Addressing Rural Participant Underrepresentation in U.S. Clinical Trials Through Transportation Support, Telehealth Access, and Community Health Worker Engagement

Author

Deryl Hasbifa

Abstract

 Representative clinical trials are essential for producing evidence applicable to diverse populations and supporting equitable access to investigational care. Rural communities in the United States face participation challenges associated with geographic isolation, limited research infrastructure, transportation costs, unreliable connectivity, and competing employment or caregiving responsibilities. This proposed narrative review examines how transportation support, telehealth access, and community health worker engagement can address these interconnected barriers. The review will synthesize U.S. evidence on travel assistance, mileage reimbursement, coordinated transportation, remote screening, electronic consent, selected virtual visits, and community health worker navigation. Particular attention will be given to broadband availability, digital literacy, disability access, confidentiality, clinical suitability, and coordination between research centers and local healthcare providers. Evidence from different diseases and trial settings will be distinguished to avoid assuming uniform effectiveness. An integrated framework will connect practical assistance with trusted communication and flexible trial delivery. Evaluation priorities will include invitation opportunities, enrollment, retention, participant burden, comprehension, and implementation costs. The review aims to inform contextually appropriate recruitment strategies that improve rural research access while preserving patient safety, voluntary decision-making, and institutional accountability.

Keywords

Rural populations; Clinical trial participation; Transportation support; Telehealth access; Community health workers; Research equity.

DOI : https://doi.org/10.5281/zenodo.23338249

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References

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