Navigating the Path to Inclusion: Understanding Barriers and Facilitators to Clinical Trial Participation Among Chinese Older Adults in the United States with Multimorbidity

Context: Older adults with multimorbidity are underrepresented in clinical trials, with enrollment of Asians particularly low.

Objective: Understand perspectives of US Chinese older adults regarding clinical trial participation.

Study design and analysis: Focus group interviews analyzed using thematic analysis.

Setting: Community/senior centers, academic health systems in Northern and Southern California, and a nationwide registry of Asian Americans/Pacific Islanders.

Population studied: Mandarin- and English-speaking Chinese adults aged ≥ 65 years with multimorbidity.

Outcome measures: Themes related to barriers and facilitators of enrollment in clinical trials of medications.

Results: We conducted 12 focus groups: 7 with non-US-born and 5 with US-born Chinese older adults (n = 83 total). Mean age was 74 years (SD = 5.9), 43 (51.8%) were female, and 47 (56.6%) Mandarin-speaking. US-born participants had greater educational attainment than non-US-born participants. Participants took a mean of 6.1 prescriptions (SD = 1.5). Barriers to participation in clinical trials of medications included lack of awareness of/exposure for patients and community-based Chinese physicians, preference for natural/traditional medicine, risk aversion and safety concerns, desire for privacy, and inconvenience. Trusted influences included physicians, hospitals/health systems, Asian/Chinese community centers, and family (for non-US-born participants). Suggestions to enhance participation included using language and culturally concordant materials/personnel, educating community-based Chinese physicians about clinical trials, involving patient-trusted physicians in recruitment, promoting trials on conditions common in Chinese people or for an existing condition, and financial incentives. US-born participants expressed greater understanding and willingness to join trials. All groups attributed low clinical trial enrollment to non-US-born Chinese adults.

Conclusions: Chinese older adults perceived obstacles to clinical trial participation that could be mitigated by involving trusted physicians in recruitment, using language and culturally concordant materials/staff, and educating patients and community-based physicians. Recognition of differences in attitudes among US- and non-US-born Chinese people may be important to tailoring recruitment strategies.