Abstract
Recruiting research participants is a vital part of health research, necessary to obtain data that can yield meaningful results. Recruiting research participants, however, can be challenging and time-consuming. The COVID-19 pandemic resulted in significant challenges to participant recruitment, as traditional methods relying on in-person interactions were not feasible with health restrictions. This was particularly challenging for community-led research with Indigenous communities, where relational approaches to recruitment are culturally appropriate and ethically necessary to build community trust. This paper describes the recruitment methods of three different Indigenous community-led studies carried out in Southern Ontario during the COVID-19 pandemic and emphasizes the necessity for flexibility and responsive recruitment strategies during this time. Despite health regulations disrupting in-person approaches to building relationships during the pandemic, our priority for a relational approach to recruitment was achieved through strong relationships with community partners and the use of technology. The examples and strategies provided here contribute to the developing body of literature describing the impacts of the COVID-19 pandemic on qualitative and community-led research, of which little is available concerning recruitment strategies. Our experience and learning will be valuable to novice researchers and those who are new to community-led and relational approaches to research.
Background
The recruitment of research participants is a necessary and vital part of health research to obtain sample sizes that can yield meaningful results. Inappropriate recruitment may lead to incorrect or misleading results which can have significant consequences on healthcare delivery and the wellbeing of individuals (Ibrahim & Sidani, 2014). What constitutes an adequate sample size differs according to methodology, with quantitative approaches typically prioritizing large sample sizes that are powered to demonstrate statistical significance and representativeness of the study population (Jones et al., 2003). Numerous qualitative methodologies value sample sizes that will demonstrate data redundancy and information power, made evident by recurring concepts and a thorough understanding of themes (Malterud et al., 2015; Parker et al., 2022). The recruitment of research participants, however, can be one of the most challenging and time-consuming components of any study, and one that researchers often have little control over (Farrugia, 2022; Garnett & Northwood, 2022).
Traditional recruitment strategies regardless of the study methodology consist of in-person and/or indirect methods. In-person approaches may include recruiting at community events, meetings, or in clinics or hospitals, endorsements by clinicians to clients, and building relationships with gatekeepers to support recruitment through their networks (Parker et al., 2022; Tseng et al., 2023). Indirect options include the use of digital research registries (where participants enrol for future contact in relevant studies), media (radio, television), social media, and marketing using paper and electronic means such as flyers (Ibrahim & Sidani, 2014; Parker et al., 2022; Tseng et al., 2023).
Several barriers can reduce the effectiveness of these strategies, including a lack of participant awareness, interest, or understanding, and participant-incurred costs associated with study involvement (Clark, 2008; Daniel et al., 2022; Gates et al., 2022; Tseng et al., 2023). In contrast, factors found to facilitate recruitment efforts, include appealing to motivational factors like a participant’s interest in the topic, their desire to improve their own wellbeing and that of others, receiving a recommendation from a trusted professional, study participation enabling access to information or services, social contact gained through participating in an interview, as well as financial incentives (Abdulhussein et al., 2022; Clark, 2008; Kammerer et al., 2019).
The COVID-19 pandemic dramatically influenced research methods, including the ability of researchers to use traditional recruitment strategies (Abdulhussein et al., 2022; Cornejo et al., 2023; Eigege et al., 2022; Melis et al., 2022; Parker et al., 2022). In response, researchers globally, and in Canada, became exceedingly flexible, responding to ever-evolving public health advice and limitations to in-person interaction. The impacts to recruitment strategies were both challenging and beneficial, as the pandemic forced researchers to shift their recruitment methods to virtual strategies (Blukacz et al., 2023; Parker et al., 2022). The pandemic resulted in negative implications for participants, who feared for their safety if research required participating in-person or necessitated the use of public transportation. Additionally, accessibility issues, such as a lack of internet access or not having a private environment to participate in virtual interactions, were also barriers for some. Participation in research often became inconvenient, particularly if participants had to find childcare, as school closures were frequent during the pandemic with children cared for by working parents at home (Abdulhussein et al., 2022; Blukacz et al., 2023; Daniel et al., 2022; Hoeflich et al., 2022; Kaur et al., 2022; Parker et al., 2022). Researchers also experienced negative impacts on their recruitment efforts, such as difficulty developing new collaborations and relationships with gatekeepers that had previously been facilitated by in-person meetings and events which were no longer possible during the pandemic (Blukacz et al., 2023).
Yet, the shift to virtual methods has been beneficial for some. Numerous studies report the initiation of digital research participant databases, some with messaging capabilities, in which participants register for future contact for research they are eligible for (Barbour et al., 2021; Helmer et al., 2021; Lessard & Puhl, 2021; Pogue et al., 2022; Sixsmith et al., 2022). Others report enhanced digital recruitment strategies including the use of social media and software applications (Sattler et al., 2022). The use of social media for recruitment purposes increased during the pandemic, enabling researchers to broaden their dissemination of study information to many more people than can be reached through traditional means, and the use of online consent processes were developed to support completely virtual research processes (Blukacz et al., 2023). While most studies have not reported the success rates of their various recruitment efforts (Garnett & Northwood, 2022; Hoeflich et al., 2022), some researchers have found that virtual recruitment strategies improved their ability to reach potential participants (Brøgger-Mikkelsen et al., 2020; Darmawan et al., 2020; Reagan et al., 2019)), such as underrepresented groups (Hoeflich et al., 2022), and lowered recruitment costs (Darko et al., 2022; Mazurenko et al., 2022).
For Indigenous communities and Indigenous-led organizations in Southern Ontario, Canada, the pandemic further emphasized already existing forms of systemic racism and resulting social inequities, which added to an already present distrust for the government and its affiliated institutions (Mashford-Pringle et al., 2021). With lockdown mandates, community centres, once the hub for community gathering and providing services and programs, were closed for public gathering (Watson et al., 2022). Indigenous service providers found themselves with significantly increased workloads as they quickly pivoted from in person to virtual means of community engagement and meeting needs (Mashford-Pringle et al., 2021). Many organizations became reliant on volunteers to deliver essential aid and services to community members, and organizations and communities were forced to use their own limited sources of funding to support community needs, possibly putting their future programming at risk (Mashford-Pringle et al., 2021; Power et al., 2020; Watson et al., 2022). Lockdown policies were reminiscent of the Pass System, previously used to limit the movement of Indigenous Peoples, further perpetuating traumatic memories of colonization, racism, and government control for many (Mashford-Pringle et al., 2021). These challenges made previous research recruitment strategies used in research with Indigenous Peoples all but obsolete during the pandemic, as in-person, relational networking with participants was no longer possible, and the link between service providers and clients was forced to virtual means, strained by waning capacity due to increased workload demands placed on service providers, while their priorities shifted to meeting essential needs and supporting clients’ mental health (Watson et al., 2022). Yet throughout the many challenges posed by the pandemic, Indigenous Peoples in Canada continued to care for their community members by way of volunteers, applied available funding to meet community needs, and adjusted program and service delivery through innovative means such as by distributing technology (tablets, internet access), mailing supplies to be used in virtually offered programs, and providing counselling via texting, online, or even drive-by methods (Watson et al., 2022).
Despite the COVID-19 pandemic restrictions lifting recently, the challenge of participant recruitment in research with Indigenous Peoples in Southern Ontario, Canada continue, as in-person meetings and events continue to take place less frequently in the post-pandemic era (Flaskerud, 2023). In the same way, the reliance on snow-ball sampling (participant-driven recommendations) to find eligible participants has also been challenging, as many people continue to work from home and may see less of friends and colleagues (Blukacz et al., 2023). As the world moves into a post-pandemic era, researchers are empowered with both traditional and new innovative recruitment strategies to engage potential participants. Researchers must now consider how to meet the evolving needs of participants who have an ongoing expectation for, and familiarity with, virtual strategies, and yet may also continue to value more traditional approaches that allow for in-person, relational methods.
Situating the Authors
The first author is a nurse researcher and nurse practitioner (clinician) with more than 10 years experience working with Indigenous community organizations in Southern Ontario. Coming to recognize structural racism and discriminatory policies and their impacts on healthcare services and delivery, she strives to use her unearned privilege as a white settler, to amplify the voices of Indigenous Peoples and advocate for culturally safe healthcare among clinicians. She hopes to be recognized as an ally to those she works alongside, using her role to facilitate meeting community needs through research while building research capacity within community partner organizations. The second author is a non-Indigenous nurse researcher and educator who has engaged with the Indigenous community alongside the first author for the past 4 years. As a nurse who has worked with children and families in both a clinical and research context, she is aware of health inequities Indigenous children and families face and is motivated to support the empowerment of community members to achieve optimal health. The third author is a program manager and anthropologist with more than 15 years experience working with Indigenous communities in Ontario and Labrador. As program manager at an Indigenous-led not-for-profit organization, she routinely encounters the structural inequalities that impact Indigenous Peoples’ health and work. Working as an ally, she supports capacity building, knowledge mobilization, and improved health outcomes in Indigenous community settings. The fourth author is an Algonquin/Mohawk scholar and educator whose work and research are rooted with Indigenous communities. Her work prioritizes bringing forth the self-determination of Haudenosaunee and Indigenous voices and perspectives that support the identity, health, and well-being of Indigenous child, youth, and families. The fifth author is the Steering Committee for the Fathers of the Next Generation project. The four previously mentioned authors participate in this Steering Committee along with additional First Nations community members, including parents, service providers from partnering Indigenous-led organizations, a Knowledge Holder, and trainees. The Steering Committee guides all research activities related to this project and is described in more detail below.
Using three Indigenous community-led research projects in Southern Ontario, Canada as examples, we detail our experience of recruiting Indigenous parents. We will illustrate our recruitment decisions and approaches and discuss lessons learned as we were forced to pivot and adjust our recruitment strategies based on evolving public health guidance during the COVID-19 pandemic. We offer our perspectives of using a relational approach to recruiting in a post-pandemic era when in-person and relational approaches are still appreciated and valued, yet online, virtual strategies are also expected and necessary to achieve adequate sample sizes. Experienced and novice researchers may find our experience helpful as they consider which recruitment strategies to implement in future studies.
First, however, we must emphasize that researchers engaging with Indigenous Peoples in Canada, should first familiarize themselves with existing literature, such as the Tri-Council Policy Statement Chapter 9: Research Involving the First Nations, Inuit or Metis Peoples in Canada (Canadian Institutes of Health Research et al., 2018), 4Rs of research (Kirkness & Barnhardt, 1991), ethical space of engagement (Ermine, 2007), and Two-Eyed Seeing framework (Bartlett et al., 2007), about best practices related to ethical research and appropriate community-engagement. The authors recognize that research with Indigenous Peoples requires authentic, trusting, and long-term relationships, as well as working at the direction of the community. In some cases, leaders of Indigenous community groups are experts in how to effectively recruit members of their community. Some Indigenous-led organizations, however, like those we have collaborated with in Southern Ontario during the pandemic and beyond, serve a large and diverse community, and while they are well-established organizations, their clientele base is so large, they cannot possibly have relationships with everyone. In these cases, given the significant implications that the pandemic has had on peoples’ wellbeing, sense of community and levels of social engagement (Flaskerud, 2023), our once effective recruitment strategies, that is, recruiting through our partner organizations’ networks, are no longer sufficient. Given this, the aim of this paper is to share with researchers our innovative approaches to recruitment, including details of their use, so that researchers can then apply them with community direction to their own contexts.
Methods
First, a discussion of our approach to study design is necessary to introduce the reader to an ethical community-engaged approach to research with Indigenous Peoples in Southern Ontario, and in particular, the relational approach we take as a group of Indigenous and non-Indigenous researchers, working in respectful friendship with Indigenous community partners to develop and conduct research that meets community-identified needs in community-led ways. The 4Rs of research (Kirkness & Barnhardt, 1991), guide the collaborative development and implementation of each study we embark on with Indigenous community partners. The 4Rs of research pertain to respect, relevance, responsibility and reciprocity, and are applicable to a number of research contexts (Kirkness & Barnhardt, 1991). During the design of the study, we ensure we are respectful of local Indigenous ways of knowing and defer to the perspectives of Indigenous community partners. We conduct research collaboratively, at the guidance and leadership of Indigenous community members who we partner with. As such, representatives from each community partner participate in a Steering Committee, created to oversee, and guide each study. These Committees will be further described later. While ethically imperative while working with Indigenous Peoples, this type of collaborative, community-led approach is often opposite to the researcher-led approach common within academia. Therefore, our Steering Committee engages in numerous strategies to ensure we are respectful of Indigenous Peoples’ rights to data sovereignty, by adhering to the principles of OCAP® (ownership, control, access, and possession) (First Nations Information Governance Centre (FNIGC), 2022). Second, our team ensures study relevance by determining research priorities with the community, and developing the research question(s), and study design at their guidance and direction. In this way, we make sure that the research findings will be directly relevant to community-identified needs and conducted in ways that align with local protocols and cultures. The Steering Committee and its team members enact responsibility by ensuring all are treated respectfully, and by deferring to Indigenous perspectives and not to non-Indigenous members of the team. We apply a strengths-based approach to the research, aiming to build up communities and individuals in supportive ways and not further perpetuate stereotypes or cause harm. The Steering Committee approves all research outputs and directs what deliverables are most meaningful to them, prioritizing outputs that are accessible to community members. Finally, the Steering Committee ensures the project engages in reciprocity throughout the research process, compensating community members for their time, and acknowledging all team members in research-related outputs. The Steering Committee members have opportunities to attend conferences and present and building research capacity within the team and community is prioritized by hiring Indigenous staff and students to the project.
In this paper, we describe our experience recruiting participants for three qualitative studies involving three significant approaches to parenting, including the experiences of Indigenous 2SLGBTQQIA + identifying parents, Indigenous parents using virtual parenting programs, and Indigenous fathers and Two-Spirit parents in Southern Ontario, Canada. Each study underwent participant recruitment during the pandemic and was conducted in collaboration with the first author and an associated Steering Committee, which will be described later. A brief description of each study follows, along with a discussion of the various recruitment strategies we used and their effectiveness.
Details of Exemplar Studies
Study A: The Parenting Resource Needs of Indigenous 2SLGBTQQIA+ Parents With Young Children
In this study, we have collaborated with the Hamilton Regional Indian Centre, the local Friendship Centre to learn more about the needs of Indigenous 2SLGBTQQIA+ parents who use health services for their children in a large metropolitan city in Southern Ontario. The purpose of this study was to understand parenting resource needs as individuals became parents and parented young children with the intent of discovering ways the Friendship Centre could better meet the needs of these families in their programming. Parents were eligible to participate in a 60–90 minute semi-structured interview, which took place virtually due to the ever-evolving public health advice during the post-pandemic 2022-2023 period, if they self-identified as Indigenous, as 2SLGBTQQIA+ and had a child 5 years of age or younger. Recognizing Indigenous 2SLGBTQQIA+ people represent a small proportion of the community we decided a goal of 10 participants was feasible to recruit within a 6-month timeframe.
Study B: The Virtual Programming Needs of Indigenous Parents With Young Children
In a second study with the Friendship Centre, we sought to understand the needs of parents with young children using virtual parenting programs through the pandemic. While virtual programming was an essential mode of delivery during the pandemic, there remains some expectation by parents for the availability of virtual programming in the post-pandemic period. As such, we hoped to learn about parents’ experiences using virtual programming during the pandemic to improve currently offered virtual programming and promote better program attendance and engagement of parents and their young children. Parents were eligible to participate in this study if they self-identified as Indigenous, had at least one child 5 years of age or younger, and had participated in a virtual parenting program in the last few years in Southern Ontario. Participants engaged in a 60–90 min semi-structured interview conducted virtually. Our goal was to recruit 20 parents for this study within a 3-month period.
Study C: Fathers of the Next Generation
In a third study, we aimed to understand the experiences, strengths, and needs of Indigenous fathers and Two-Spirit parents during their transition to parenthood. In this three-phase study, we plan to use this understanding, gathered in phase one of the project, to inform Phase 2 which is the development of a parenting program specifically for Indigenous fathers and Two-Spirit parents, built in close collaboration with the Indigenous community in Southern Ontario. In the third phase of the study, the parenting program will be piloted and evaluated according to community-identified indicators of success. In Phase 1, we recruited parents to participate in 60–90 min semi-structured interviews conducted virtually, if they identified as fathers or Two-Spirit parents, self-identified as Indigenous, had at least one child aged 5 years or younger, and lived in Southern Ontario. Our recruitment goal for this phase was to interview 20 fathers and 10 Two-Spirit parents within a 6-month timeframe.
Data analysis is currently ongoing in all studies; study details and results will be published separately.
Steering Committee Guidance
Prior to seeking research funding for each project, Steering Committees were struck consisting of representatives from the community partners who were committed to meeting community-identified needs through research. These individuals informed the research question development, study design, and methods as we wrote grant applications for funding. Once funding was obtained, the same individuals continued to participate in the Steering Committees and oversaw the research process to completion.
Studies A and B were guided by the same Steering Committee, consisting of five individuals: two First Nations women, one of whom is a Knowledge Holder, both responsible for early childhood programming at the local Friendship Centre, our project partner; a First Nations PhD trainee (also a mother); and two non-Indigenous researchers (first and second authors).
Study C was guided by a Steering Committee consisting of First Nations and Métis representatives from each community partner, a Knowledge Holder, parents, a First Nations PhD trainee, First Nations researcher, and the two non-Indigenous researchers from studies A and B. Following funding, additional representatives from other community partners, First Nations trainees, and parents (including fathers, mothers, and Two-Spirit parents) were invited to join the Steering Committee, making the total membership approximately 20 people. This number changed during the project duration as people left positions within the partner organizations and new parents were invited to participate in the Steering Committee.
Each Steering Committee confirmed the associated study designs and ethics applications prior to embarking on data collection. Studies A and B were approved by the University of Toronto Research Ethics Board and reviewed by the Hamilton integrated Research Ethics Board. Study C was approved by the University of Toronto Research Ethics Board and the Six Nations Research Ethics Committee.
Initial Recruitment Strategy
Our recruitment strategies in all three studies were initially informed by our pre-pandemic research experience, and consisted of distributing both online and printed copies of recruitment flyers, in conjunction with a community engagement strategy. Yet as all three studies underwent participant recruitment and data collection during the pandemic, we quickly realized we needed flexible and innovative approaches to successfully recruit our target sample sizes. The following describes our initial strategy, followed by a description of our strategies to pivot our approaches to meet current public health advice and the needs of potential participants.
Project websites were created for all three studies, using the same website for studies A and B, and a separate website for study C, to enhance communication with community members who were located across Southern Ontario. Because study C is a large project consisting of three different phases over 3 years, as a first step in our recruitment strategy, the Steering committee members engaged in a branding exercise and selected an image and associated colour palate to market the project throughout its duration. Additionally, a social media profile using Facebook and Instagram were developed for study C, to broaden our reach to community members and make project information and findings accessible. We posted recruitment flyers on each project website and on the social media pages for study C. Community partners were asked by representatives of our Steering Committees, to share hard copies and electronic versions of the recruitment flyers for each study, and the websites URLs and study C’s social media handles with members of their organization and throughout their networks. To keep recruitment front of mind among the larger Steering Committee group for Study C, we created quarterly newsletters, which included information about our recruitment numbers, announcements of upcoming events and meetings, new team members, evolving findings from concurrent data analysis, and reminders to continue to share our recruitment flyers, website address and social media site links. While community partners did their best to advertise the study using these strategies, we failed to see the interest in participation that we anticipated and were forced to pivot to new strategies.
Pivot One: Enhanced Flyer Distribution
When our community partners sharing the recruitment flyer within their organizations and networks was unable to achieve our desired reach to potential participants, we enhanced our flyer distribution efforts. First, we adjusted our flyers across all three studies to be more eye-catching by applying imagery that changed with each season (winter/spring). Then, using a snowball approach, we emailed the flyer to existing study participants, asking them to share with their contacts. We also emailed and called Indigenous-specific programs at universities and colleges in our catchment area to ask them to share the flyer with their students and staff via their internal email contact lists. Next, we emailed and called various Indigenous organizations in Southern Ontario, including health centres, childcare centres, and other culturally-based and 2SLGBTQQIA+ supportive organizations, and asked them to email the flyers to their clients, post them to their social media pages, and to hang hard copies of the flyers in their centres, which we mailed or dropped off to their location. We also asked Indigenous research assistants on the teams to share the flyers with their contacts.
Pivot Two: Social Media
Next, using our social media account for Study C, we joined interest groups and pages that were relevant to Indigenous parents with young children, and messaged through these programs to ask their site administrators to post our flyers for all three studies on their pages. In some instances, this strategy was very effective when a page had a large number of followers. Most participants we asked reported seeing our flyer on a Facebook page they followed.
Once we recognized the effectiveness of recruiting using social media, particularly Facebook, we asked one of the fathers on the Steering Committee for Study C to create a short recruitment video, which we posted to our Facebook and Instagram sites for Study C. We tested long and short versions of the video and found the shorter video (21 s) was watched more often than the longer version. In response we opted to keep the shorter version on our site and asked other organizations to share our video as well. To try to increase the number of followers on our social media sites for Study C, we held a competition, providing a gift card via lottery, to one new follower who liked our page during the competition timeframe. Other Indigenous organizations shared our competition on their own pages, but despite our competition being well marketed, this was not effective, and we only gained two new followers this way. Our use of social media created additional complications by the way of fraudulent participants, who attempted to enroll in our study despite not meeting eligibility criteria. Once we realized that a participant was not who they claimed to be during an interview, we removed specific eligibility criteria, such as our catchment area from our recruitment flyers and instead screened potential participants over the phone so we could gauge their ability to answer the screening questions for ourselves. Following the implementation of these steps, we were confident in the eligibility of the participants we enrolled in the three studies.
Pivot Three: Virtual Community Engagement
While the pandemic restricted us to virtual-only communication, we were left with only online strategies with which to build relationships with community members and organizations to promote interest in the studies. Using Zoom, we met with members of leadership teams from numerous different organizations who interacted with Indigenous parents and young children to share about the studies. We kept in regular contact with these organizations after our meetings to foster ongoing engagement, and regularly provided electronic flyers and reminders to share them with their clients. Additionally, in collaboration with one of our community partners, we held a men’s webinar session during which an Elder spoke about the role of fathers in the family and community. At the end of the session, we shared our recruitment flyer for Study C and briefly described the study to the attendees. Several attendees from this webinar reached out to participate in Study C.
Pivot Four: In-Person Community Engagement
Once the pandemic restrictions started to lift in Southern Ontario, during the summer of 2023, and in-person gatherings began to take place again, we attended in-person events to build relationships with community members and Indigenous parents, and to further support our recruitment efforts. We attended a local Indigenous-focused conference for early childhood development service providers, a preschool event at the local reserve, and a large community family event held in a local park. To help remind people of the studies after they had gone home, we offered paper versions of our flyers in large (poster) and small (postcard) sizes, as well as water bottles and packages of crayons printed with our logo and website for Study C. While attending these events was a great way to speak to community members about the study, we did not manage to recruit new participants using this strategy.
Challenges
The evolving nature of the pandemic necessitated the constant evaluation and re-consideration of our recruitment strategies. Throughout this journey we faced several challenges, including multiple changes in recruitment strategies requiring ethics amendments which prolonged the timeline to recruit participants and complete data collection. We will now review each of these challenges in detail in the hopes that our learning will benefit researchers considering how to design recruitment strategies for their own research. Our learning may benefit new and existing researchers, as well as graduate students, who may not have adequate research experience to inform their decisions.
First, each adjustment we made to our recruitment strategy required an amendment be made to our ethics applications. As such, these amendments prolonged our recruitment time as we could not pivot to using a more effective recruitment strategies until we had received ethics approval. As the pandemic restrictions changed so often, this was problematic, as we found ourselves constantly pivoting to what might be a more effective strategy. We learned that we should always include all possible recruitment strategies in our initial ethics applications to protect us from future delays. This will enable us to pivot to a new strategy without having to seek additional approval from the ethics board.
Second, we learned that previously effective strategies such as the distribution of paper flyers and word of mouth from staff at respected Indigenous-led community organizations has become less effective throughout the pandemic. We suspect this is a result of staff having less frequent in-person interactions with clients due to public health restrictions and significantly less time with increased workload pressures, as well as people becoming more comfortable in virtual spaces. Despite public health restrictions lessening, many individuals have yet to return to in-person socializing at pre-pandemic frequency, and organizational staff continue to experience high workloads. Consequently, we found it much more effective when respected and popular Indigenous organizations shared information about our studies online, using Facebook rather than in person distribution or word of mouth.
Third, due to our use of social media for participant recruitment, we encountered fraudulent participants attempting to infiltrate our participant pool. This problem required us to remove eligibility information from our recruitment flyers, such that fraudulent participants could not readily answer screening questions and be admitted to the study. We screened over the phone to gauge participant responses more accurately.
Finally, fourth, we learned how to interpret social media data to inform our online recruitment strategies, however we discovered this was misleading-- despite our Facebook page having few followers, and limited sharing of our posts by others, nearly all our participants reported seeing our flyers on the Facebook page of a local Indigenous-led organization. Additionally, we could not determine whether people had seen a flyer on Facebook and were disinterested, or whether they had not seen a flyer at all. On our Instagram page for Study C, we were granted access to special metric data, such as which days and at what time people were most likely to see our posts. We used these metrics to better inform our social media recruitment approach for this study, yet we still could not determine whether those who clicked and viewed the flyer were just disinterested or otherwise ineligible to participate in the study.
Discussion
Using three studies as examples to document our experience devising and adjusting our strategies to recruit Indigenous parents during the pandemic and beyond, we have illustrated the evolving impact of COVID-19 on recruitment methods and the necessity for researchers to be flexible and creative. While public health restrictions have lessened, in our experience, participants continue to prefer virtual communication about research participation opportunities. Despite engaging with potential participants in-person at local community events and receiving positive feedback about the importance of our projects, participants were still more likely to report seeing study information on Facebook during eligibility screening than by other means. For this reason, we continued to use a relational approach to recruitment using social media for all three studies, and successfully met our recruitment goals in each. All the while, we ensured the 4Rs of research (Kirkness & Barnhardt, 1991) stayed ever at the forefront of our minds and designed our recruitment strategies accordingly ensuring we remained respectful, relevant, responsible, and reciprocal. Throughout the following description of our lessons learned, we link back to these four Rs (Kirkness & Barnhardt, 1991), in the considerations in our approach.
Some lessons we have gleaned in our work over the last few years during the COVID-19 pandemic, include the necessity of building relationships with community members and potential research participants to facilitate fostering trust, and also lessening potential participant fatigue. By prioritizing building relationships, we demonstrate our respect of individuals and communities and ensure we engage in responsible ways that do not cause further harm.
In our experience conducting research during the pandemic, we recognized the major impact both the pandemic and an increasingly busy and complex world had on participant recruitment. Staff from our partner organizations were less able to support study recruitment, while participants demonstrated signs of disinterest and possible research-related fatigue. In being thoughtful about our approach, we considered that participant fatigue may be a significant contributing factor impacting our recruitment efforts, as participants may have been bombarded by numerous online studies via email requests or social media posts requesting their participation in research during the pandemic (Clark, 2008; de Koning et al., 2021; Patel et al., 2020). It is well documented that Indigenous Peoples are highly researched, often not benefiting from study findings, and researchers do not always adequately collaborate with communities to ensure studies align with community-identified needs and priorities in culturally appropriate ways (Mashford-Pringle & Pavagadhi, 2020). Coupled with a history of unethical research practices, it is not surprising then that some Indigenous Peoples in Canada and globally, are distrustful of researchers, research, and academia (Mashford-Pringle & Pavagadhi, 2020). These two concerns increase the likelihood that Indigenous Peoples may experience participation fatigue, particularly during the pandemic. To lessen our potential contributions to participant fatigue, we prioritized building relationships with participants. Yet despite our long-term relationships with respected Indigenous-led community partners and our efforts to co-create knowledge, virtual recruitment methods made building trusting relationships with community members and potential research participants challenging, though not impossible. To build relationships in a virtual space, we worked hard to create connections with other relevant Indigenous-led organizations (parenting groups, early childhood education groups, prominent leaders in the community) through social media, by reaching out to site administrators to promote one another’s events and projects. Additionally, we prioritized using our social media sites to foster a sense of community amongst Indigenous parents, as well as support a connection with culture, by creating content that celebrated the strength of communities, recognizing important events and holidays while simultaneously educating others about their significance, and highlighting Indigenous languages to support their revitalization. Regular content, delivered via individual emails, quarterly newsletters, and on social media helped to enable recognition of Study C as our project titles, images and colours were made visible on all our communication (Makrides et al., 2020).
Simultaneously, we created content with the intention of lessening participant fatigue and building relationships by appealing to motivational factors that also met requirements for relevance and reciprocity in our approach (Clark, 2008; Patel et al., 2020). To do this, we created posts with clear language about the study rationale and its importance, so participants could quickly understand why the studies were relevant to them. Second, we emphasized the uniqueness and significance of the participants’ contributions, to ensure participants knew why their experience was valuable and necessary to the studies. Interviewers took time to build relationships with participants at the outset of interviews, even while in a virtual space, to demonstrate their commitment to relationality and to engage in reciprocity through creating a safe and friendly environment for dialogue and sharing. Third, we made sure that modes of reciprocity were both clear and adequate, such as the dollar amount and type of honoraria, as well as extending invitations to join our study teams to participate further in project activities, and ensuring support was made available by Elders and/or Knowledge Holders after interviews, to enable participants’ confidence in feeling valued throughout their participation. Fourth, we endeavour to lessen any pressure to participate by limiting our contact with potential participants to three attempts and emphasizing a person’s choice to participate while obtaining study consent and throughout the interview. Finally, fifth, we shared study data and findings with community members in accessible and timely ways, posting findings in the form of infographics to our social media pages for Study C and on the websites for all three studies. This approach to knowledge dissemination enables fast access to findings that is not dependent on publishing times. These initiatives also assisted us in meeting our goals of responsibility and reciprocity with the community.
Future Research
It is evident, given our experience, that individuals continue to have an ongoing expectation for virtually available information even after the pandemic, yet how best to reach potential research participants using relational approaches to virtual strategies is not well known. Certainly, whether strategies are considered preferable and effective by participants will be context specific, but studies investigating people’s preferences for virtual information according to demographic factors such as age, ethnicity, gender, socioeconomic status, and so on, will be very helpful to informing the design and implementation of recruitment strategies in a post-pandemic era. Second, data interpreting the types of interactions (liking, sharing, clicking on links to see more information) potential participants have with research study information on social media will better support researchers to understand whether recruitment flyers are reaching eligible participants, and if there are opportunities to present study information in more attractive ways. Third, a better understanding of how to deter fraudulent participants is essential if virtual recruitment is to be successful and not compromise data integrity. Finally, further research examining effective and innovative approaches to fostering relationality with potential research participants is key, as building relationships and creating a sense of trust with Indigenous and other made-marginalized participants is important not only ethically, but morally, as we attend to the 4Rs of research.
Conclusion
It is clear the pandemic has had lasting impacts on peoples’ willingness to participate in research and their communication preferences. Recognizing this, we have been creative and flexible in our approach to study recruitment, developing innovative strategies to recruit participants while also prioritizing a relational approach, and building relationships in the virtual space. Researchers embarking on research collaborations with Indigenous communities should prioritize community engagement and building trusting relationships, in addition to ensuring they are familiar with and following existing guidance on ethical research practices. Through sharing our experience navigating the evolving demands created by the COVID-19 pandemic in Canada on our study recruitment strategies, we have demonstrated numerous methods that can be used to support an ethical and relational approach to engagement with Indigenous communities while appealing to preferences for virtually accessible information and mitigating potential participant fatigue. Researchers can avoid some of the pitfalls associated with designing recruitment strategies by gleaning insight from our lessons learned and applying these to their own studies and local contexts.
Footnotes
Acknowledgements
We would like to thank our community partners, including the Hamilton Regional Indian Centre, the Indigenous Diabetes Health Circle, Six Nations of the Grant River Social Services and Birthing Centre, for all their support and guidance throughout these projects. We are all thankful for the opportunity to learn from one another, to help address programming needs through research. In addition, we would like to acknowledge all the Steering Committee members for each study, especially the Fathers of the Next Generation project, whose members have had the privilege of working together for several years. Finally, we would like to acknowledge the parents who have taken the time to share their experiences to help us develop culturally safe parenting resources for their families and communities. These studies would not have been possible without their important voices.
Statements and declarations
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Canadian Institutes of Health Research (CIHR) Funding Reference Number: 179317.
Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.