JMIR Publications

ABSTRACT

Background:

A growing body of literature highlights the health inequities faced by lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans when compared to their heterosexual or cisgender peer groups. As with other ‘hard-to-reach’ populations, LGBTQ+ veterans’ unique social context and lived experiences are shaped by their intersecting identities, including their sexual and/or gender minority identities and veteran status. Yet, there is little to no guidance in the health disparities literature describing the recruitment of LGBTQ+ veterans.

Objective:

This article provides an overview of the recruitment methodology of the Health for Every Veteran Study (Veterans Health Administration (VA) Health Services Research & Development Study, IIR 17-089), the first VA-funded, nationwide study on LGBTQ+ veterans’ health that relies exclusively on primary recruitment methods. We describe the demographics of the enrolled cohort, challenges faced during recruitment, and considerations for recruiting LGBTQ+ veterans in health research.

Methods:

Recruitment for this study was conducted over 15 months, from September 2019 through December 2020, with the goal of enrolling 1,600 veterans evenly split amongst eight sexual orientation and gender identity subgroups: cisgender heterosexual women, cisgender lesbian women, cisgender bisexual women, cisgender heterosexual men, cisgender gay men, cisgender bisexual men, transgender women, and transgender men. Three primary recruitment methods were used: (1) social media advertising predominantly through Facebook ads, (2) outreach to community organizations serving veterans and LGBTQ+ individuals across the U.S., and (3) contracting with a research recruitment company, Trialfacts.

Results:

Out of 3,535 participants screened, 1,819 participants met eligibility criteria, and 1,062 completed the baseline survey to enroll. At baseline, 25% (n=268) were recruited from Facebook ads, 40% (n=430) from community outreach, and 34% (n=364) from Trialfacts. Most subgroups neared target enrollment goals, except for cisgender bisexual men and women and transgender men. An exploratory group of nonbinary, genderqueer, and veterans with diverse gender identities was added to the study.

Conclusions:

All methods of recruitment contributed to significant portions of the enrolled cohort, suggesting that a multi-pronged approach was a critical and successful strategy in our study of LGBTQ+ veterans. We discuss strengths and challenges for all recruitment methods, including factors impacting recruitment such as the COVID-19 pandemic, negative comments on Facebook ads, congressional budget delays, and high-volume surges of heterosexual participants from community outreach. In addition, our subgroup stratification offers important, disaggregated insights to the recruitment of specific LGBTQ+ subgroups. Finally, the entirely online methodology offers important perspectives not only for reaching veterans outside of the VA, but also for research studies taking place in a post-COVID-19 world. Overall, this study outlines useful recruitment methodologies as well as lessons learned to inform future research studies that seek to recruit ‘hard-to-reach’ communities. Clinical Trial: VA Health Services Research & Development Study, IIR 17-089