Building More Inclusive Clinical Trials Across Queensland

Clinical research depends on participants who reflect the communities that will use new medicines, devices, and models of care. When enrolment is concentrated in major metropolitan hospitals, evidence may overlook the experiences of people living in regional, rural, and remote areas.

Queensland presents a distinctive setting for this work. Its population is spread across a large geographic area, with substantial differences in transport access, health services, digital connectivity, cultural background, income, and exposure to specialist care. These factors make it difficult to sustain broad participation throughout a study.

Maintaining clinical trial diversity in a geographically dispersed population therefore requires more than opening recruitment at additional sites. It calls for practical support, culturally safe engagement, flexible study design, and strong collaboration between researchers, health services, universities, and communities.

Distance shapes who can take part

Travel is one of the clearest barriers to participation. A person living several hours from a trial centre may need to take time off work, arrange childcare, find accommodation, or manage fuel and transport costs for every visit. For people with disability, chronic illness, or limited mobility, the burden can be greater still.

These pressures can produce a sample that overrepresents people who live near tertiary hospitals, have flexible employment, or can afford repeated travel. A trial may technically be open to a wide population while remaining inaccessible in practice. Decentralised visits, local clinical partnerships, home-based assessments, and reimbursement paid promptly can reduce this gap.

Representation involves more than location

Geographic diversity is closely linked to other dimensions of inclusion. Regional communities may include Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse families, older adults, agricultural workers, people experiencing financial hardship, and residents with limited access to health information. Each group may face different concerns about research participation.

Trust is particularly important where communities have experienced exclusion, rushed consultation, or research that offered little visible benefit. Engagement should begin before recruitment, with community-controlled organisations, Aboriginal health services, local clinicians, and patient advocates contributing to study planning. The health translation network model demonstrates how connections between research and health services can help move evidence into care that is relevant to local communities.

Language access also needs careful attention. Translated consent forms are useful, but they do not replace interpreters, culturally appropriate explanations, or time for family and community discussion. Researchers should assess whether recruitment materials, consent processes, and outcome measures are understandable and meaningful for the people they hope to enrol.

Trial design can widen or narrow access

Eligibility criteria are essential for participant safety and scientific validity, yet overly restrictive rules can exclude the people most affected by a condition. Requirements related to travel frequency, stable internet access, English proficiency, medication history, or the absence of multiple health conditions may unintentionally remove large parts of the population.

Study teams should distinguish between criteria that protect participants and criteria that merely simplify administration. Hybrid trials, telehealth appointments, mobile research teams, local pathology collection, and flexible scheduling can make participation more realistic. Remote methods should be offered as an option rather than imposed, since poor connectivity, limited digital confidence, and privacy concerns can create a different form of exclusion.

Site networks need sustained support

Adding regional sites can improve access, but a site is effective only when it has the workforce, governance systems, equipment, and time to deliver research safely. Smaller services may have enthusiastic clinicians yet lack dedicated trial coordinators, research nurses, pharmacy capacity, or reliable administrative support.

Long-term investment is more valuable than short recruitment campaigns. Shared coordinator roles, centralised training, standardised digital systems, and mentoring from experienced trial centres can strengthen local capability. Partnerships across health services and research institutions can also help smaller sites participate in studies that would otherwise remain limited to capital-city hospitals.

Workforce continuity matters for participants as well. Familiar local staff can explain procedures, identify practical problems, and support retention. When trial responsibilities are added to already stretched clinical roles without protected time, follow-up may become inconsistent and the participant experience can suffer.

Ethics and data must reflect local realities

Ethics review should examine access and representation from the beginning, rather than treating diversity as a recruitment target added after the protocol is complete. Reviewers can ask whether the study budget covers travel, interpreting, community consultation, compensation, and local workforce development. They can also assess whether the consent process is suitable for participants with different literacy levels and communication needs.

Data governance is equally important. Participants and communities need clear information about who will use their data, where it will be stored, how it may be linked, and whether future research is possible. For Aboriginal and Torres Strait Islander communities, data sovereignty principles should guide decisions about collection, ownership, access, interpretation, and benefit sharing.

Researchers should monitor enrolment and retention by geography, age, sex, cultural identity, language, socioeconomic circumstances, and other relevant characteristics. These data should be used to identify barriers while protecting privacy. A diverse sample at recruitment is insufficient if participants from remote areas are more likely to withdraw because the study is difficult to sustain.

Measuring success beyond enrolment

Recruitment numbers provide only a partial picture of inclusion. A trial can enrol participants from several regions while still excluding people who have the greatest barriers to care. Evaluation should consider who was approached, who declined, who withdrew, how much participation cost, and whether study procedures were acceptable to patients and carers.

Retention, completion of follow-up, participant experience, and the usefulness of findings for local services are equally important. Feedback should be collected in accessible formats and shared with participating communities. This creates accountability and helps study teams refine methods during the trial rather than waiting for final publication.

Practical priorities for a more representative research system include:

• Design recruitment with local communities and health workers before funding applications are finalised.
• Budget for transport, accommodation, interpreters, participant reimbursement, and digital alternatives.
• Use inclusive eligibility criteria that reflect real-world multimorbidity and service access.
• Build regional research capability through protected staff time, training, and shared infrastructure.
• Report participation and retention patterns transparently across metropolitan, regional, rural, and remote locations.

Making inclusion part of research quality

Clinical trial diversity is a scientific and ethical responsibility. Evidence is more useful when it reflects the people who will receive the intervention, including those who live far from specialist centres or face barriers that are easy to overlook in a metropolitan research setting.

Health services, investigators, funders, policymakers, and communities can make geographic inclusion a standard feature of study design. Explore partnership opportunities, research resources, and health translation initiatives through Brisbane Diamantina Health Partners, and help build clinical evidence that works across Queensland’s varied communities.