A Proposed Framework For More Inclusive Clinical Trials

A 2025 article in the Journal of Clinical and Translational Science examines how community health workers (CHWs) could play a more meaningful role in clinical research to address the persistent underrepresentation of Black people in clinical trials. The authors acknowledge that low participation among racial and ethnic minorities in clinical trials has long limited the equity, relevance, and generalizability of health research.

The study draws on interviews with 12 Black community health workers and 12 Black community members, followed by a focus group with CHWs to refine themes and recommendations. While many participants expressed deep mistrust of clinical research—rooted in historical and ongoing harms by the medical establishment against Black people—they also recognized its potential to generate benefits for future generations if conducted ethically and transparently.

Participants emphasized that CHWs’ trusted relationships, cultural knowledge, and community accountability uniquely position them to contribute far beyond traditional recruitment roles. Rather than serving solely as intermediaries, the authors posit that CHWs could be integrated as full research team members involved in study design, communication, consent processes, and interpretation of findings.

The authors identified four key elements for building trustworthy research experiences: transparency, shared purpose, reciprocity, and respect for community priorities.

Overall, the article proposes a high-level framework for strengthening community-engaged research by more fully integrating CHWs into all stages of the research process. The authors argue that this approach could help rebuild trust, deepen community participation, and support more inclusive, ethical, and equitable health knowledge generation.