How to include a race/ethnic diverse hard-to-reach adult population into the planning process of health education programs

The US has been historically a nation of immigrants, and the challenge to health education and health promotion remains the incorporation of the needs of an ever changing complexity of race, ethnicity, gender and age. During the implementation of our comprehensive needs assessment we encountered and successfully overcame multiple barriers accessing the low income multiethnic resident population (41% immigrants) in a large apartment complex (17 floors). Many of the immigrants came from countries with oppressive political structures and had a genuine mistrust and fear of authorities in government or the private sector. The ethnic make-up of the residents included Caucasian, African American, Filipino, Chinese, Korean, Russian, American Indian, Armenian, and Japanese. With conventional methods, the response rate to the face-to-face interview was initially less than 10%. Through the implementation of more creative outreach strategies we increased the response rate to 82% (N=199). Thus, the purpose of this paper is to discuss these successful strategies. In particular we will address the following issues: breaking the ice between research team and target population, establishing trust, integrating input of population and community resources into questionnaire construction, selection criteria in hiring interviewers, training interviewers to collect valid and reliable data in an ethnically diverse population, including members of the target population in the interpretation of findings and recommendations, and presenting the findings to a multi-ethnic/multi-lingual population. The successful strategies employed in this community-based participatory research can be translated to the development and implementation of health education programs to reduce health disparities in hard-to-reach populations.