Sampling 'hard-to-reach' populations in health research: yield from a study targeting Americans living in Canada.
BACKGROUND
Some populations targeted in survey research can be hard to reach, either because of lack of contact information, or non-existent databases to inform sampling. Here, we present a methodological "case-report" of the yield of a multi-step survey study assessing views on health care among American emigres to Canada, a hard-to-reach population.


METHODS
To sample this hard-to-reach population, we held a live media conference, supplemented by a nation-wide media release announcing the study. We prepared an 'op-ed' piece describing the study and how to participate. We paid for advertisements in 6 newspapers. We sent the survey information to targeted organizations. And lastly, we asked those who completed the web survey to send the information to others. We use descriptive statistics to document the method's yield.


RESULTS
The combined media strategies led to 4 television news interviews, 10 newspaper stories, 1 editorial and 2 radio interviews. 458 unique individuals accessed the on-line survey, among whom 310 eligible subjects provided responses to the key study questions. Fifty-six percent reported that they became aware of the survey via media outlets, 26% by word of mouth, and 9% through both the media and word of mouth.


CONCLUSIONS
Our multi-step communication method yielded a sufficient sample of Americans living in Canada. This combination of paid and unpaid media exposure can be considered by others as a unique methodological approach to identifying and sampling hard-to-reach populations.
Southern
Danielle A
DA
Centre for Health and Policy Studies & Dept, of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada. dasouthe@ucalgary.ca
Lewis
Steven
S
Maxwell
Colleen J
CJ
Dunn
James R
JR
Noseworthy
Tom W
TW
Corbett
Gail
G
Thomas
Karen
K
Ghali
William A
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology*; D002170:Canada; D003627:Data Interpretation, Statistical; D003695:Delivery of Health Care; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States / Q000208:ethnology