A systematic review of studies with a representative sample of refugees and asylum seekers living in the community for participation in mental health research

Abstract

BackgroundThe aim was to review the literature to identify the most effective methods for creating a representative sample of refugee and asylum seeker groups living in the community to participate in health and mental health survey research.MethodsA systematic search of academic and grey literature was conducted for relevant literature with ‘hidden’ groups published between January 1995 and January 2016. The main search used Medline, PsycINFO, EMBASE, CINAHL and SCOPUS electronic databases. Hidden groups were defined as refugees, asylum seekers, stateless persons or hard/difficult to reach populations. A supplementary grey literature search was conducted. Identified articles were rated according to a created graded system of ‘level of evidence for a community representative sample’ based on key study factors that indicated possible sources of selection bias. Articles were included if they were assessed as having medium or higher evidence for a representative sample. All full-text papers that met the eligibility criteria were examined in detail and relevant data extracted.ResultsThe searches identified a total of 20 publications for inclusion: 16 peer-reviewed publications and four highly relevant reports. Seventeen studies had sampled refugee and asylum seekers and three other hidden groups. The main search identified 12 (60.0%) and the grey search identified another eight (40.0%) articles. All 20 described sampling techniques for accessing hidden groups for participation in health-related research. Key design considerations were: an a priori aim to recruit a representative sample; a reliable sampling frame; recording of response rates; implementation of long recruitment periods; using multiple non-probability sampling methods; and, if possible, including a probability sampling component. Online social networking sites were used by one study. Engagement with the refugee and asylum seeker group was universally endorsed in the literature as necessary and a variety of additional efforts to do this were reported.ConclusionsThe strategies for increasing the likelihood of a representative sample of this hidden group were identified and will assist researchers when doing future research with refugee groups. These findings encourage more rigorous reporting of future studies so that the representativeness of samples of these groups in research can be more readily assessed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-017-0312-x) contains supplementary material, which is available to authorized users.

Finding “hard to find” literature on hard to find groups: A novel technique to search grey literature on refugees and asylum seekers

“…The grey literature search described in this article was devised during a systematic review conducted in 2016, which aimed to identify the most effective methods for achieving a representative sample of refugees and asylum seekers living in the community for participation in mental health research (Enticott et al, ). The complete methods of the systematic review are not the focus of this article and are presented in detail elsewhere (Enticott et al, ), but for illustrative purposes, we will provide a brief overview of the broader study methodology in order to specify the decision points that led to the incorporation of a grey literature search into the review.…”

“…Although the review primarily focused on methods for achieving representative samples of refugee and asylum seeker groups, health‐related research involving participants from other hidden groups (i.e., hard or difficult to reach populations such as men who have sex with men) was also included if the sampling methods used were suggested as potentially transferrable to other groups. Articles were excluded if they offered a service to participants (e.g., a free health check‐up) or were classified as an incomplete article (see Enticott et al, for full description of the inclusion and exclusion criteria).…”

“…On the basis of the recommendations of the expert advisory committee, an initial grey literature search was executed that involved conducting searches of Google and Google Scholar using the key search terms specified in the peer‐reviewed literature component of the systematic review (see Enticott et al, for the complete list of search terms). Additionally, study investigators and members of the advisory committee were asked to identify relevant sources of nonpeer‐reviewed literature known to them, such as websites or reports.…”

“…Grey literature is of particular relevance in fields such as refugee and asylum seeker research, where academic researchers continue to have difficulty accessing and engaging the participation of these groups. Like other populations that are known to be “hard to find” or “hidden,” such as illegal immigrants, people with chronic mental illness, men who have sex with men, and the homeless (Lambert & Wiebel, ), refugees and asylum seekers present particular challenges for researchers at all stages of the sampling process, including identification, contact, recruitment (particularly of large and/or representative samples), and data collection (Bloch, ; Enticott et al, ). In refugee and asylum seeker groups, these sampling challenges are likely to be exacerbated by issues around mental health and trauma, as well as concerns related to safety, privacy, and trust, particularly for those with undetermined refugee status.…”

“…Here we describe a novel grey literature search methodology that was developed during the process of conducting a recent systematic review on obtaining representative samples in refugee and asylum seeker groups for participation in health research (Enticott et al, ). We provide an overview of the rationale for including a search of the grey literature in the review, describe the development and execution of our search strategy, and provide a brief summary of the results of the grey literature search within the context of the broader systematic review.…”