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Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

Billie Bonevski14*, Madeleine Randell1, Chris Paul2, Kathy Chapman3, Laura Twyman1, Jamie Bryant2, Irena Brozek3 and Clare Hughes3

Author Affiliations

1 School of Medicine & Public Health, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia

2 Health Behaviour Research Group, Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia

3 Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, Australia

4 School of Medicine & Public Health, Calvary Mater Hospital, University of Newcastle, Level 5, McAuley Building, Callaghan 2308, NSW, Australia

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BMC Medical Research Methodology 2014, 14:42  doi:10.1186/1471-2288-14-42

Published: 25 March 2014



This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups.


A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition.


In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials.


To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.

Systematic review; Medical research; Vulnerable groups