Recruitment has been referred to as a relational process ‘contingent on the decisions of a number of actors, including the researcher, and on the dynamic relationships between these actors over time’.7 Barriers to recruitment have previously been categorised by these ‘actors’, or separated into participant-related (eg, personal interest in topic, mistrust), recruiter-related (eg, relationship with participant, credibility) and institutional-related (eg, facilities, personnel capacity) factors.8–13 Given the importance of the researcher and target audience, barriers to research recruitment are often multifaceted and focus on the intersection of characteristics such as the target sample demographics (eg, adolescents), study context (eg, rural, community-based) and sensitivity of topic (eg, firearms).

Engaging adolescents requires thoughtful consideration of developmental stage and associated impacts on recruitment and data collection—a topic generally missing in the recruitment literature.¹⁴ Adolescence is a salient life stage marked by biological, emotional and cognitive changes including a desire for increased autonomy, decision-making and belonging.¹⁵ This period of rapid growth means early adolescents (ie, 11–14 year-olds) often have differing decision-making, critical thinking and reasoning capacities than middle (ie, 15–17 year-olds) or late adolescents (ie, 18–20 year-olds). When these developmental factors are not considered in recruitment, assent/consent and data collection, they may pose barriers to participation in research.

In addition to developmental factors, adolescent participants are often harder to recruit due to the need to obtain both parental consent and adolescent assent.¹⁶ Parents of rural adolescents may be mistrustful of outsiders who are perceived as disconnected from what are often tight-knit rural communities with shared values, especially around potentially sensitive topics, such as firearms.^{14 17} Rural adolescents may be particularly hard to recruit due to fewer families within a given community.^{7 10} Lower population density means there is less privacy, increasing concerns about confidentiality. Rural adolescents may know, or even be related to, peers in a focus group and feel less comfortable disclosing personal information.¹⁸

Available literature on recruitment for firearms research has focused on clinical, urban settings, leveraging systems of care (eg, large hospital system, Level 1 trauma centre).⁹ With larger patient volume, research participants are potentially easier to access. However, such systems are less common in rural areas. Barriers in these settings include limited personnel capacity to recruit participants who enter the healthcare system at all hours of the day and difficulty tracking eligible participants as they received treatment and were discharged. Fewer firearm injury prevention research efforts have focused on community-based, rural settings despite the greater burden compared with urban areas.^{6 19}

In the Youth Experiences in Rural Washington: Research on Firearm Safety project, adolescent participants, their parents or guardians, and Extension personnel were involved in the refining the data collection protocols and recruitment materials.

Barriers related to participant characteristics included concerns of confidentiality, misalignment with developmental stage, mistrust of the research process and transportation. Some adolescents and/or their parents expressed a preference for engaging in an individual interview rather than a focus group. In response, we adjusted the format to offer in-person focus groups as well as virtual focus groups and individual interviews. Not only did this address confidentiality concerns but also better met the adolescents’ preferred format for sharing. As mentioned previously, developmental stage was a factor not often addressed in the literature. We created developmentally appropriate recruitment materials (eg, advertisements) and consent forms and provided financial compensation in the form of a gift card. For example, in our social media advertisement, we included the incentive (“Do you want a $25 Amazon gift card?”) and the desire to hear the voice of adolescents by saying “WE WANT TO HEAR FROM YOU! WSU Extension invites you to join us for a Zoom focus group discussion with other teens or individual interview to share your experiences and opinion on firearms in rural communities.” We leveraged personal connections adolescents had with 4-H leaders as an additional motivator for participating in research and engaged adolescents in planning for data collection and recruitment. In rural areas and among historically minoritised individuals, historical mistrust and exploitation by researchers, academic institutions and even funders can serve as a barrier.^{8 10 21 22} Our strategy employed a CBPR process to engage community members, adolescents and parents in developing data collection protocols, identifying specific language used and piloting measures and processes. Finally, transportation is a consistent barrier in rural communities which often lack public transportation.^{10 21 22} Adolescents can have full calendars between school, extracurricular activities, work and home obligations, making scheduling data collection challenging, especially when long-travel times are required. In addition to collecting data online via Zoom, we provided a $15 fuel gift card to compensate participants for travel time and held focus groups during downtime at existing events (eg, Shooting Sports tournament) to leverage adolescents already being in one location.

Recruiter-related and institutional-related barriers included institutional structure, personnel characteristics and access to or ability to reach the study population. Institutional factors such as systems, policies and structure can serve as barriers to recruitment depending on available personnel and formal or informal relationships with other partners, providers etc.¹² The CBPR approach engaged Extension and 4-H youth development programmes which have a statewide presence and close partnerships with community-based organisations in rural areas. To ensure personnel had sufficient time allotted, project staff, including community-based Extension personnel, had a portion of their salary and effort paid for with project funds. Personnel characteristics can serve as barriers, such as lack of understanding of project, credibility and difficult or non-welcoming personality.¹² Strategies used to address this barrier included engaging Extension and 4-H Youth Development personnel with expertise in youth development and approaches to effectively engage youth, local credibility and, at times, personal relationships, as well as personal engagement with firearms. This resulted in personnel being viewed as ‘insiders’ among adolescents, their parents and in rural communities. Finally, access is needed to ensure the ability to reach the intended population. Engaging Extension and 4-H Youth Development meant we had access to online enrollment data including contact information for adolescents and parents. Recruitment intentionally leveraged connections between 4-H personnel and families. Instead of sending a mass email from a campus-based researcher, adolescents and parents were contacted via email, phone, 4-H social media and word of mouth by 4-H personnel. The contact list was used to verify enrollment and for targeted outreach by geographic region, race and or gender. To increase recruitment, we advertised through state and county Extension and 4-H Youth Development social media accounts (ie, Facebook, Instagram).

While carrying out the study, several strategies emerged addressing multiple participant and recruiter/institutional factors with potential to enhance firearms research with rural adolescents more broadly. These key considerations are grouped into logistics, use of a CBPR approach and accounting for developmental stage.