Tensions Within Incentives, Altruism, and Trust in Clinical Trial Participation: Perspectives From African American and Black Caribbean Patients and Clinical Research Coordinators Who Recruit Them

This study employs the Integrated Model of Behavioral Prediction (IMBP) to investigate factors that influence African American and Black Caribbean patients' decisions to participate in clinical trials and research studies. It also offers recommendations for improving clinical trial recruitment processes through targeted interventions. Nine focus groups (N = 48 participants) involving patients and clinical research coordinators (CRCs) were conducted. Thematic analysis was used to compare perspectives, revealing salient attitudes, beliefs, perceived norms, and perceived control regarding clinical trial participation. Findings indicate that both patients and CRCs share similar positive (e.g., personal relevance and altruism) and negative (e.g., medical mistrust and health risks) outcome beliefs. Notably, financial incentives emerged as a double-edged sword-while they motivated some participants, they repelled others who perceived them negatively. This underscores the need for a nuanced understanding of community values and clear communication about the purpose of incentives. Insights from patient focus group discussions about their social networks highlighted community-level concerns regarding severe health consequences and mistrust in medical research, which impacted their normative beliefs. Additionally, concerns about clinical trial features influenced participants' control beliefs. These insights suggest that addressing both motivational and control factors sensitively can enhance intervention messages. Ultimately, these findings can inform training programs to improve communication strategies for CRCs, aiming to boost recruitment of African American and Black Caribbean populations into clinical trials.