Conducting Health Literacy Research on Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: An Evaluation of Recruitment and Retention Methods Before and During COVID-19 (Preprint)

BACKGROUND Culturally and linguistically diverse (CALD) health care consumers residing within Australia are recognized as having low health literacy, leading to increased hospitalizations and poorer health outcomes. CALD populations living within regional Australia have been identified as a disadvantaged group. To understand and address this disadvantage, region-specific studies are required to map healthcare barriers related to geographic location, specific health services, and societal makeup. Despite the need to research the relationship between cultural and linguistic diversity and health literacy, CALD participants are often cited as hard-to-reach or hidden. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals. As this study was taking place in 2020, the COVID-19 pandemic and subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considers the effectiveness of recruitment and data collection methods used throughout pre-COVID and during-COVID periods. OBJECTIVE This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers, during a study which targeted regional-dwelling, hard-to-reach CALD participants. METHODS In this paper, recruitment and retention methods have been categorized into five phases: recruitment, pre-intervention data collection, intervention, post-intervention data collection and interviews. To compare the methods used by researchers, recruitment and retention rates have been dissected into pre-COVID and during-COVID periods. Researchers thereafter provide an in-depth reflection of the methods employed within this study. RESULTS This paper provides results relating to participant recruitment and retainment over the course of five research phases which occurred pre- and during-COVID. During the pre-COVID recruitment phase 22 participants were recruited. Of those, 68.2% of participants transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with a 72.2% continuance rate. The success rate of the intervention phase in the pre-COVID period was 93.3% versus 84.6% during-COVID. Lastly, 92.9% of participants completed the post-intervention data collection phase pre-COVID, compared with 90.9% during-COVID. Against the intended 30 participants, 40 participants took part in the initial data collection phase, with 23 going on to complete the project in its entirety. CONCLUSIONS The success of this program in recruiting and maintaining hard-to-reach CALD populations was preserved over pre and during-COVID periods. The emergence of COVID during the study period forced researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period is also due to flexibility offered by the research program through adoptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, limitation of intervention group size, use of digital platforms and more.