Page 216 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Chapter 5
Literacy (SAHL-D) [60] and the Newest Vital Sign (NVS-D) [61]. In the current project, though, the researchers were forced to drop their ambition to perform a last study on the impact the TTSQ may have on provider-patient interaction with patients with low health literacy. In spite of numerous adjustments in their recruitment strategy, the researchers only managed to include five such patients (measured with the Dutch version of SAHL-D) [60]) in 1.5 years of recruitment in a physical therapy practice which was located in a deprived area of Utrecht, Netherlands. This shows how hard to reach this population really is. Among a variety of reasons that make it hard to reach this population may well be the fact that persons with low functional health literacy tend to avoid challenging situations, like participating in research, especially when they know that their (health) literacy skills will be tested. Using TT technology for health literacy assessment is a promising development which may help solve this problem, because people seem to feel less reluctant to answer questions and be tested on subjects they feel ashamed about in the absence of an interviewer [18,26]. The shame of having low literacy, being poorly educated and having trouble communicating in Dutch did not seem to play a significant role in the recruitment of Turkish participants. These participants openly discussed their limitations in these areas. One of the researchers in the current project functioned as a Turkish intermediary. His role was described thoroughly in Chapter 4.3 of this thesis. Because of this strategy, the researchers managed to include the most vulnerable members of the target population. This led to other problems, though, because, although very carefully chosen, the research methodology used was too burdensome and challenging for some of the study participants. Various researchers have shared their experiences with recruiting, including and working with hard-to- reach populations in social and medical research [35]. Researchers should keep doing this in order to help each other strive for research results that are transferable to and representative of ‘real life patient populations’. However, it is hard to give full insight in successful and unsuccessful (elements in) recruitment strategies and research methods in papers that primarily revolve around results of research. Therefore, it would be interesting to develop research projects with the primary goal of investigating what strategies, techniques and methods increase or decrease participation of members of hard-to- reach populations in research.
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