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© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. 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.

Background In response to a cholera outbreak among mobile, difficult-to-reach fishermen on Lake Chilwa, Malawi in 2016, a novel vaccine distribution strategy exploited the proven vaccine thermostability. Fishermen, while taking the first vaccine dose under supervision, received the second dose in a sealed bag, and were told to drink it two weeks later. This study assessed short-term vaccine protection of this strategy. Methods Patients with diarrhoea admitted to health facilities around lake were interviewed and a stool sample collected for PCR testing. Vaccine effectiveness was assessed in a case-control test-negative design by comparing cases (PCR-positive for V. cholerae O1) and controls (patients with diarrhoea but PCR-negative) and with the screening method that compared the proportions of vaccinated among cholera cases versus the general fishermen population. Results Of 145 study participants, 120 were fishermen living on the lake. Vaccine effectiveness at three-months was 90.0% [95% CI: 38.8; 98.4] among fishermen and 83.3% [95% CI: 20.8; 96.5] among all participants in the case-control test-negative design, and 97.5% [95% CI: 90.9; 99.3] with the screening method. Conclusion This strategy was effective in providing short-term protection in fishermen against cholera. Further research is needed to determine the adding value of the second dose and to identify the optimal vaccination strategies for different contexts.

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

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.

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.