Conducting Health Literacy Research with Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: An Evaluation of Recruitment and Retention Methods Before and During COVID-19.

Perrins, Genevieve; Ferdous, Tabassum; Hay, Dawn; Harreveld, Bobby; Reid-Searl, Kerry

BACKGROUND Culturally and linguistically diverse (CALD) health care consumers residing within Australia are recognized as having low health literacy, leading to increased hospitalizations and poorer health outcomes. Despite the need to research the relationship between cultural and linguistic diversity and health literacy, CALD participants are often cited as hard-to-reach or hidden. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place in 2020, the COVID-19 pandemic and subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considers the effectiveness of recruitment and data collection methods used throughout pre-COVID and during-COVID periods. OBJECTIVE This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers, during a study which targeted regional-dwelling, hard-to-reach CALD participants. METHODS In this paper, recruitment and retention methods have been categorized into five phases: recruitment, pre-intervention data collection, intervention, post-intervention data collection and interviews. To compare the methods used by researchers, recruitment and retention rates have been dissected into pre-COVID and during-COVID periods. Thereafter in-depth reflections of the methods employed within this study are presented. RESULTS This paper provides results relating to participant recruitment and retainment over the course of five research phases which occurred pre- and during-COVID. During the pre-COVID recruitment phase 22 participants were recruited. Of those, 15 (68.2%) of participants transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72.2%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93.3% (14 of 15) versus 84.6% (11 of 13) during-COVID. Lastly, 92.9% (13 of 14) of participants completed the post-intervention data collection in the pre-COVID period, compared with 90.9% (10 of 11) during-COVID. In total, 40 participants took part in the initial data collection phase, with 23 (57.5%) completing the five research phases. Due to a small sample size, it was not determined if there was any statistical significance between the groups (pre-COVID and during-COVID). CONCLUSIONS The success of this program in recruiting and maintaining regional-dwelling, hard-to-reach CALD populations was preserved over pre and during-COVID periods. The pandemic required researchers adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, use of digital platforms and more. The major findings of this evaluation are twofold. Firstly, increased diversity in the research sample requires a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Secondly, community organizations present a valuable opportunity to connect with potential hard-to-reach research participants. CLINICALTRIAL