Definition Hard to Reach Groups - Literature review Example

Introduction The definition of the term “hard to reach” has been a subject of great debate. Local government has defined “hard to reach” groups as those that are difficult to engage and involve in public participation (Boag-Munroe & Evangelou 2012) . Since many of the issues arising from the lack of a convergent definition for the term affect local government workings, it is prudent to take a bird’s eye view of the term and its various definitions in order to come up with a proper working definition for this paper. According to Jones and Newburn (2001), it has always been unclear exactly what is meant when people use the term “hard to reach”. Sometimes, it is used to refer to different minority groups such as gays and lesbians, the homeless, or very commonly to ethnic minorities. Other times it is used in reference to “hidden people” who are difficult to contact either as a direct result of their choices or by default because of their locations. Such groups may include drug users and/or peddlers, or people of remote locations outside of the range of mainstream communication means. Other times still, it may refer to broader categories of people within the community like the elderly, the young, or those with disabilities. When used within the context of service, the term may refer to those who are “underserved” or those who are often difficult to engage in service- these may be mainly ethnic minority groups (Doherty et al. 2004). According to Atkinson and Flint (2001), and Duncan et al. (2003), this phrase may refer to populations which are hidden in a sampling context to mean that they are physically not easily accessible or noticeable therefore often not included. Again, these groups may be hidden as a consequence of their attempts to conceal their identities- sexually active teens, active users of illicit drugs, or gays and lesbians may fall within this category. The main problem with the term “hard to reach” is that it implies homogeneity within a group which may not always be the case, and the meaning varies from context to context. The definitions in use also insinuate that the problem lies within the fabric of the group under scrutiny as opposed to one’s efforts to reach them (Smith, 2006; Murphy 2006). It is therefore no wonder that hard to reach is taken to be a stigmatizing term. As observed by Freimuth and Mettger (1990), the prejudices surrounding this terminology can be summed in the words of Brackertz (2007) as follows: chronically uninformed, illiterate, obstinate, have-not, recalcitrant, disadvantaged, and malfunctional. In the context of this paper, hard to reach will mean people that are difficult to reach in terms of passing on information, and involvement in activities. This paper will discuss ways in which communities that have been hard to reach in Sunderland (which has been chosen at random to illustrate the ‘hard to reach’ concept) can be engaged successfully—for which purpose a framework will be created. It will also contain a conclusion section. Hard to reach groups in the City of Sunderland Sunderland, being the most populous city in the North East stands at a population of 280,807 as at the 2001 census. It is moderately ethnically mixed with 1.8% of its people being non-Caucasian. In the Tyne and Wear region, Sunderland’s proportion of people living in communal establishments (including special care and medical facilities) is higher than the average for the area at 1.9% according to the same census. Sunderland’s population is also marginally above average in comparison to the rest of the Tyne and Wear area in terms of the proportion of people with no qualifications as well as those who consider themselves as having one or more limiting chronic illnesses (Sunderland City Council 2015). The desire for community cohesion and the fulfillment of equalities standard work has driven the Council of Sunderland to define and address those communities perceived as hard to reach. Some of the city’s hard to reach groups are identified as: Individuals belonging to ethnic minority groups Individuals with disabilities The young The elderly Individuals who are gay, lesbian, or bisexual (Sunderland City Council 2015). It is important to note that this list is obviously non-comprehensive and misses a large number of groups which would fit within the definition of hard to reach such as the illiterate who may include the very young, and the uneducated among others. It also fails to take into account that some people may fit within more than one of these groups. This brings light to one of the problems underlying hard to reach groups: by categorizing them, does it make people in hard to reach groups even “harder” to reach perhaps through the exclusion of certain people? This implies that in the quest to characterize hard to reach groups, we create some even harder to reach groups which further compounds the problem (Rhodes, Kling & Johnston 2004). A list of identified groups is therefore not the most useful tool when it comes to dealing with hard to reach groups in the attempt to establish consultation with them. Consultation is defined as the development of a relationship and engagement with the community identifies as hard to reach (Sadler et al. 2010). As has already been substantiated above, certain groups may be hard to reach in some contexts and not in others. Health and Safety Executive (1994), and Jones and Newburn (2001) have found that it is more fruitful to link strategies that have been proven successful in consultation with hard to reach groups after characterizing the communities in question rather than just characterizing them. This basically means that it has been more beneficial to form solutions for these groups as opposed to just stopping at their identification and mapping. Because it is so broad, the term hard to reach is rendered rather impotent in terms of utility as it makes no attempt to solve the problem while complicating it further still. Some of these groups may perhaps be not-so-hard-to-reach if the correct approach is used in consultation (Sunderland City Council 2015). If one thing is agreed upon in the involvement of these groups, it is that those who wish to embark on the journey to engage them must set aside their own assumptions and prejudices. By doing so, they take down the filters through which they sieve and perceive everything about the community. They are forced to forget everything they may have held as true regarding these people in order to come to a new understanding of them and the issues facing them. The preconceptions held against hard to reach groups, when rationally and logically dissected, are often proven to have been misconceptions (Freimuth & Mettger 1990). Rather than labeling those classified as hard to reach as “not interested” or “difficult”, one may take the standpoint of the thesis on difference as opposed to the theory on deficit. The difference thesis stresses upon the utility of information to a people: if information is deemed useful by a group of people, then they will be motivated to seek it themselves and make use of it. A good case scenario that exemplifies this point is in the medical arena, if patients of a certain chronic disease, say diabetes mellitus, are drummed on with information about what to or not to do, they are more likely to not follow instructions as opposed to if one took the time to explain to them why certain things are good for their health while others aren’t and the decision is left to them to choose health. By adding value to the information, they are more likely to make use of it (Brackertz 2007). How to Improve Consultation In order to deliver on the intention of the UK government to create inclusive communities, improved consultation in Sunderland and other such diverse cities is fundamental (Sunderland City Council 2015). How might consultation be improved with hard to reach groups in this area? Some of the actions that could go into improving consultation in Sunderland are discussed here. First and foremost, it will be important to take another look at how hard to reach has been defined in the past, and to come up with a new, more constructive way to define the term. How else might hard to reach be defined and identified? MORI uncovered a new way to engage hard to reach groups: by picking out the means by which a service may be accessed by a group of people as opposed to by singling out people with certain characteristics and therefore classifying them as hard to reach. The idea behind this new approach is that the factors that make people hard to reach are not intrinsic, they are rather found in the service being offered and their inability to get to it. The distance, therefore, that needs covering, is not in the changing of the mindsets or whatever other internal factors there are governing these people but rather in the modification of the service to better fit the people it is meant for (Sunderland City Council 2015). A case scenario that is quintessential to the above hypothetical is as follows: if a school wishes to conduct consultation between its faculty, and its students and their parents, then those who would qualify as hard to reach would be those who have chronically low attendance or fail to see value in conventional education. These variations should therefore be taken to mind when constructing the model for consultation. A probable solution to this problem would be to engage the culprits by paying an actual visit to their physical addresses in order to capture them in the bracket being targeted (Feiler 2010). If a certain organization, say a hospital for example, wants to find out how well its services are delivered, then they might find that the hardest population to reach would be those who are not seriously unwell as they see no need to receive treatment for illnesses that are self-limiting or that they are able to care for on their own. This method of classification therefore breaks down the hard to reach group based on the service that they are not making contact with rather than on the basis of characteristics which are considered to be problematic. Although one may argue that in the evaluation of a service, the group to be scrutinized needs to consist of actual service users, the point here is to illustrate how one may define hard to reach in different contexts (Brafield & Eckersley 2008). The emphasis of this system takes away blame from the group and instead places the responsibility in the hands of the service provider and it is now he who has to reanalyze their systems and restructure them so that they are more appropriate for this group. This is the most important part of establishing consultation with any hard to reach group (Baruch, Fonagy & Robins 2007). The next step is ensuring that consultation is carried out in a manner that is highly effective, competent, held to a high standard and that systems are installed to be used as checkpoints for accountability purposes. Constant monitoring and regular evaluation of consultation is necessary if standards are to be maintained. A document for standardization of the consultation activities throughout the City should be created in order to for the process to be success. The document should entail the dos, don’ts, whys and hows of consultation. This should ensure uniformity and as a by-product, cohesion within the community (Baruch, Fonagy & Robins 2007). Importance of Community Consultation Community consultation refers to the spectrum of activities involved in the engagement of residents, both users and non-users or services, and finally businesses in a bid to make decisions that influence service delivery to the community by the county council and thus improve the community. It is therefore important that the community engages in the process of consultation to Help the county council improve the way they deliver services, Improve the residents’ satisfaction from the use of services intended for them Improve the relationship between the council and residents Promote community cohesion in the long run (Flanagan & Hancock, 2010). By improving community consultation, the community gets a chance to participate in the making of policies and have a say in the quality and ways in which services are delivered. This way, both parties come out on top as their work becomes easier and they are satisfied by each other in a symbiotic relationship (Flanagan & Hancock, 2010). Some of the methods used in Sunderland for improving consultation include the following: public meetings, discussion groups, online forums, surveys, local events, citizens’ juries, participatory workshops, exhibitions which involve a higher level of involvement like citizens’ panel or other forums which are based around specific issues. Those involved may be residents, those working or studying or visiting in Sunderland, service users and business owners among others (Sunderland Partnership 2011). Conclusion Hard to reach is a difficult though not impossible term to define. Though it has been established that the problem lies not so much in its definition but the actions that follow its identification, hard to reach groups continue to face stigma from society and those in authority alike. In redefining the term hard to reach lies all the solutions to the age old problem. References Atkinson, R., & Flint, J. (2001). Accessing hidd en and hard-to-reach populations: Snowball research strategies. London: University of Surrey. Retrieved from http://www.soc.surrey.ac.uk/sru/SRU33.html Baruch, Geoff, Peter Fonagy, and David Robins. Reaching The Hard To Reach. Chichester, England: John Wiley & Sons, 2007. Print. Boag-Munroe, Gill, and Maria Evangelou. 'From Hard To Reach To How To Reach: A Systematic Review Of The Literature On Hard-To-Reach Families'. Research Papers in Education 27.2 (2012): 209-239. Web. Brackertz, Nicola. Who Is Hard To Reach And Why?. ISR Working Paper, 2007. Print. Brafield, Helen, and Terry Eckersley. Service User Involvement. London: Jessica Kingsley Publishers, 2008. Print. Doherty, P., Stott, A., & Kinder, K. (2004). Delivering Services to Hard to Reach Families in On Track Areas: Definition, Consultation and Needs Assessment. London: Home Office Development and Practice Report, 15. Retrieved from http://www.homeoffice.gov.uk/rds/pdfs2/dpr15.pdf Duncan, D., White, J., & Nicholson, T. (2003). Using internet-based surveys to reach hidden populations: Case of nona busive illicit drug users. American Journal Of Health Behavior, 27(3), 208-218. Retrieved from http://www.duncan-associates.com/hiddenpop.pdf Feiler, Anthony. Engaging 'Hard To Reach' Parents. Chichester, West Sussex, England: John Wiley & Sons, 2010. Print. Flanagan, S., & Hancock, B. (2010). 'Reaching the hard to reach' - lessons learned from the VCS (voluntary and community Sector). A qualitative study. BMC Health Services Research, 10(1), 92. doi:10.1186/1472-6963-10-92 Freimuth, V., & Mettger, W. (1990). Is there a hard-to-reach audience?. Public Health Reports, 105(3), 232-238. Health and Safety Executive,. (1994). Successful Interventions in Hard to Reach Groups. Retrieved 26 May 2015, from http://www.hse.gov.uk/research/misc/hardtoreach.pdf Jones, T., & Newburn, T. (2001). Widening Access: Improving Police Relations with Hard to Reach Groups. London: Home Office Policing and Reducing Crime Unit. Murphy, P. (2006). Practical: Reaching the Hard-to-Reach. ProjectsETC. Retrieved 26 May 2015, from http://www.projectsetc.org/all_about_audiences/reaching_the_hard_to_reach.html Rhodes, William, Ryan Kling, and Patrick Johnston. A Model-Based Approach For Estimating Prevalence Of Hard To Reach Populations. Cambridge: Abt Associates, Inc., 2004. Web. 28 June 2015. Sadler, Georgia Robins et al. 'Research Article: Recruitment Of Hard-To-Reach Population Subgroups Via Adaptations Of The Snowball Sampling Strategy'. Nursing & Health Sciences 12.3 (2010): 369-374. Web. Smith, G. (2006). Hard-to-reach groups don’t exist. Delib. Retrieved 26 May 2015, from http://www.delib.co.uk/dblog/hard-to-reach-groups-don-t-exist Sunderland City Council,. (2015). Corporate Consultation Framew ork for Hard to Reach Groups. Sunderland: Sunderland City Council. Retrieved from http://www.sunderland.gov.uk/CHttpHandler.ashx?id=8343&p=0 Sunderland Partnership,. 'Consultation-Ref'. Sunderlandpartnership.org.uk. N.p., 2011. Web. 28 June 2015. Read More

It is moderately ethnically mixed with 1.8% of its people being non-Caucasian. In the Tyne and Wear region, Sunderland’s proportion of people living in communal establishments (including special care and medical facilities) is higher than the average for the area at 1.9% according to the same census. Sunderland’s population is also marginally above average in comparison to the rest of the Tyne and Wear area in terms of the proportion of people with no qualifications as well as those who consider themselves as having one or more limiting chronic illnesses (Sunderland City Council 2015).

The desire for community cohesion and the fulfillment of equalities standard work has driven the Council of Sunderland to define and address those communities perceived as hard to reach. Some of the city’s hard to reach groups are identified as: Individuals belonging to ethnic minority groups Individuals with disabilities The young The elderly Individuals who are gay, lesbian, or bisexual (Sunderland City Council 2015). It is important to note that this list is obviously non-comprehensive and misses a large number of groups which would fit within the definition of hard to reach such as the illiterate who may include the very young, and the uneducated among others.

It also fails to take into account that some people may fit within more than one of these groups. This brings light to one of the problems underlying hard to reach groups: by categorizing them, does it make people in hard to reach groups even “harder” to reach perhaps through the exclusion of certain people? This implies that in the quest to characterize hard to reach groups, we create some even harder to reach groups which further compounds the problem (Rhodes, Kling & Johnston 2004).

A list of identified groups is therefore not the most useful tool when it comes to dealing with hard to reach groups in the attempt to establish consultation with them. Consultation is defined as the development of a relationship and engagement with the community identifies as hard to reach (Sadler et al. 2010). As has already been substantiated above, certain groups may be hard to reach in some contexts and not in others. Health and Safety Executive (1994), and Jones and Newburn (2001) have found that it is more fruitful to link strategies that have been proven successful in consultation with hard to reach groups after characterizing the communities in question rather than just characterizing them.

This basically means that it has been more beneficial to form solutions for these groups as opposed to just stopping at their identification and mapping. Because it is so broad, the term hard to reach is rendered rather impotent in terms of utility as it makes no attempt to solve the problem while complicating it further still. Some of these groups may perhaps be not-so-hard-to-reach if the correct approach is used in consultation (Sunderland City Council 2015). If one thing is agreed upon in the involvement of these groups, it is that those who wish to embark on the journey to engage them must set aside their own assumptions and prejudices.

By doing so, they take down the filters through which they sieve and perceive everything about the community. They are forced to forget everything they may have held as true regarding these people in order to come to a new understanding of them and the issues facing them. The preconceptions held against hard to reach groups, when rationally and logically dissected, are often proven to have been misconceptions (Freimuth & Mettger 1990). Rather than labeling those classified as hard to reach as “not interested” or “difficult”, one may take the standpoint of the thesis on difference as opposed to the theory on deficit.

The difference thesis stresses upon the utility of information to a people: if information is deemed useful by a group of people, then they will be motivated to seek it themselves and make use of it. A good case scenario that exemplifies this point is in the medical arena, if patients of a certain chronic disease, say diabetes mellitus, are drummed on with information about what to or not to do, they are more likely to not follow instructions as opposed to if one took the time to explain to them why certain things are good for their health while others aren’t and the decision is left to them to choose health.

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