Table 2.

Summary of Strategies to Overcome Barriers to Enrolling Underrepresented Populations in Clinical Trials

Strategies Addressing Barriers to Clinical Trial Awareness	Addressing Study Design and Implementation10 Targeting		Addressing Minority Perceptions of the Research Process10 Targeting
	Providers/Staff	Research Participants	Communities
Partnership with community members, leaders, organizations prior to protocol development, study start and/or recruitment strategies or after study start to make adjustments if enrollment targets were not met	[20, 40, 48, 56]	[46]	[20, 25, 40, 46, 56, 57]
Outreach to providers directly, through community provider organizations, or through trusted provider associations	[25, 44, 46, 48, 56, 58, 59] [45]
Community research staff embedded in the communities doing education and networking with providers and community organizations	[47]		[20, 46, 56, 60]
Use of community members and/or community coordinators to recruit participants		[43, 56]	[43, 46]
Training and educational programs regarding clinical trials in general or specific ones	[20, 25, 42, 49, 61, 62]	[20]	[20, 25, 62]
Material and direct outreach, with an emphasis on culturally sensitive material and in the native language		[40, 41, 43, 45, 46, 48, 57, 60]	[25, 45, 46, 57]
Community providers sent letters of support and/or invitations to participate with follow-up from study staff		[41, 45, 47, 48, 57]

Strategies Addressing Barriers to Opportunity to Participate	Addressing Study Design and Implementation10 Targeting
	Providers/Staff	Research Participants
Recruiting at local, community practices caring for underrepresented populations	[25, 38, 40–47, 49, 56, 58–60, 62, 63]	[46–48, 57, 62, 64]
Consultation with patients, providers, and staff regarding the study intervention and/or materials	[41, 56, 64]	[40, 41, 46, 56]
Pilot testing recruitment approaches prior to study start or with adjustments of methods and/or recruitment sites if enrollment targets were not met	[48, 49, 56]	[40, 46, 48, 56]
Regular interactions between study researchers and community practice providers and staff to address study issues	[25, 39, 41–43, 45, 46, 48, 49, 56]
Hiring research staff from within the community or who reflected community demographics	[40, 41, 43, 45, 47, 49, 56, 60]	[45, 46, 48]
Provided study research nurse and other research staff at community practices to recruit and educate patients	[25, 38–40, 42]	[20, 38, 40, 42–49]
Provided patient navigators, either at community practices or at the academic center/hospital site	[44, 64]	[44, 60, 64]
Provided infrastructure at community practices, such as research nurse coordinators and support for data collection	[20, 25]	[48]
Incentives to participants and/or to providers (e.g., educational materials or grants) for recruitment and/or reimbursement for recruiting and study expenses	[40, 42, 44, 56]	[38, 40, 43, 45, 48, 49]

Strategies Addressing Barriers to Acceptance of Enrollment	Addressing Study Design and Implementation10 Targeting
	Providers/Staff	Providers/Staff
Management of trials in community rather than academic settings	[20, 25, 41, 42, 44, 47, 49, 56, 58]	[25, 46, 48, 57]
Oncology nurse navigators or research staff members assumed responsibility to meet patient needs to participate		[25, 44, 47, 64]
Transportation assistance		[25, 41, 43–45, 48, 49, 57, 64]