Underserved, Recruitment, Hard-to-Reach, Lesbian, Gay, Transgender, Low Income


‘Hard-to-reach’ is a term primarily used by researchers to describe groups of people who have been historically difficult to find or contact. It is important for the public interest to include hard-to-reach groups in research because excluding certain sub-populations diminishes the ability to identify groups that potentially have the highest burden of illness and to develop an understanding of why group differences exist. Thus, the purposes of this paper are to: 1) describe the challenges in recruiting hard-to-reach population in two separate research studies; 2) discuss the strategies that were used to overcome those challenges; and 3) provide recommendations for researchers. This paper followed a case study research strategy, with the authors using two of their own research studies involving hard-to-reach populations as case studies. The research studies used in these case studies involved two different hard-to-reach groups—low-income ethnic minorities who were un- or under-insured and lesbian or bisexual women and transgender men. Two overarching themes were identified as barriers to reaching the population of interest: (1) gaining interest and (2) building trust. These themes add to the literature regarding the multi-prong approach that is needed to recruit members of hard-to-reach populations. Despite the authors having buy-in from stakeholders and a multi-prong recruiting approach, barriers to gaining the interest of potential participants included language in recruitment flyers, competing demands for time, and transportation to the data collection site. Building trust with interested study participants was also a large issue noted between both studies, especially concerning sensitive questions or cultural barriers regardless of the reliability and validity of the tools used in the study.