Challenges of the Traditional Clinical Trial Recruitment Process

From novel treatments in oncology to vaccine innovations, modern-day advancements in medication research have accelerated significantly. However, whether the trials spurring these progressions have been equitable is questionable. A whopping 75% of trial participants were White in 2020.  ‍

This gap in representation reveals a tough truth: traditional recruitment has fallen drastically short of including all communities that could benefit from novel therapies. As this problem continues to pervade the pharmaceutical industry, it’s essential to understand the exact challenges are at play for representative clinical trial recruitment, as well as what strategies can help remove barriers to recruitment in clinical trials. 

Challenges in recruitment and retention of clinical trial subjects

1. A failure to mobilize diverse participant pools 

Drug research that takes a one-size-fits-all approach to clinical recruitment often fails to attract diverse participant pools that accurately represent the broader population. This includes underrepresentation of racial and ethnic groups, but also of women, the elderly, and individuals from rural or low-income areas. This lack of diversity can lead to biased results that do not adequately reflect the effectiveness or safety of treatments for all population groups. Indeed, this results in healthcare disparities, where certain groups may not benefit equally from medical advancements. But it could also present go-to-market obstacles when it comes to advertising new medicine across demographics.

Acclinate’s NOWINCLUDED community platform includes over 100,000 members. Discover how it works here.

2. Distrust in the healthcare system

Historical abuses and unethical practices in medical research — such as the Tuskegee Syphilis Study — have fostered deep distrust in the healthcare system among certain communities, particularly Black Americans and other communities of color. This makes it challenging to engage and recruit participants from these groups, leading to a continued underrepresentation in clinical trials and perpetuating a cycle of inequity in medical research and treatment outcomes. 

3. Accessibility and convenience 

Many clinical trials are conducted at specialized centers — some of which may be located far from where potential participants live. This geographic barrier can make participation difficult, especially for individuals without reliable transportation or those living in remote areas. Lack of accessibility disproportionately affects low-income individuals and those living in remote areas, limiting their participation in clinical trials and skewing trial results towards more urban and affluent populations. This issue can be observed on a macro scale. For instance, Texas is home to just under 10% of the country’s population, but a mere 3.56% of clinical trials take place in the Lone Star State.

4. Awareness and education

Potential participants might not be aware of clinical trials or might not understand the importance and potential benefits of participating. There can be a lack of effective communication and outreach to diverse communities. Subpar awareness and education efforts contribute to the underrepresentation of communities of color, as a lack of information about opportunities and relevance to their health further diminishes participation.

Discover how Acclinate helped one clinical research organization improve diverse recruitment for an RSV trial.

5. Biases built into eligibility criteria

Stringent and narrow eligibility criteria for clinical trials can exclude a significant portion of the population. Research often focuses on individuals without comorbidities, not reflecting the diversity of patients who will eventually use the resulting treatments, and also disproportionately excludes older adults and those from diverse racial and ethnic backgrounds. For example, one study discovered only 8% of cancer drug trials between 2008 and 2018 included participants from all four major racial groups in the U.S.

Overcoming barriers to recruitment in clinical trials

These challenges to successfully implementing inclusive trials are significant. But they are possible to overcome. Some strategies clinical research sponsors should consider include:

• Developing targeted outreach and education programs to genuinely raise awareness and build trust in underrepresented communities. There’s no question that traditional, mass-market strategies for recruiting diverse trial participants are outdated and ineffective. Clinical research sponsors must invest in nuanced community-building platforms that actively educate potential participants and build trust.
• Carefully planning trial sites in locations that are accessible to diverse and underserved populations. It’s one thing to prioritize outreach to diverse communities. It’s another to secure locations to conduct trials in areas that are easily accessible by these constituents. It’s imperative to carefully select facilities where diverse participants can easily attend. Acclinate’s AI-powered predictive analytics platform, e-DICT, enables trial sponsors to pinpoint participation interest by location to support better decision-making when it comes to identifying ideal zones for conducting research.
• Providing logistical support, such as transportation and flexible scheduling, to make participation more accessible. Even when your company does its due diligence to provide education opportunities for historically marginalized communities, you might not see the participation in clinical trials you expect if target participants face significant barriers related to social determinants of health (SDOH). Establish support systems such as complementary shuttle services to ensure everyone has access to your medical research.
• Engaging community leaders and advocates to promote trial participation and ensure culturally sensitive communication. People don’t listen to brands. People listen to people. Forge sincere and ongoing partnerships with community leaders to promote diverse clinical recruitment. Acclinate’s NOWINCLUDED community platform is driven by long-standing, mutually beneficial collaborations that can accelerate your DEI efforts and authenticate your clinical recruitment process.

Advance and expand your clinical recruitment process

The barriers to recruitment in clinical trials are multifaceted. They range from where research is made available to how sponsors approach community members to historical factors that mitigate chances for success. That’s why more and more companies are turning to partners who specialize in sustained community engagement, transforming clinical recruitment into a genuine and targeted process that benefits everyone.

Acclinate is uniquely positioned to mobilize hard-to-reach populations with an omnichannel community engagement platform and a robust network of grassroots activation partners. To learn more, schedule a 1:1 meeting with our team.