Breakthrough Patient Recruitment

: Addressing the Underrepresentation of African Americans in Clinical Trials

Addressing the Underrepresentation of African Americans in Clinical Trials

Content Specialist

African Americans' underrepresentation in clinical trials is often framed as the legacy of historical, institutionalized racism in scientific research. Tragedies such as the Tuskegee Syphilis study are highlighted as events that magnified lack of trust among African Americans toward researchers and research institutions. Thus, lack of trust has emerged as a critical theme when examining barriers to African Americans' participation in clinical trials.  

A history of institutionalized racism undoubtedly has shaped the African American psyche; yet poverty, unequal access to health care, and unequal access to education among African Americans coincide with characteristics of individuals who are often less likely to participate in clinical trials. Stressing attitudes of African Americans toward research detracts from the importance of other factors in an individual's decision to participate in a clinical trial and places the burden of change on African Americans.  

Community partnerships are a logical tactic when examining African Americans' participation through the lens of attitudes toward research. However, community outreach should not completely replace other strategies when recruiting this population.

Social marketing, for example, is effective in recruiting individuals from all ethnic and racial minorities, particularly those with a higher socioeconomic status. Since the Civil Rights Movement, the demographics for African Americans have continuously changed, particularly along the lines of education and socioeconomic status. The increasing presence of African Americans who fit the demographics of individuals who tend to participate in a clinical trial-well educated and affluent-presents an opportunity that could be missed if participation in clinical trials continues to be framed in a way that does not resonate with all the diverse segments within this minority group. 

Furthermore, pre-existing, long-standing relationships between a research institution and community organizations may be the most beneficial for both retention and recruitment of African Americans into clinical trials. An exclusive focus on community work just for the duration of a clinical trial places pressure on study staff to develop and leverage interpersonal relationships in a short time and may not always yield the desired number of participants.

Building long-term partnerships between research institutions and community organizations would:

  • Create a more reciprocal relationship, building trust in research institutions
  • Provide better access to members of a community who could be eligible for a clinical trial
  • Provide an environment where participants in a clinical trial are supported by members of their community to stay in a clinical trial

Addressing socioeconomic, health care, and educational inequality requires large-scale, sustained policy initiatives; however, using a multitude of outreach strategies informed by a more inclusive assessment of the African American population can assist current recruitment and retention efforts.

This is part 2 of the Healthyist's series "Recognizing Unseen Opportunities: Increasing Recruitment and Retention of Ethnic and Racial Minority Populations in U.S. Clinical Trials." For more information on our thoughts on minority recruitment in clinical trials, read part 1, Redefining Barriers to Minority Participation in Clinical Trials.

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