title: A Qualitative Examination of Respondent-Driven Sampling (RDS) Peer Referral Challenges Among Young Transwomen in the San Francisco Bay Area.
abstract: BACKGROUND
  Efforts have focused on developing innovative recruitment strategies to engage the most marginalized of populations in public health research. Respondent-driven sampling (RDS) has been found to be an effective sampling strategy for hard-to-reach, hidden populations. Though studies have documented RDS peer referral as challenging, literature contextualizing these challenges is scant and rarely do they discuss the role of Internet technologies.
  
  
  OBJECTIVE
  The objective of the study was to explore reasons for peer referral challenges in a human immunodeficiency virus (HIV) risk and resilience study among a hidden population of youth, specifically, young transwomen. These findings amplify the unique opportunities Internet technologies bring to public health research and methodology.
  
  
  METHODS
  We conducted focused, semistructured, qualitative interviews with 16 young transwomen to investigate the reasons why youth did or did not refer peers to an RDS study for transwomen ages 16-24 in the San Francisco Bay Area. Qualitative interview data were coded and analyzed using grounded theory.
  
  
  RESULTS
  Participants discussed specific barriers and facilitators related to four factors that include study design, study implementation, community characteristics, and individual characteristics, which contributed to RDS peer referral challenges.
  
  
  CONCLUSIONS
  Our grounded theory analysis identifies important considerations for future RDS studies with hidden youth populations. Exploring research participants' experiences is integral in strengthening future epidemiologic research efforts that plan to use RDS to sample and estimate the hidden epidemics among at-risk youth and transgender women. Additionally, Internet technologies and Web-based adaptations offer solutions to traditional RDS peer referral challenges, having the potential to increase accessibility and use among hidden youth populations.
authors.affiliation: Center for Public HealthPopulation Health DivisionSan Francisco Department of Public HealthSan Francisco, CAUnited States.|Medical SociologyDepartment of Social and Behavioral SciencesUniversity of California San FranciscoSan Francisco, CAUnited States.
authors.forename: Sean
authors.identifier: 0000-0001-7698-6206
authors.initials: S
authors.lastname: Arayasirikul
authors.affiliation: Yale UniversityNew Haven, CTUnited States.
authors.forename: Xiang
authors.identifier: 0000-0002-3611-4152
authors.initials: X
authors.lastname: Cai
authors.affiliation: Center for Public HealthPopulation Health DivisionSan Francisco Department of Public HealthSan Francisco, CAUnited States.|Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan Francisco, CAUnited States.
authors.forename: Erin C
authors.identifier: 0000-0002-0237-495X
authors.initials: EC
authors.lastname: Wilson
keywords: epidemiology; methodology; qualitative research; transgenders; young adults