These nine strategies highlight some of the most effective ways research sites can improve enrollment diversity. Each reflects common barriers that patients face and draws on published research or real-world examples showing how these challenges can be overcome.
-
Map Your Local Community Demographics
Why it works: You can’t improve what you don’t know. Many sites overestimate how representative their enrolled populations are.
Evidence: A 2024 JAMA Network Open study found that fewer than 20% of clinical sites regularly assessed whether trial demographics matched local communities (Liu et al., 2024).
Action step: Use U.S. Census QuickFacts or hospital service maps to run a “gap analysis” comparing historical enrollment to local demographics and set numeric DAP targets accordingly.
-
Partner with Trusted Community Organizations
Why it works: Trust is often built outside the clinic. Community organizations can bridge historical mistrust.
Evidence: The NIH’s All of Us program enrolled significantly more diverse participants by partnering with federally qualified health centers (FQHCs) and community groups (All of Us Research Program, 2021).
Action step: Identify 3–5 trusted local organizations (churches, cultural associations, FQHCs) and co-host recurring, bilingual educational events.
-
Hire or Train Diverse Staff
Why it works: Language and cultural concordance directly improve trust and willingness to enroll.
Evidence: Language-concordant care increases engagement and participation by up to 24% (Flores, 2006).
Action step: Recruit bilingual staff where possible and train existing coordinators in cultural humility and plain-language consent.
-
Reduce Logistical Barriers
Why it works: Transportation, childcare, and work conflicts are leading reasons patients decline participation.
Evidence: A CISCRP survey reported that 60% of patients cite logistical challenges as the main barrier to enrollment (Anderson et al., 2019).
Action step: Provide rideshare credits or shuttles, offer evening/weekend visits, and use a “participant barrier checklist” at screening to preempt obstacles.
-
Use Patient-Friendly Technology
Why it works: Digital accessibility broadens reach, especially for rural, older, or mobility-limited participants.
Evidence: Decentralized trials using eConsent and telehealth improved rural/older adult participation by ~25% (Izmailova et al., 2021).
Action step: Roll out multilingual eConsent with audio/video support and adopt bring-your-own-device options for ePROs.
-
Translate and Tailor Materials with Community Input
Why it works: Literal translations can miss cultural nuance; community-tailored materials resonate more deeply.
Evidence: In a hypertension study, community advisor–reviewed Spanish materials raised Spanish-speaking enrollment from 6% to 22% in one year (Borrayo et al., 2014).
Action step: Establish a Community Advisory Board (CAB) of 5–10 local representatives to review outreach materials for clarity and cultural fit before launch.
-
Monitor Recruitment Progress Weekly
Why it works: Ongoing tracking enables rapid adjustments; quarterly reviews often come too late.
Evidence: Sites that monitored diversity weekly were twice as likely to hit targets compared to those reviewing quarterly (Getz et al., 2021).
Action step: Build a dashboard with enrollment breakdowns by race, ethnicity, sex, and age. Review it in weekly staff meetings and pivot instantly if a group lags.
-
Reward and Recognize Participant Commitment
Why it works: Participation requires significant time and effort; recognition reinforces retention.
Evidence: Participants receiving appreciation gestures (e.g., stipends, thank-you notes) reported 30% higher satisfaction and were more likely to recommend trials (Getz et al., 2019).
Action step: Provide stipends for time and small tokens like grocery gift cards. Create a standardized appreciation plan.
-
Share Progress with Sponsors and Regulators
Why it works: Transparent performance builds trust and competitive advantage with sponsors.
Evidence: Sponsors are increasingly awarding more trials to sites demonstrating strong diversity performance (Getz et al., 2021).
Action step: Send monthly diversity updates to sponsors and post summary metrics (e.g., by race/ethnicity/sex/age) on public channels such as your website or ClinicalTrials.gov listing.