title: Using Participatory Learning & Action research to access and engage with 'hard to reach' migrants in primary healthcare research.
abstract: BACKGROUND
  Communication problems occur in general practice consultations when migrants and general practitioners do not share a common language and culture. Migrants' perspectives have rarely been included in the development of guidelines designed to ameliorate this. Considered 'hard-to-reach' on the basis of inaccessibility, language discordance and cultural difference, migrants have been consistently excluded from participation in primary healthcare research. The purpose of this qualitative study was to address this gap.
  
  
  METHODS
  The study was conducted in the Republic of Ireland, 2009 - 2011. We developed a multi-lingual community-university research team that included seven established migrants from local communities. They completed training in Participatory Learning & Action (PLA) - a qualitative research methodology. Then, as trained service-user peer researchers (SUPERs) they used their access routes, language skills, cultural knowledge and innovative PLA techniques to recruit and engage in research with fifty-one hard-to-reach migrant service-users (MSUs).
  
  
  CONCLUSIONS
  In terms of access, university researchers successfully accessed SUPERs, who, in turn, successfully accessed, recruited and retained MSUs in the study. In terms of meaningful engagement, SUPERs facilitated a complex PLA research process in a language-concordant manner, enabling inclusion and active participation by MSUs. This ensured that MSUs' perspectives were included in the development of a guideline for improving communication between healthcare providers and MSUs in Ireland. SUPERs evaluated their experiences of capacity-building, training, research fieldwork and dissemination as positively meaningful for them. MSUs evaluated their experiences of engagement in PLA fieldwork and research as positively meaningful for them.
  
  
  CONCLUSIONS
  Given the need to build primary healthcare 'from the ground up', the perspectives of diverse groups, especially the hard-to-reach, must become a normative part of primary healthcare research. PLA is a powerful, practical 'fit-for-purpose' methodology for achieving this: enabling hard-to-reach groups to engage meaningfully and contribute with ease to academic research. PLA has significant potential to become a 'standard' or generic approach in building community-based primary health care. Community-university partnerships have a significant role to play in this, with capacity to radically influence the shape of healthcare research, expanding the research agenda to incorporate the views and needs of hard-to-reach and vulnerable populations.
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland. mary.oreillydebrun@nuigalway.ie.
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly-de Brún
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Tomas
authors.initials: T
authors.lastname: de Brún
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Okonkwo
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Jean-Samuel
authors.initials: JS
authors.lastname: Bonsenge-Bokanga
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Maria Manuela
authors.initials: MM
authors.lastname: De Almeida Silva
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Florence
authors.initials: F
authors.lastname: Ogbebor
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Aga
authors.initials: A
authors.lastname: Mierzejewska
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Lovina
authors.initials: L
authors.lastname: Nnadi
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Evelyn
authors.initials: E
authors.lastname: van Weel-Baumgarten
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.|Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.|Pharos, Centre of Expertise on Health Disparities, Utrecht, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: van den Muijsenbergh
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D000328:Adult; D003142:Communication; D003153:Community Health Services; D005260:Female; D058006:General Practice; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D012017:Referral and Consultation; D012108:Research Personnel; D012111:Residence Characteristics; D014171:Transients and Migrants; D035862:Vulnerable Populations / Q000208:ethnology*