title: Strategies for moving towards equity in recruitment of rural and Aboriginal research participants.
abstract: BACKGROUND
  Equitable recruitment strategies, designed to ensure improved opportunities to participate in the research, are needed to include First Nations (FN) communities. The purpose of this article is to report on a set of successful strategies trialed with rural and FN communities in Canada. The strategies discussed were designed as part of a larger mixed-method study examining the effectiveness of Group Medical Visits (GMVs) on the quality of primary healthcare (PHC) in both FN reserve and northern communities in British Columbia (BC).
  
  
  METHODS
  Community partners and the study's decision-maker partners helped to identify and recruit primary care practices and reserve communities who were offering GMVs. Eleven communities (6 rural and 5 FN reserve) within the Northern Health Authority, BC participated in the study. Participants completed a survey either in person or via telephone. Content analysis was conducted on team meeting and field notes, focusing on issues related to the data collection process. Financial analysis was conducted on monetary resources spent on recruitment efforts in the various communities. Data were recorded regarding the number of times potential participants were contacted and mode of interview. Descriptive statistics were used to examine whether there were differences by mode of data collection, gender, and FN status. Logistic regression was used to examine whether FN status remained statistically significant after controlling for sex, education, employment status, age and health status.
  
  
  RESULTS
  Once people were contacted, participation rate was 68% with 269 (n=90 men, n=179 women) people. Of those who participated in the survey, 42% were from FN communities. Content analysis revealed two overarching categories: (1) communication and coordination of the geographically dispersed research team and participating communities was maintained using synchronous and asynchronous methods; and (2) flexibility was needed to tailor recruitment strategies. Financial resources required to achieve equitable recruitment across these communities can cost up to 17 times more than travel to sites accessible by a direct flight or car. The farther away from Prince George (BC's capital in the north), the more resources were needed to ensure equitable recruitment from a community. Community partners played a critical role in recruiting potential participants. Team members, particularly those from urban areas, require support to successfully navigate working in small northern communities.
  
  
  CONCLUSIONS
  Achieving equity in recruitment requires flexibility, trusting partnerships within each community and regular communication among the research team. A significant portion of time and resources needs to be allocated towards travel to these communities. While achieving equity in recruiting research participants poses a number of challenges, including greater costs, research that ensures participation opportunities for rural and FN communities is likely to better inform effective strategies to meet the needs of these communities.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada. sabrina.wong@mail.ubc.ca
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Wong
authors.forename: Leena
authors.initials: L
authors.lastname: Wu
authors.forename: Brooke
authors.initials: B
authors.lastname: Boswell
authors.forename: Laura
authors.initials: L
authors.lastname: Housden
authors.forename: Josee
authors.initials: J
authors.lastname: Lavoie
mesh_terms: D000328:Adult; D035843:Biomedical Research; D002170:Canada; D055812:Community-Based Participatory Research; D005260:Female; D006123:Group Practice; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D018579:Patient Selection; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult