Reaching women with disabilities in Alaska: Nontraditional recruitment strategies

Health disparities in cancer morbidity and mortality are important public health problems. The NCI reports that lower rates of cancer screening contribute to more advanced disease at diagnosis and higher cancer death rates. As many as one in five women in the United States are living with disabilities. Healthy People 2010 reports that women with disabilities lack access to health services. For these individuals, access to primary care and cancer screening services may be very limited, especially among low-income women. In Alaska, the influence of climate, geography, and public transportation may intensify problems with access to breast and cervical cancer screening. The goal of our community-based study is to examine if low-income women with disabilities living in the Anchorage area have reduced access to and participation in cancer screening, and to understand the reasons women report for not participating (or participating) in cancer screening. The purposive sampling strategy is employing a broad-based recruitment plan that collaborates with key informants, uses snowball sampling, and distributes announcements in accessible, frequented locations (e.g., grocery markets, discount stores) throughout the city. Despite deliberate, exhaustive recruitment efforts by a research assistant with strong ties to the disability community, enrollment has not reached anticipated levels. Our experience suggests that flexibility, responsiveness to input from participants and community partners, and tenacity are essential for effective recruitment. We provide data and offer recommendations regarding nontraditional recruitment strategies for reaching this important population group.