See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/291162231

Snowball sampling

Article in The BMJ · December 2013

DOI: 10.1136/bmj.f7511

CITATIONS READS

58 21,071

1 author:

Philip M. Sedgwick
St George's, University of London
437 PUBLICATIONS 9,743 CITATIONS

SEE PROFILE

All content following this page was uploaded by Philip M. Sedgwick on 19 January 2016.

The user has requested enhancement of the downloaded file.

BMJ 2013;347:f7511 doi: 10.1136/bmj.f7511 (Published 20 December 2013)
Endgames
STATISTICAL QUESTION
Snowball sampling
Philip Sedgwick reader in medical statistics and medical education
Centre for Medical and Healthcare Education, St George’s, University of London, London, UK
Researchers examined the association between plasma HIV-1
RNA concentrations and the incidence of HIV in injecting drug
users. A prospective cohort study design was used. Participants
were injecting drug users, with or without HIV, followed up
every six months between 1 May 1996 and 30 June 2007. Cohort
members were recruited from an inner city community in
Vancouver, Canada, using the method of snowball sampling.
In total, 622 injecting drug users with HIV and 1429 injecting
drug users without HIV were recruited.1
The researchers reported that in the community of injecting drug
users, a longitudinal measure of plasma HIV-1 RNA
concentration was positively correlated with the HIV incidence
rate, independently of unsafe sexual behaviours and sharing
used syringes. It was concluded the results could help inform
HIV prevention and treatment interventions.
Which of the following statements, if any, are true?
a) Snowball sampling constitutes probability sampling
b) Snowball sampling requires the construction of a sampling
frame
c) Snowball sampling is prone to selection bias
Answers
Statement c is true, whereas a and b are false.
Two types of sampling methods can be used to recruit
participants to a study—random sampling (sometimes called
probability sampling) and non-random sampling (sometimes
called non-probability sampling) methods. Snowball sampling
is a type of non-random (non-probability) sampling method (a
is false).
Random sampling methods involve some form of random
selection of the members of the population. Each member of
the population has a known and typically equal probability of
being selected for the sample. The most straightforward type
of random sampling method is simple random sampling
(sometimes referred to as random sampling). Random sampling
requires knowledge of exactly who is in the population, with
construction of a sampling frame—that is, a list of everyone in
the population. A sample of a fixed size is selected at random
from the list, with all members of the population having the
p.sedgwick@sgul.ac.uk
For personal use only: See rights and reprints http://www.bmj.com/permissions
Page 1 of 2
ENDGAMES
same probability of being selected independently of all others.
The probability that a population member will be chosen is
known in advance.
In the above study, snowball sampling initially involved
identifying an easily accessible small number of injecting drug
users for recruitment to the cohort. These cohort members then
recommended other injecting drug users as potential cohort
members, who in turn suggested others. The method is so called
because the number of sample members increases with time,
analogous to a snowball accumulating snow as it rolls down a
hill. Snowball sampling is used to recruit samples when
members of the desired population are hard to reach or access
because they feel disempowered, socially excluded, or
vulnerable.
Snowball sampling was probably the only sampling method
that could have been used to obtain a reasonably representative
sample of injecting drug users. Unlike random sampling
methods, it did not require the construction of a sampling frame
(b is false). However, it would probably not have been possible
to construct a list of injecting drug users in the community
because they would have been hard to access. Even if they were
identified, they might have shown a certain amount of distrust
and been reluctant to be recruited if approached at random. The
use of existing cohort members to recommend other potential
members probably encouraged recruitment through an element
of trust in the community. To increase recruitment and ensure
that loss to follow-up was minimised, cohort members were
offered $C20 (£11.5; €13.7; $18.8) at each study visit.
The cohort that resulted from snowball sampling was prone to
selection bias (c is true). Selection bias, described in a previous
question,2 would have occurred if the injecting drug users
recruited to the cohort were systematically different from those
who were not recruited—resulting in the cohort not being
representative of the population. Recruitment of injecting drug
users depended on the recommendations of existing cohort
members. Therefore, the cohort was unlikely to be representative
of the population owing to biases in the injecting drug users
who were recommended. For example, injecting drug users who
did not have many friends were less likely to be recruited.
Typically, any sample resulting from non-probability sampling
Subscribe: http://www.bmj.com/subscribe
 BMJ 2013;347:f7511 doi: 10.1136/bmj.f7511 (Published 20 December 2013) Page 2 of 2

ENDGAMES

methods is considered not to be representative of the population. 1 Wood E, Kerr T, Marshall BDL, Li K, Zhang R, Hogg RS, et al. Longitudinal community
plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users:
Little is known about the properties of samples resulting from prospective cohort study. BMJ 2009;338:b1649.
snowball sampling. 2 Sedgwick P. Selection bias versus allocation bias. BMJ 2013;346:f3345.

Competing interests: None declared. Cite this as: BMJ 2013;347:f7511

© BMJ Publishing Group Ltd 2013

For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
View publication stats