Communication problems occur in general practice consultations when migrants and general
practitioners do not share a common language and culture. Migrants’ perspectives have rarely been included in the
development of guidelines designed to ameliorate this. Considered ‘hard-to-reach’ on the basis of inaccessibility,
language discordance and cultural difference, migrants have been consistently excluded from participation in
primary healthcare research. The purpose of this qualitative study was to address this gap.
Methods: The study was conducted in the Republic of Ireland, 2009 – 2011. We developed a multi-lingual
community-university research team that included seven established migrants from local communities. They
completed training in Participatory Learning & Action (PLA) - a qualitative research methodology. Then, as trained
service-user peer researchers (SUPERs) they used their access routes, language skills, cultural knowledge and
innovative PLA techniques to recruit and engage in research with fifty-one hard-to-reach migrant service-users
Results & discussion: In terms of access, university researchers successfully accessed SUPERs, who, in turn,
successfully accessed, recruited and retained MSUs in the study. In terms of meaningful engagement, SUPERs
facilitated a complex PLA research process in a language-concordant manner, enabling inclusion and active
participation by MSUs. This ensured that MSUs’ perspectives were included in the development of a guideline for
improving communication between healthcare providers and MSUs in Ireland. SUPERs evaluated their experiences
of capacity-building, training, research fieldwork and dissemination as positively meaningful for them. MSUs
evaluated their experiences of engagement in PLA fieldwork and research as positively meaningful for them.
Given the need to build primary healthcare ‘from the ground up’, the perspectives of diverse groups,
especially the hard-to-reach, must become a normative part of primary healthcare research. PLA is a powerful,
practical ‘fit-for-purpose’ methodology for achieving this: enabling hard-to-reach groups to engage meaningfully
and contribute with ease to academic research. PLA has significant potential to become a ‘standard’ or generic
approach in building community-based primary health care. Community–university partnerships have a significant
role to play in this, with capacity to radically influence the shape of healthcare research, expanding the research
agenda to incorporate the views and needs of hard-to-reach and vulnerable populations.