABSTRACT FROM AUTHOR]

Policy researchers face a range of pressures to incorporate the perspectives of ‘hard-to-reach’ groups in their research. In the specific case of public involvement policy in health (one example of the growing field of citizen participation initiatives in administrative contexts), researchers have struggled to accomplish this without compelling research participants to enter into a policy discourse that is unfamiliar and may be at odds with their self-understood roles as patients and citizens. This paper presents findings from an interpretive project which sought to understand the perspectives of young adults on local practices of public involvement in a socio-economically deprived area of Scotland. It recounts the researcher’s shifting standpoint in response to silences and absences within young adults’ reaction to the project, and argues that the everyday ‘tactics’ young adults described using in their interactions with health services be reimagined as relevant, albeit challenging forms of citizen participation. [ABSTRACT FROM PUBLISHER]

Respondent-driven sampling (RDS) is a widely used method for sampling from hard-to-reach human populations, especially populations at higher risk for human immunodeficiency virus or acquired immune deficiency syndrome. Data are collected through a peer referral process over social networks. RDS has proven practical for data collection in many difficult settings and has been adopted by leading public health organizations around the world. Unfortunately, inference from RDS data requires many strong assumptions because the sampling design is partially beyond the control of the researcher and not fully observable. We introduce diagnostic tools for most of these assumptions and apply them in 12 high risk populations. These diagnostics empower researchers to understand their RDS data better and encourage future statistical research on RDS sampling and inference. [ABSTRACT FROM AUTHOR]

The use of personal names for screening is an increasingly popular sampling technique for migrant populations. Although this is often an effective sampling procedure, very little is known about the properties of this method. Based on a large German survey, this article compares characteristics of respondents whose names have been correctly classified as belonging to a migrant population with respondentswho aremigrants and whose names have not been classified as belonging to a migrant population. Although significant differences were found for some variables even with some large effect sizes, the overall bias introduced by name-based sampling (NBS) is small as long as procedures with small false-negative rates are employed. [ABSTRACT FROM AUTHOR]

As part of a large sexual health study, we used two different approaches to target Sexual Minority Individuals (SMIs). Firstly, we drew on a probability sample (1,832 respondents aged 14-80) of the Flemish population in Belgium. Secondly, we set up a targeted sampling design followed by an Internet survey. Our focus was to explore how two different sampling procedures and survey designs could lead to differences in sample characteristics. Results showed that for female SMIs (we excluded male SMIs from the analyses due to their low numbers) the population sample differed from the Internet sample in terms of sociodemographic characteristics (the latter included younger and more highly educated respondents) and scores on sexual orientation dimensions (the population sample included more respondents who didn't identify as lesbian or bisexual but reported same-sex sexual experiences and desire). Respondents' scores on sexual health indicators differed between the samples for two of the seven variables. We discuss implications for improving the quality and validity of nonrandom samples. [ABSTRACT FROM AUTHOR]

Human trafficking has long-lasting implications for the well-being of trafficked people, families, and affected communities. Prevention and intervention efforts, however, have been stymied by a lack of information on the scale and scope of the problem. Because trafficked people are mostly hidden from view, traditional methods of establishing prevalence can be prohibitively expensive in the recruitment, participation, and retention of survey participants. Also, trafficked people are not randomly distributed in the general population. Researchers have therefore begun to apply methods previously used in public health research and other fields on hard-to-reach populations to measure the prevalence of human trafficking. In this topical review, we examine how these prevalence methods used for hard-to-reach populations can be used to measure the prevalence of human trafficking. These methods include network-based approaches, such as respondent-driven sampling and the network scale-up method, and venue-based methods. Respondent-driven sampling is useful, for example, when little information about the trafficked population has been produced and when an adequate sampling frame does not exist. The network scale-up method is unique in that it does not target the hidden population directly. The implications of our work internationally include the need for documenting and validating the various prevalence estimation methods in the United States in a more robust way than was done in existing efforts. In providing this roadmap for estimating the prevalence of human trafficking, our overarching goal is to promote the equitable treatment and overall well-being of the socially disadvantaged populations who disproportionately experience human trafficking. [ABSTRACT FROM AUTHOR]

For studies using respondent driven sampling (RDS), the current practice of collecting a sample twice as large as that used in simple random sampling (SRS) (i.e. design effect of 2.00) may not be sufficient. This paper provides empirical evidence of sample-to-sample variability in design effects using data from nine studies in six countries among injecting drug users, female sex workers, men who have sex with men and male-to-female transgender (MTF) persons. We computed the design effect as the variance under RDS divided by the variance under SRS for a broad range of demographic and behavioral variables in each study. We also estimated several measures for each variable in each study that we hypothesized might be related to design effect: the number of waves needed for equilibrium, homophily, and mean network size. Design effects for all studies ranged from 1.20 to 5.90. Mean design effects among all studies ranged from 1.50 to 3.70. A particularly high design effect was found for employment status (design effect of 5.90) of MTF in Peru. This may be explained by a 'bottleneck'-defined as the occurrence of a relatively small number of recruitment ties between two groups in the population. A design effect of two for RDS studies may not be sufficient. Since the mean design effect across all studies was 2.33, an effect slightly above 2.00 may be adequate; however, an effect closer to 3.00 or 4.00 might be more appropriate. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of providing education on breast, cervical and cardiovascular health to hard-to-reach women throughout Massachusetts using an innovative derivation of the ‘train-the-trainer’ approach. Innovation included use of contracts with community-based organizations (CBOs) that required data collection in return for payment.Design: Quantitative and qualitative evaluation.Setting: Hard-to-reach women throughout Massachusetts.Methods: Contracted with CBOs to conduct educational sessions on breast, cervical, and cardiovascular health using a standardized curriculum. Collected and analyzed quantitative data from 2,526 women educated by CBOs to assess the programme’s reach and effectiveness. Interviewed staff involved in programme implementation and conducted focus groups with women educated to identify programme successes and areas for improvement.Results: Thirty-three unique CBOs conducted 264 educational sessions, educating 2,526 women in one or more units (breast, cervical, or cardiovascular health) of the Helping You Take Care of Yourself curriculum. Quantitative data were obtained to assess programme effectiveness and the curriculum successfully increased knowledge for all health units. Qualitative evaluation identified several factors that contributed to the success of the programme, including: establishing relationships with CBOs that had existing ties in target communities; executing memoranda of understanding that required data collection for payment; developing curriculum toolkits and intensive staff training; and delivering education in small group settings.Conclusion: The innovative structure of implementation of a ‘train-the-trainer’ approach allowed for expanded reach of the health education curriculum, educating more than 2,000 hard-to-reach women. The strategies employed can be applied to other health education programmes. [ABSTRACT FROM PUBLISHER]

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The article presents a study which aims to overcome the challenges in accessing hired farm workers with the use of the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study sample. It describes the MICASA study which investigates the occupational and environmental health risks in the households of farm workers in Mendota, California. It compares the results of the MICASA study with the findings of the California Health Interview Survey (CHIS).

In health-communication research, participants who are disproportionately affected by health disparities are often 'hard-to-reach,' making them difficult to identify for formative research. This study used communication infrastructure theory (CIT) to create a strategy for locating a specific subset of residents-those who use 911 for healthcare-within a low-income Atlanta community. Findings suggest the need for strategies that involve employing both the communication channels that are part of the neighborhood storytelling network and the community's discursive spaces, more specifically the communication hot spots and community comfort zones located within the community's built environment. [ABSTRACT FROM AUTHOR]