Abstract Body (Do not enter title and authors here): Background:
Despite national efforts to diversify clinical trial populations, participation remains disproportionately low among racial and ethnic minorities. This underrepresentation undermines both the generalizability of findings and equity in evidence-based care.
Research Question:
What factors contribute to reluctance and underrepresentation in clinical research among diverse racial and socioeconomic groups?
Methods:
We surveyed 400 adults at Mount Sinai clinics and hospitals across New York City. Participants self-reported willingness to participate in research using a 1–5 Likert scale. Demographics included race/ethnicity, education level, and prior invitations to participate in research. ZIP code was used as a proxy for socioeconomic status (SES). Participants also identified their strongest motivators. Logistic regression identified predictors of low willingness (score ≤3).
Results:
Among participants (31% White, 26% Black, 24% Hispanic, 16% Asian, 3% Other), low education, low SES, and minority race were associated with lower willingness to participate in research (OR 1.90, 2.74, and 2.11; p < 0.01). Prior invitations were less frequent among Black (18%), Hispanic (22%), and Asian (25%) participants, compared to White participants (41%). Disparities were most pronounced in individuals with both low SES and limited education, where invitation rates were 22%, compared to 41% among participants with higher SES or education. Motivational factors varied: White and Asian participants most often cited improved understanding and perceived health benefit. Black and Hispanic participants emphasized institutional trust, communication, and safety. Among low-SES individuals, financial compensation and transportation access were the most commonly reported concerns.
Conclusions:
To improve participation of underrepresented populations in clinical research, structural changes are essential to ensure equitable inclusion. Initiatives that prioritize outreach to diverse communities, culturally tailored education, trust-building, and removal of practical barriers such as transportation and compensation are critical for meaningful engagement.