Internet Sexuality Research with Rural Men Who Have Sex with Men: Can We Recruit and Retain Them?

Article excerpt

HIV seroprevalence in rural areas has increased steadily since 1982 (Lam & Liu, 1994). In rural areas, men who have sex with men (MSM) account for a majority of the HIV/AIDs cases (Centers for Disease Control and Prevention, 2001). Quantitative research studies with rural MSM are sparse, probably because traditional methods of recruiting are difficult with such highly stigmatized groups, and the travel expenses required to make face-to-face contact are high. The emergence of the internet, both as a virtual social community and as a research tool, presents an excellent opportunity for contacting rural populations. Rural people, particularly rural MSM, are rapidly increasing their use of the internet (Bell, Reddy, & Rainie, 2001), rural MSM in particular. In Wyoming (Williams, Bowen, & Horvath, 2005), MSM indicate that the internet is a primary resource for making contact with other MSM and that internet-delivered risk reduction interventions would be welcomed.

The internet's accessibility, affordability, anonymity (Cooper, 1998), and acceptability (King, 1999) make it especially attractive for research with hidden and stigmatized groups. Anyone with access to a computer and a modern is a potential participant, and respondents may access the research at a time and place convenient to them (Binik, 2001; Mustanski, 2001). Internet data collection is rapid and reasonably inexpensive, and large numbers of participants can be recruited from diverse locations (Cooper, Scherer, & Mathy, 2001). Samples appear to provide more variability than face-to-face interviews (Ross, Tikkanen, & Mansson, 2000; Tikkanen & Ross, 2000). Also, surveys can be tailored to the participants' responses and branching is invisible, thus lowering the participant burden.

Conversely, the internal validity of internet research may be threatened if participants feel less pressure to complete surveys (Frick, Bachtiger, & Reips, 2001), resulting in high "hit" to completion rates (Birnbaum & Mellers, 1989; Ross, Danebeck, Mansson, Tikkanen, & Cooper, 2003) or early abandonment (Crawford, Couper, & Lamias, 2001). Studies with urban MSM support this concern. For example, Ross, Rosser, Stanton, and Konstan (2004) recruited Latino MSM for an internet study and received 33,024 clicks on their banner ads. While 1,742 (5%) of the "click through" men qualified for the study and said they wanted to enroll, only 1,546 (89%) initiated the questionnaire. The survey completion rate for initiators was 65.4%. Similar hit to initiation (0.7%) and survey completion rates (51.2%) were reported by Ross et al. (2003) in their internet study of Swedish MSM. On the other hand, Elford, Bolding, Davis, Sherr, and Hart (2004) conducted an online survey of MSM in London, and although they did not report absolute completion rates, 97% of 1,250 men provided sufficient data to examine HIV status and sexual risk behaviors.

Three important outcomes should be noted from these studies: web banners attract urban MSM, including minorities; banners successfully recruit large numbers of initiators; and survey completion rates are often low. Ross et al. (2004) identified some correlates of completion among their urban participants. The men identified their preferred reimbursement method prior to initiating the questionnaire, and dropouts were more likely to have rejected the $20 compensation or offered it to a charity. Other correlates of dropping out included having not met men for sex on the internet, identifying as bi- or heterosexual, and using the internet less at home. Bull, Lloyd, Rietmeijer, and McFarlane (2004), in an internet-based prevention program for MSM, cited lack of contact information and inadequate incentives as primary issues leading to only 13% retention at the one-month follow-up. Meaningful compensation has also been identified as a successful retention strategy in non-internet studies (Leonard et al., 2003). …