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      Barriers and recruitment strategies for precarious status migrants in Montreal, Canada

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          Abstract

          Background

          Precarious status migrants are a group of persons who are vulnerable, heterogeneous, and often suspicious of research teams. They are underrepresented in population-based research projects, and strategies to recruit them are described exclusively in terms of a single cultural group. We analyzed the recruitment strategies implemented during a research project aimed at understanding precarious status migrants’ health status and healthcare access in Montreal, Canada. The research sample consisted of 854 persons recruited from a variety of ethnocultural communities between June 2016 and September 2017. This article analyzes the strategies implemented by the research team to respond to the challenges of that recruitment, and assess the effectiveness of those strategies. Based on the results, we share the lessons learned with a view to increasing precarious status migrants’ representation in research.

          Method

          A mixed sequential design was used to combine qualitative data gathered from members of the research team at a reflexive workshop ( n = 16) and in individual interviews ( n = 15) with qualitative and quantitative data collected using the conceptual mapping method ( n = 10).

          Results

          The research team encountered challenges in implementing the strategies, related to the identification of the target population, the establishment of community partnerships, and suspicion on the part of the individuals approached. The combination of a venue-based sampling method, a communications strategy, and the snowball sampling method was key to the recruitment. Linking people with resources that could help them was useful in obtaining their effective and non-instrumental participation in the study. Creating a diverse and multicultural team helped build trust with participants. However, the strategy of matching the ethnocultural identity of the interviewer with that of the respondent was not systematically effective.

          Conclusion

          The interviewers’ experience and their understanding of the issue are important factors to take into consideration in future research. More over, the development of a community resource guide tailored to the needs of participants should be major components of any research project targeting migrants. Finally, strategies should be implemented as the result of a continuous reflexive process among all members of the research team.

          Electronic supplementary material

          The online version of this article (10.1186/s12874-019-0683-2) contains supplementary material, which is available to authorized users.

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          Most cited references51

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          A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders.

          To assess the experienced or perceived barriers and facilitators to health research participation for major US racial/ethnic minority populations, we conducted a systematic review of qualitative and quantitative studies from a search on PubMed and Web of Science from January 2000 to December 2011. With 44 articles included in the review, we found distinct and shared barriers and facilitators. Despite different expressions of mistrust, all groups represented in these studies were willing to participate for altruistic reasons embedded in cultural and community priorities. Greater comparative understanding of barriers and facilitators to racial/ethnic minorities' research participation can improve population-specific recruitment and retention strategies and could better inform future large-scale prospective quantitative and in-depth ethnographic studies.
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            Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies.

            Researchers have increasingly turned to mixed-method techniques to expand the scope and improve the analytic power of their studies. Yet there is still relatively little direction on and much confusion about how to combine qualitative and quantitative techniques. These techniques are neither paradigm- nor method-linked; researchers' orientations to inquiry and their methodological commitments will influence how they use them. Examples of sampling combinations include criterion sampling from instrument scores, random purposeful sampling, and stratified purposeful sampling. Examples of data collection combinations include the use of instruments for fuller qualitative description, for validation, as guides for purposeful sampling, and as elicitation devices in interviews. Examples of data analysis combinations include interpretively linking qualitative and quantitative data sets and the transformation processes of qualitizing and quantitizing.
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              Recruiting vulnerable populations into research: a systematic review of recruitment interventions.

              Members of vulnerable populations are underrepresented in research studies. To evaluate and synthesize the evidence regarding interventions to enhance enrollment of vulnerable populations into health research studies. Studies were identified by searching MEDLINE, the Web of Science database, personal sources, hand searching of related journals, and article references. Studies that contained data on recruitment interventions for vulnerable populations (minority, underserved, poor, rural, urban, or inner city) and for which the parent study (study for which recruitment was taking place) was an intervention study were included. A total of 2,648 study titles were screened and 48 articles met inclusion criteria, representing 56 parent studies. Two investigators extracted data from each study. African Americans were the most frequently targeted population (82% of the studies), while 46% targeted Hispanics/Latinos. Many studies assessed 2 or more interventions, including social marketing (82% of studies), community outreach (80%), health system recruitment (52%), and referrals (28%). The methodologic rigor varied substantially. Only 40 studies (71%) incorporated a control group and 21% used statistical analysis to compare interventions. Social marketing, health system, and referral recruitment were each found to be the most successful intervention about 35-45% of the studies in which they were attempted, while community outreach was the most successful intervention in only 2 of 16 studies (13%) in which it was employed. People contacted as a result of social marketing were no less likely to enroll than people contacted through other mechanisms. Further work with greater methodologic rigor is needed to identify evidence-based strategies for increasing minority enrollment in research studies; community outreach, as an isolated strategy, may be less successful than other strategies.
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                Author and article information

                Contributors
                fete.margaux@gmail.com
                josephine.aho@umontreal.ca
                magalie.benoit.1@umontreal.ca
                patrick.cloos@umontreal.ca
                valery.ridde@ird.fr
                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central (London )
                1471-2288
                26 February 2019
                26 February 2019
                2019
                : 19
                : 41
                Affiliations
                [1 ]ISNI 0000 0001 2292 3357, GRID grid.14848.31, University of Montreal Public Health Research Institute (IRSPUM), ; Montreal, Canada
                [2 ]ISNI 0000 0001 2292 3357, GRID grid.14848.31, School of Public Health, University of Montreal, ; Montreal, Canada
                [3 ]ISNI 0000 0001 2292 3357, GRID grid.14848.31, School of Social Work, , Faculty of Arts and Sciences, University of Montreal, ; Montreal, Canada
                [4 ]ISNI 0000 0001 2188 0914, GRID grid.10992.33, French Institute for Research on Sustainable Development (IRD), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, ; Paris, France
                [5 ]Fellow de l’Institut Français des Migrations, Paris, France
                Article
                683
                10.1186/s12874-019-0683-2
                6390306
                30808301
                2cc4e9ee-7d0c-422f-9291-22a4993ee219
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 August 2018
                : 14 February 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: MOP142332
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Medicine
                precarious status migrants,recruitment strategies,research method,research participation,hard to reach population

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