Successful recruiting for clinical research isn’t just about filling seats or collecting as much data as possible. True equity in clinical recruiting means ensuring underrepresented populations receive the same consideration as all others. Unfortunately, this is an area where many research efforts fall short, resulting in findings that may be wildly inaccurate for certain segments of the population.
Ensuring diverse participation in trials must be top-of-mind, as it may be the only way to rectify historical inequities and build a foundation of trust that fosters long-term engagement from marginalized groups.
Barriers to Representation
One of the most powerful barriers researchers encounter when recruiting underrepresented groups is a deep and pervasive mistrust of medical institutions. This isn’t surprising given historical injustices. Many have heard of the Tuskegee Syphilis Study, a decades-long syphilis study, during which 400 Black men were withheld treatment. Henrietta Lacks is the subject of another infamous case: Lacks was a Black woman with cervical cancer, whose cancer cells were taken, without her consent, for research. Her cells, now called HeLa, are still used today – nearly 75 years after her death.
These are just two of countless examples of historical mistreatment of marginalized groups in medical settings. To rebuild confidence among this demographic, researchers must strive to be transparent and culturally competent.
A dearth of trust is just one of the barriers preventing equity in recruiting for clinical research; practical hurdles are also pervasive. A large number of underrepresented individuals may lack the ability to participate in clinical trials due to geographic constraints, economic hardships, or educational limitations. Someone working multiple jobs to make ends meet is less likely to learn about a trial, much less have the time to participate.
Beyond that, there are cultural and linguistic mismatches that can easily prevent a research team from attracting participants from varied ethnic backgrounds. Childcare, transportation, and scheduling limitations are yet another hurdle that may discourage engagement from one or more demographics.
Lack of diversity within the research teams themselves only exacerbates these challenges. Would-be participants who don’t see representation within the team conducting the trial may be less inclined to engage with the study or trust the results.
Strategies that Promote Inclusive Recruitment
When it comes to increasing clinicoequity in recruitment, there are many strategies to consider, but research teams can adjust their approach using practical guidelines, including:
Community-Focused Engagement: Research teams can partner with local groups, faith-based organizations, or trusted community leaders to bridge the gap to underrepresented populations. These partnerships will take time, but they are ultimately essential to repairing trust that has eroded over time in key demographics.
Inclusive Communication: Multilingual recruitment materials are a must, and researchers should do their best to avoid overly technical jargon or needlessly complex concepts. Messaging should be designed to resonate with the target population while being transparent about the goals of the research team.
Tackling Logistical Barriers: Catering the trial to individuals who otherwise struggle to participate will yield more accurate results for patients of all ethnic and social backgrounds. In practice, offering mobile clinical sites, transportation, scheduling flexibility, and even childcare services can significantly lower the barrier for many participants.
Research Team Diversity: Ensure diversity within research teams to build trust and establish meaningful relationships with participants, demonstrating a commitment to inclusivity at every level of the study.
Clinical research teams can easily implement many of these strategies and foster trust and inclusivity with marginalized groups. Doing so also ensures that trial results are more accurate, as the sample correctly represents the larger population.
An Ethical and Scientific Imperative
For research teams conducting clinical trials, true diversity isn’t just a “nice to have.” Inclusivity significantly enhances the resulting data and bolsters the findings. We know that genetic variations, environmental impacts, and socioeconomic factors all impact health outcomes in different ways. Developing treatments based on trials that take these factors into account is a safer and more effective way to treat a broad population and mitigate side effects and questionable efficacy.
As an added positive — and one not to be taken lightly — recruitment that is highly inclusive also puts us one step closer to health equity. Ensuring participation by underrepresented groups allows researchers to discover new interventions while at the same time building bonds with communities that may not inherently trust modern medical systems. It’s a virtuous cycle that leads to boosted engagement and even better outcomes down the road.
Building a More Equitable Future
How different could the medical research look if we put clinicoequity at the center?
Just consider the case of Henrietta Lacks. Her cells were valuable because, while other cancer cells collected typically died quickly – Henrietta’s doubled every 20 to 24 hours, meaning that they could provide endless opportunities for research.
Since Henrietta’s cancer cells were collected shortly before her death in 1951, they have played a monumental role in developing healthcare advancements, including polio and COVID-19 vaccines, treatments for cancer, HIV, AIDS, and more. To date, a staggering 55 million tons of these cells have been used in over 75,000 scientific studies around the world. None of these life-saving innovations would have been possible without the discovery of Henrietta’s unique cells.
Now, we have the opportunity to uncover those groundbreaking types of discoveries in a systematic, ethical way; one where patients are informed of their contributions and play an active role in their healthcare decisions. By actively recruiting patients of unique and diverse backgrounds, we can pave the way for a healthier future that benefits us all.
A Path Forward
Striving for clinicoequity in recruitment isn’t just an ethical goal, but also a strategic imperative. Addressing decades of mistrust by ensuring inclusivity means that the research community can create a framework that serves all populations in the same manner.
More than just a compliance effort, Clinicoequity is about building a more effective and just healthcare system. Through these efforts, we will build a brighter future where clinical research is equitable and impactful for all segments of the population.