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
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.
marketing, for example, is effective in recruiting individuals
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.
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.
long-term partnerships between research institutions and community
- Create a more reciprocal relationship, building trust in
- 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
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