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Abstract 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.

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]

Abstract Purpose Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research. Methods This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned. Results Creative strategies to engage hard-to-reach populations in research included considering the participants’ socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants’ preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live. Conclusions Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.

Abstract 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 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.

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: 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]

BackgroundDisseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.ObjectivesTo describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.MethodologyWe consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.ResultsWe included all 30 patients reported during the study period—5, 9, and 16 in 2019, 2020, and 2021 respectively—20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8–30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p

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]

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 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.

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]

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.

This article summarizes the main elements, advantages, and disadvantages of Respondent-driven Sampling (RDS). Some criticisms regarding the feasibility of the inherent assumptions, their point estimators, and the obtained variances are pointed out. This article also comments on the problems observed in the quality of reports. Surveys using RDS should be methodologically sound as they are being applied to define priorities in health programs and develop national and international policies for financing service delivery, among other uses. However, there is considerable potential for bias related to implementation and analytical errors. There is limited empirical evidence on how representative the results obtained by RDS are, and the quest to improve the methodology is still in progress. Nevertheless, to have confidence in RDS results, we must verify that the social structure of the networks conforms to the assumptions required by the theory, that the sampling assumptions are reasonably fulfilled, and that the quality of the report is optimal, particularly for methodological and analytical items.

ObjectiveReport lessons learned in an RCT of Stop My Smoking (SMS) USA, a mHealth smoking cessation program for young adult smokers.Methods164 18-24-year-olds were recruited nationally, online in 2011. Program evaluation data were provided at 12-week post-Quit Day.Results(1) Inviting participants to complete a brief text messaging survey and then asking them to complete a longer online survey resulted in the highest response rate (89%). (2) The positive tone of program messages was the most commonly noted program strength. (3) Suggested improvements included more social connectivity and additional assistance overcoming stressful situations. (4) Half of intervention participants moved through the program linearly and half went through various paths that reflected multiple relapses. Suggestions to use pharmacotherapy resulted in 22% of heavy smokers to utilize it.ConclusionParticipant feedback provided concrete ways in which this and other young adult-focused interventions can improve messaging and program features to be even more salient.Practice implicationsFuture young adult mHealth interventions could: Integrate models that are flexible to different "paths" of behavior change; address stressful life events directly and comprehensively; integrate proactive messaging that promotes pharmacotherapy options; and use text messaging as a gateway to longer online surveys.

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.

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]

Abstract 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.

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.

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]

Existing methods to estimate the prevalence of chronic hepatitis C (HCV) in New York City (NYC) are limited in scope and fail to assess hard-to-reach subpopulations with highest risk such as injecting drug users (IDUs). To address these limitations, we employ a Bayesian multi-parameter evidence synthesis model to systematically combine multiple sources of data, account for bias in certain data sources, and provide unbiased HCV prevalence estimates with associated uncertainty. Our approach improves on previous estimates by explicitly accounting for injecting drug use and including data from high-risk subpopulations such as the incarcerated, and is more inclusive, utilizing ten NYC data sources. In addition, we derive two new equations to allow age at first injecting drug use data for former and current IDUs to be incorporated into the Bayesian evidence synthesis, a first for this type of model. Our estimated overall HCV prevalence as of 2012 among NYC adults aged 20–59 years is 2.78% (95% CI 2.61–2.94%), which represents between 124,900 and 140,000 chronic HCV cases. These estimates suggest that HCV prevalence in NYC is higher than previously indicated from household surveys (2.2%) and the surveillance system (2.37%), and that HCV transmission is increasing among young injecting adults in NYC. An ancillary benefit from our results is an estimate of current IDUs aged 20–59 in NYC: 0.58% or 27,600 individuals. [ABSTRACT FROM AUTHOR]

The quest for integrated care has often been depicted as “crossing the boundaries”, going “beyond silos” or “cutting across” multiple systems, services, providers and settings. More recently, these health system and organization-centred concerns have been complemented with person-centred perspectives that focus on the needs of service users, their families and communities and what matters most for them. This new emphasis implies a new understanding of the scope of responsibilities of care systems: rather than waiting for people to attend the system to receive integrated care, it involves actively seeking those who might need it most and which are usually “hard-to-reach”. Person-centred approach urges systems and services to be more proactive and reach out to those vulnerable populations who are hard-to-reach. The chances of reaching these groups increase when organisations and services from all sectors align, coordinate their actions and work together. EFFICHRONIC: The EU-funded project EFFICHRONIC http://effichronic.eu/ aims to empower vulnerable hard-to-reach patients and caregivers to self-manage their chronic conditions. The project seeks to provide evidence on the positive return of investment and cost-efficiency of the application of the Chronic Disease Self-Management Programme (CDSMP) in different regions of 5 European countries (France, Italy, The Netherlands, Spain and UK) with a particular focus on the health-related, medical, social, cultural and economic factors linked with a higher burden of chronic disorders in Europe. Targeted Population: EFFICHRONIC aims at implementing the CDSMP in those groups of society that are most exposed to the negative effect of the social determinants of health. The EFFICHRONIC project uses the term “vulnerable” to refer to individuals that are not fully socially integrated and risk falling into social exclusion, either due to socio-economic hardship or due to physical or psychological reasons (the chronically ill, the disabled, the frail elderly or people suffering from mental health problems). A total sample of 2000 individuals receives the CDSMP programme. Acknowledgements: The project EFFICHRONIC has received funding from the European Union’s Health Programme (2014-2020) under Grant Agreement 738127. Workshop Programme Outline: We propose short presentations, followed by a half an hour discussion: EFFICHRONIC Overall Project approach: by Marta Pisano and An Boone (DG Public Health, Asturias Regional Government. Spain). 15 minutes The identification of vulnerable groups/individuals in the 5 countries through a multidimensional analysis and stratification methodology (Selfy-Multidimensional Prognostic Index): by Alberto Pilotto (Ente Galliera Hospital. Italy). 10 minutes Intersectoral strategies used to recruit vulnerable populations: by Yves-Marie Pers (Centre Hospitalier Universitaire Montpellier. France).Preliminary results after a year and a half into the EFFICHRONIC project. 10 minutes Project Evaluation framework: Siok-Swan Tan (Erasmus University Medical Centre. The Netherlands). A rigorous methodology, involving 5 different settings will provide evidence on the impact of EFFICHRONIC. 10 minutes Methodology of Internal Quality control: by Barbara Branchini (Polibienestar Research Institute. Spain). 10 minutes Communication and Dissemination: by Graham Edward Baker (Quality Institute for Self-management education and training. UK). 10 minutes Policy recommendations and guidelines to scale up the most effective outreach strategies to other settings in Europe: by Arturo Alvarez. 10 minutes

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]

Background: ‘Hard-to-reach’ is a term used to describe those sub-groups of the populationthat may be difficult to reach or involve in research or public health programmes. Applicationof a single term to call these sub-sections of populations implies a homogeneity within distinctgroups, which does not necessarily exist. Different sampling techniques were introduced sofar to recruit hard-to-reach populations. In this article, we have reviewed a range of approachesthat have been used to widen participation in studies.Methods: We performed a Pubmed and Google search for relevant English language articlesusing the keywords and phrases: (hard-to-reach AND population* OR sampl*), (hidden ANDpopulation* OR sample*) and (“hard to reach” AND population* OR sample*) and a consultationof the retrieved articles’ bibliographies to extract empirical evidence from publicationsthat discussed or examined the use of sampling techniques to recruit hidden or hard-to-reachpopulations in health studies.Results: Reviewing the literature has identified a range of techniques to recruit hard-to-reachpopulations, including snowball sampling, respondent-driven sampling (RDS), indigenousfield worker sampling (IFWS), facility-based sampling (FBS), targeted sampling (TS), timelocation(space) sampling (TLS), conventional cluster sampling (CCS) and capture re-capturesampling (CR).Conclusion: The degree of compliance with a study by a certain ‘hard-to-reach’ group dependson the characteristics of that group, recruitment technique used and the subject of interest.Irrespective of potential advantages or limitations of the recruitment techniques reviewed,their successful use depends mainly upon our knowledge about specific characteristics of thetarget populations. Thus in line with attempts to expand the current boundaries of our knowledgeabout recruitment techniques in health studies and their applications in varying situations,we should also focus on possibly all contributing factors which may have an impact onparticipation rate within a defined population group.

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]

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]

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]