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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]

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]

Respondent-driven sampling (RDS) is widely used to sample populations with higher risk of HIV infection for whom no sampling frames exist. However, few studies have been done to assess the reliability of RDS in real world settings. We assessed the reliability of naïve RDS samples using five rounds of the National HIV Behavioral Surveillance – People Who Inject Drugs surveys in Newark, New Jersey from 2005 to 2018. Specifically, we compared the distributions of time-insensitive demographic characteristics in temporally adjacent RDS samples with Monte Carlo Two-Sample Kolmogorov-Smirnov Test with 100,000 replicates. The distributions of time-sensitive demographic characteristics were also compared as sensitivity analyses. The study showed that repeated RDS samples among people who inject drugs in the greater Newark area, New Jersey were reliable in most of time-insensitive demographics and recruitment homophily statistics. Sensitivity analyses of time-sensitive demographics also presented consistencies in most of temporally adjacent samples. In conclusion, RDS has the potential to provide reliable samples, but demographic characteristics of RDS samples may be easily biased by homophily. Future studies using RDS may need to pay more attention to potential homophily bias and consider necessary diagnostic procedures and sample adjustments. [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.

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]

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: 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: 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]

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

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]

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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.

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]

Pediatric schistosomiasis in hard-to-reach communities is poorly understood, hampering tailored interventions. This study investigated the prevalence, intensity, health impact, and risk factors for schistosomiasis in preschool-aged children (PSAC) residing in hard-to-reach areas and populations of Homa Bay County, Kenya. A cross-sectional study was conducted among 476 PSAC aged 2-5 years across 6 islands in Lake Victoria, Homa Bay County, Kenya. Kato-Katz and urine filtration techniques diagnosed Schistosoma mansoni and S. haematobium infections respectively. Fecal occult blood (FOB) was tested to assess morbidity, and questionnaires captured sociodemographic and household water, sanitation, and hygiene data. Logistic regression models explored risk factors. The overall prevalence of S. mansoni was 26.0 %, varying considerably between islands; Ringiti had the highest prevalence (62.1 %), while Sukru had the lowest (7.7 %). No S. haematobium infections were diagnosed. Light infections were most common (15.4 %), followed by moderate (8.5 %) and heavy infections (2.2 %). Significantly increased odds for infection were observed in children aged four (aOR = 4.4, 95 % CI: 1.7-11.2) and five years (aOR = 5.6, 95 % CI: 2.2-14.5), in girls (aOR = 2.5, 95 % CI: 1.3-4.8), and in children living in Ringiti (aOR = 6.1, 95 % CI: 1.8-15.0). We noted a strong association between S. mansoni infection and FOB (aOR= 3.3, 95 % CI: 1.6-7.0). We found a high burden of schistosomiasis among PSAC in hard-to-reach communities of Homa Bay County, emphasizing the urgent need to include them in control programs. FOB could be a promising indicator for assessing schistosomiasis-related morbidity in this age group., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

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 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: 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]

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.

To enumerate people experiencing homelessness in the U.S., the federal Department of Housing and Urban Development (HUD) mandates its designated local jurisdictions regularly conduct a crude census of this population. This Point-in-Time (PIT) body count, typically conducted on a January night by volunteers with flashlights and clipboards, is often followed by interviews with a separate convenience sample. Here, we propose employing a network-based (peer-referral) respondent-driven sampling (RDS) method to generate a representative sample of unsheltered people, accompanied by a novel method to generate a statistical estimate of the number of unsheltered people in the jurisdiction. First, we develop a power analysis for the sample size of our RDS survey to count unsheltered people experiencing homelessness. Then, we conducted three large-scale population-representative samples in King County, WA (Seattle metro) in 2022, 2023, and 2024. We describe the data collection and the application of our new method, comparing the 2020 PIT count (the last visual PIT count performed in King County) to the new method 2022 and 2024 PIT counts. We conclude with a discussion and future directions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

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]

This article reviews methodological barriers to victimological research on vulnerable hard-to-reach populations and presents a reflexive discussion of insider and outsider positions in a study researching Roma communities' victimization in Sweden. As a Roma (Traveler/resande) academic, I found that some aspects of my identity were linked to an insider position, while other aspects of my identity were often perceived by study participants as outsider attributes. Within the framework of critical reflexivity, this article considers the impact of my insider/outsider position at each stage of the research process. The article rearticulates the importance of researcher reflexivity, mainly when both researchers and participants exhibit multiculturality, which has become more common in the globalized world. [ABSTRACT FROM AUTHOR]

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.

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.

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]