TABLE 2.

Barriers to demographically diverse and clinically relevant clinical trial enrolment in relation to the participants, clinical trial sites and the Sponsor/Academic Investigator

Barriers
Participants	Clinical trial sites	Sponsor/academic investigator
Lack of trust in pharmaceutical industry and medical researchers, and fears of exploitation	Limited commitment and effort	Limited commitment and effort
Practical obstacles to participation and inconvenience	Unconscious bias	Low willingness to work with research naïve sites/investigators
Lack of awareness/information about disease and trials	Lack of culturally or racially/ethnically diverse staff	Limited understanding of what a potential participant wants or needs to enrol
Low health literacy	Lack of effective referral basis/ health care providers fear of losing patient	Negative attitudes about minority willingness
Lack of access to clinical trial sites	Lack of community engagement	Assumptions that diverse enrolment would conflict with trial efficiency
Language barriers	Lack of knowledge of cultural differences leading to ineffective communication	Costs and potential time delays associated with engagement