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A more recent article on preventive health care for women who have sex with women is available. Patient information: See related handout on health care for lesbians and bisexual women. For the most part, lesbians and bisexual women face the same health issues as heterosexual women, but they often have difficulty accessing appropriate care.

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The study of sex trafficking, prostitution, sex work, and sexual exploitation is associated with many methodological issues and challenges. Community advisory boards and key stakeholder involvement are essential to study de to increase safety of participants, usefulness of study aims, and meaningfulness of conclusions. Nonrandomized sampling strategies are most often utilized when studying exploited women and girls, which have the capacity to provide rich data and require complex sampling and recruitment methods.

This article reviews the current methodological issues when studying this marginalized population as well as strategies to address challenges while working with the community in order to bring about social change. The authors also discuss their own experiences in collaborating with community organizations to conduct research in this field. There are numerous methodological issues to consider when studying individuals who trade or sell sex, some of whom may be described or self-identify as victims, prostitutes, or sex workers and traders. The complexity of definitions related to individuals who trade or sell sex in some capacity is described elsewhere in great detail Gerassi, The ways in which we describe individuals who trade or sell sex i.

Ranging degrees of force and coercion involved in sexual exploitation as well as differences in terminology require clear inclusion criteria that will further advance the field of study in this area. Consequently, the discussion here will draw primarily from existing literature to explore best practices when deing studies that focus broadly on the study of individuals who are exploited in some way into trading or selling sex.

Deing studies in collaboration with community partners and other experts from the field is an important step to ensure the safety of participants in addition to high levels of participant recruitment and overall success of the project.

Although community involvement and collaboration may be time consuming to any research agenda, it is Women want sex Bybee to the feasibility and utility of the research process and. Research questions and applicability were strengthened by collaboration and existing participation with community boards and coalition members.

Existing partnerships were critical in crafting research questions and dissemination of findings.

The rest of of the sampling strategies that target sexually exploited women are a review of the literature. This article reviews the methodological developments and sampling techniques when studying sexual exploitation and sex work drawing from the extant research, and closes with a reflexive of the benefit of community collaboration in study de.

The process of deing a safe and highly rigorous study of sexually exploited women and girls is not without its challenges. Due to the hidden nature of the population, nonrandomized sampling techniques must are often utilized, charging researchers to balance methodological rigor and feasibility. Community and key stakeholder involvement will increase the likelihood of gathering rich data, drawing meaningful conclusions, and creating the most impact from the study.

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Project des and sampling strategies have become more diverse and stronger methodologically, especially in the use of innovative recruitment techniques. The following section reviews the major methodological issues when conducting research with sexually exploited women and girls.

It is imperative to employ strategies to increase safety measures for both participants and researchers, particularly when studying highly stigmatized and vulnerable populations involved in dangerous situations. In addition to ethical requirements of any research interviewer i.

These described precautions were taken to increase the safety of participants and researchers throughout the course of the study. Beyond the essential safety considerations, deing studies in order to effectively and rigorously survey and understand this population without causing further exploitation or harm is both critical and challenging.

Ongoing involvement in organized groups may also be helpful in processing complex problems in practice and research. For example, our ongoing involvement in a local coalition, which includes survivors of and practitioners who address sexual exploitation has been essential in shaping research questions and in gaining support for ongoing projects.

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Without this ongoing participation and collaboration, our insight into the challenges of serving this complex population would be hindered. These partnerships and trusted relationships are important in the de of any study involving sexually exploited women and girls. As such, this educational process for both researchers and participants analyzes the named problem and takes collective action as a planned consequence of scientific inquiry. While models of participatory research may vary, there are five general guidelines to be upheld with any project Maguire, : 1 organization of the project and knowledge of the working area, which requires establishing relationships with community organizations, leaders, institutions, and therefore originates within the particular community; 2 process by which researchers and participants identify and understand various perceptions of the most ificant problem within the community; 3 advancing inquiry in which researchers and participants compile questions and themes to be investigated; 4 researching social reality and analyzing collected information in which the research is deed and conducted Women want sex Bybee researchers with community partners; and 5 definition of action projects, in which researchers and community members decide on next steps to address the identified problem.

Involving community practitioners as well as members of the target population who are in a safe and emotionally ready space to participate healthily can be essential to the safety and breadth of any project with this population. One step in involving community participation is the creation of a community advisory panel or board, which may provide much needed perspective to translate methodological des into reality and strengthen safety measures taken against coercion of participants Martin et al.

Community advisory boards can be assembled through coalitions or other advocates working with the population of interest as well as members of that population, as applicable.

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For example, in its original de Martin relied on study participants to come into contact with probation, law enforcement, prostitution-specific programming or other locales, and subsequently be recruited into the study by those partners. Participants were asked to call and schedule an appointment, yielding 20 calls from participants and only four completed interviews. Based on feedback from the committee, consisting of practitioners and individuals who traded sex, the project shifted its approach from an appointment-based de to a completely anonymous, drop-in model utilizing outreach flyers that neither required nor even asked names or any identification as ly described.

Researchers credit their collaboration with community practitioners and individuals who had ly traded sex with the restructuring and ultimate success with the project. Other examples include several count variables that are then added into an overall sexual risk behavior score. Partnering with the community would reduce limitations of count variables and existing scales, creating the potential to provide richer data.

De strategies from sexual exploitation and sex work studies among women and girls: methodological considerations in a hidden and vulnerable population

Empirical studies that utilize quantitative and qualitative methodological des and are grounded in partnership with stakeholders have the opportunity to construct more meaningful research questions that are applicable to sexually exploited populations. Without such partnerships, researchers remain at risk of conducting poor and meaningless social science. Research questions and subsequent findings may not elucidate the true nature of sexual exploitation and may lead to counterproductive decisions with regard to identification, prevention, and practice.

Utilizing a community advisory board or other forms of member checking throughout the methodological process may strengthen the quality of the project and the utility and applicability of the. Consequently, it is important to look for details describing such community advisory boards or community involvement throughout research publications and reports.

Such information gives us context as to whether the study de choices made attempted to consider all practical implications to collecting data safely and the dissemination and implementation of among local communities. Nonrandomized sampling strategies with increasing rigor and innovative methodology are almost always utilized with the study of hidden and hard-to-reach populations, such as sexually exploited individuals.

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The majority of studies focusing on sexual exploitation and sex work have utilized a qualitative approach, which requires nonrandomized sampling strategies, as these studies generally aim to uncover phenomena and understand processes that would be lost in quantitative des Padgett, Purposive sampling snowball sampling in particular and facility-based or target sampling are most often utilized for hidden, stigmatized populations and can present various strengths and weaknesses for methodological rigor. Despite some criticism, a relatively new technique in the literature called respondent-driven sampling RDS is gaining increased evidence as another rigorous sampling strategy for hidden populations and has primarily been used to administer surveys and collect data.

The diversification of sampling strategies has also been shown to provide a more inclusive sample of any heterogeneous target population Singer, This section reviews the relevant sampling strategies and the state of rigor associated with each method as well as recruitment techniques for hidden and hard-to-reach populations.

Purposive sampling is commonly used with the study of sexual exploitation and sex work, particularly when a qualitative study is deed. The first respondents to the study, known as seeds, then refer other individuals who meet inclusion criteria to researchers.

A review of the evidence suggests that snowball sampling is the most commonly utilized method for studying sexually exploited women and girls, as it is described in multiple studies i. Although purposive and specifically snowball sampling allows for stigmatized or hidden populations to be interviewed or surveyed, it has been criticized for its tendency to sample more cooperative participants as well as those already connected to a particular service.

Thus, the truly stigmatized or hidden members of that population who may have fewer or no known connections to the original seeds may be missed Shaver, This further underscores the importance of community involvement and collaboration when deing the study, as they may be able to penetrate into more hidden networks than the researcher could do alone.

When conducting qualitative work, findings should lead to saturation, that is a point in which the collection of new data does not shed any further light on the issue under investigation Mason, Because qualitative work aims to uncover contextual complexities and key dynamics of a particular phenomenon and not necessarily generalize to an entire population, nonrepresentative sampling and particularly purposive sampling is considered a rigorous and appropriate methodology Padgett, Facility-based or target sampling involving one particular location is often used to capture experiences, correlates, and prevalence of sexually exploited women and girls in prisons or juvenile detention Lopez et al.

In addition, many Women want sex Bybee reports cite prevalence statistics from hotline call centers, which requires individuals to self-identify or identify another as a potential sex trafficking victim in order to file a report Lange, Facility-based sampling is particularly helpful in understanding the dynamics of those individuals who actually seek services voluntarily or are mandated through law enforcement Magnani et al.

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Although it can be useful if the researcher is able to penetrate all networks of the population, it may also result in the overrepresentation of the more visible participants i. Clinical samples are limited, in that those who receive services may have distinct experiences from those who do not access them or who choose not to use them. RDS begins with a small of individuals, known as seeds, and expands participant involvement through various waves of peer recruitment.

When the second wave of participants are recruited and interviewed, they are then given the same predetermined of coupons to give their peers until several waves of recruitment have occurred. In order for this method to be employed as it was intended, Magnani et al. Without the presence of just one of these components, true RDS has not occurred. RDS is helpful in creating voice as it requires considerable interactions with key stakeholders, and thus can give a voice to research in a way that other traditional quantitative methods may not.

For example, a participant of a study targeting exploited individuals only may give a coupon to a friend who does not identify as exploited.

To combat these potential problems, Gile and Handcock recommend that Women want sex Bybee pay particular attention in the selection of initial seeds in ensuring that they meet specified inclusion criteria of the target population and across various population components. In addition, targeting individuals with a broader terminology i. This process can and we hope would occur with community involvement to strengthen the feasibility and utility of the study. However, this method may not be the best fit for all studies within this population, as it requires seeds or participants to provide some identifying information such as a name to be tracked in some way and therefore creates potential challenges for safety.

Those with safety or confidentiality concerns may consequently be less likely to participate, thereby limiting the sample. With the involvement and collaboration of a community board, the most rigorous yet safest study de may be achieved. Outreach methods of recruitment are seen as a bridge between service providers and those in need of services and may be a tool of selective recruitment from deated Women want sex Bybee or neighborhoods by specific subgroups Singer, In using this method for research purposes, there are three criteria for evaluation of potential use and rigor, which include 1 ability to reach the target population, 2 ability to successfully rerecruit appropriate study participants, and 3 ability to rerecruit participants for follow-up as necessary Singer, Outreach recruitment methods within particular geographic areas and in conjunction with outreach organizations that are already integrated into target communities may be instrumental in accessing a hidden population, as this population subgroup may not come into contact with services any other way.

Researchers who have conducted this work appear to have different philosophies on the implementation of outreach methods in the field. For example, Shaver strolled in known areas of prostitution, introduced themselves and their research projects, and provided potential participants with business cards with full research center and other contact information. Others have opted out of this type of procedure in the event that identifying information was found by another party i. While confidentiality and anonymity are key concepts in any research study, these concerns are of particular importance to women and girls who live in potentially dangerous and even lethal situations.

There are different strategies to increase safety while targeting hard-to-reach and hidden populations, such as sexually exploited women and girls. The utilization of a mobile van or stationary field site has gained support as a technique to both increase safety and conduct a methodologically rigorous study Singer, Partnerships in place with a fixed field site has the potential to increase general access to services, as participants of the research study may return to the same sites to acquire prevention materials, snacks, or safe sex kits.

One way to ensure increased variability of experiences when studying hidden and hard-to-reach populations is to diversify sources and strategies of recruitment. Another approach would be to begin with purposive sampling and continue with participant-led recruitment strategies from fixed sites. The diversification of sampling strategies and sites i.

For example, in a study examining domestic violence victim advocacy practices conducted by the third author, relationships with individuals in two participating organizations had already been established through volunteer work, as well as personal and professional relationships Nichols, Through these relationships, informal discussions of challenges to advocacy and key research needs took place over a period of time, eventually guiding the study de and resulting research questions.