A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations

Am J Health Promot. May-Jun 2015;29(5):332-8. doi: 10.4278/ajhp.130514-QUAL-247. Epub 2014 Mar 26.


Purpose: Participation in clinical trials (CTs) is low among rural communities. Investigators report difficulty recruiting rural individuals for CTs. The study purpose was to identify recruitment barriers, motivators, and strategies to help increase access to and participation in CTs in rural and urban communities.

Approach: Qualitative focus groups/interviews.

Setting: Rural and urban counties in one southeastern state.

Participants: Two hundred twelve African-American and white men and women ages 21+.

Method: Nineteen focus groups and nine interviews were conducted. Audio files were transcribed and organized into NVivo10. Recurring themes were examined by geographic location.

Results: Although similar barriers, motivators, and strategies were reported by urban and rural groups, perceptions regarding their importance varied. Recruitment barriers mentioned in both rural and urban groups included fear, side effects, limited understanding, limited time, and mistrust. Rural groups were more mindful of time commitment involved. Both rural and urban participants reported financial incentives as the top motivator to CT participation, followed by personal illness (urban groups) and benefits to family (rural groups). Recruitment strategies suggested by rural participants involved working with schools/churches and using word of mouth, whereas partnering with schools, word of mouth, and media were recommended most by urban groups.

Conclusion: Perceived recruitment barriers, motivators, and strategies did not differ considerably between rural and urban groups. Major barriers identified by participants should be addressed in future CT recruitment and education efforts. Findings can inform recruitment and communication strategies for reaching both urban and rural communities.

Keywords: Clinical Trials; Focus Groups; Health focus: prevention, treatment, participation in clinical trials; Interviews; Manuscript format: research; Motivators; Outcome measure: perceptions, knowledge; Prevention Research; Qualitative; Recruitment Barriers; Research Participation; Research purpose: descriptive; Setting: statewide, community; Strategy: education, recruitment; Study design: qualitative; Target population age: adults, seniors; Target population circumstances: all education levels, all income levels, South Carolinians, rural and urban, African-American and white.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans
  • Aged
  • Aged, 80 and over
  • Clinical Trials as Topic / methods*
  • Clinical Trials as Topic / psychology*
  • European Continental Ancestry Group
  • Fear
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Motivation*
  • Patient Selection*
  • Qualitative Research
  • Rural Population*
  • Socioeconomic Factors
  • Time Factors
  • Trust
  • Urban Population*