title: A qualitative analysis of peer recruitment pressures in respondent driven sampling: Are risks above the ethical limit?
abstract: BACKGROUND
  This paper examines peer recruitment dynamics through respondent driven sampling (RDS) with a sample of injection drug users in Hartford, CT to understand the strategies participants use to recruit peers into a study and the extent to which these strategies may introduce risks above the ethical limit despite safeguards in RDS.
  
  
  METHODS
  Out of 526 injection drug users who participated in a mixed-method RDS methodology evaluation study, a nested sample of 61 participants completed an in-depth semi-structured interview at a 2-month follow-up to explore their experiences with the recruitment process.
  
  
  RESULTS
  Findings revealed that participants used a variety of strategies to recruit peers, ranging from one-time interactions to more persistent strategies to encourage participation (e.g., selecting peers that can easily be found and contacted later, following up with peers to remind them of their appointment, accompanying peers to the study site, etc.). Some participants described the more persistent strategies as helpful, while some others experienced these strategies as minor peer pressure, creating a feeling of obligation to participate. Narratives revealed that overall, the probability of experiencing study-related risks remains relatively low for most participants; however, a disconcerting finding was that higher study-related risks (e.g., relationship conflict, loss of relationship, physical fights, violence) were seen for recruits who participated but switched coupons or for recruits who decided not to participate in the study and did not return the coupon to the recruiter.
  
  
  CONCLUSIONS
  Findings indicate that peer recruitment practices in RDS generally pose minimal risk, but that peer recruitment may occasionally exceed the ethical limit, and that enhanced safeguards for studies using peer recruitment methods are recommended. Suggestions for possible enhancements are described.
authors.affiliation: Institute for Community Research, 2 Hartford Square West, 146 Wyllys Street, Hartford, CT 06106-5128, United States. Electronic address: heather.mosher@icrweb.org.
authors.forename: Heather I
authors.initials: HI
authors.lastname: Mosher
authors.affiliation: Institute for Community Research, 2 Hartford Square West, 146 Wyllys Street, Hartford, CT 06106-5128, United States.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Moorthi
authors.affiliation: Institute for Community Research, 2 Hartford Square West, 146 Wyllys Street, Hartford, CT 06106-5128, United States.
authors.forename: JiangHong
authors.initials: J
authors.lastname: Li
authors.affiliation: Institute for Community Research, 2 Hartford Square West, 146 Wyllys Street, Hartford, CT 06106-5128, United States.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Weeks
mesh_terms: D000293:Adolescent; D000328:Adult; D055030:Drug Users / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018579:Patient Selection / Q000941:ethics*; D010379:Peer Group; D012494:Sampling Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
keywords: Injection drug use; Peer recruitment; Qualitative; Research ethics; Respondent driven sampling