Abstract
Purpose: Participation in clinical trials among people who use drugs (PWUD) in rural areas remains disproportionately low compared to those in urban communities. Our objective was to describe the barriers and facilitators to clinical trial participation among this understudied and underserved population. Methods: We conducted semi-structured in-depth interviews among rural PWUD in Kentucky, Ohio, and Oregon. Using the Ickovics and Meisler framework, we classified factors associated with participation in clinical trials among rural PWUD into five categories: the individual, trial and intervention characteristics, participant-trial staff relationship, clinical trial setting, and features of the disease. We used inductive qualitative analysis methods to identify salient themes. Findings: Thirty-five rural participants (median age: 39, 51% men) completed in-depth interviews. Facilitators for rural clinical trial participation were mainly situated within the individual, trial and intervention characteristics, and clinical trial setting. Individual characteristics, such as altruistic motivations to help their communities and peers, as well as trial and intervention characteristics like visit reminders and resource assistance, were the most frequently noted facilitators of clinical trial participation. In contrast, participation barriers were mainly related to participant-trial staff relationships and disease features. Judgmental and untrustworthy trial staff, along with involvement in the criminal legal system, were obstacles to clinical trial participation. Conclusions: Individual, intrapersonal, and logistical factors described by rural PWUD must be addressed to enhance the participation and retention of this population in clinical trials. Successful clinical trial participation may contribute to equitable access to essential health services by PWUD in rural communities.
| Original language | English |
|---|---|
| Article number | e70009 |
| Journal | Journal of Rural Health |
| Volume | 41 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2025 |
Bibliographical note
Publisher Copyright:© 2025 National Rural Health Association.
Funding
Thank you to Hannah Piscalko, Skylar Gross, Morgan Brown, and Chrissie Schalkoff for contributing to the coding and memo\u2010ing of the qualitative analysis; Lisa Maybrier, Rhonda Gilliam, Renee McDowell, Cathy O'Neal, and Anyssa Wright for leading recruitment and data collection; and Edward Freeman for data management.This work was supported by the National Institutes of Health NCATS [grant no. U01TR002631] and NIDA [grant nos. UH3DA044831, UH3DA044798, and UG1DA015815]. KEL was also supported by NIDA through grant no. K01DA048174. ATE was supported by NIDA through grant no. F31DA054752.
| Funders | Funder number |
|---|---|
| Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse | K01DA048174, F31DA054752, UG1DA015815, UH3DA044798, UH3DA044831 |
| Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse | |
| National Institutes of Health (NIH) | U01TR002631 |
| National Institutes of Health (NIH) |
Keywords
- clinical trial
- enrollment
- retention
- rural
- substance use
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
