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#DemandDiversity: Why cultural safety is an important step towards achieving diversity in clinical trials

In our recent Demand Diversity research, a Black American participant said, “I wish people were more educated. Doctors are supposed to treat everyone the same, not have favourites. They need unconscious bias training.”

Our report, containing findings from interviews with Americans from different ethnic groups, only touches on the discrimination and cultural insensitivity experienced in healthcare by Black Americans, Asian Americans, Hispanics and Native Americans. But the interviews revealed important insights into how people from these ethnic groups feel. They do not appreciate being grouped together through terms such as BAME. They want to be recognised and respected as individuals, with their own unique culture. On the other hand, people shouldn’t be made to feel singled out, for example, as if their ethnic group is the only group taking part in a clinical trial. This can raise suspicion and people may question why only their group is needed. Lastly, Black American and Hispanic women were able to recount negative healthcare experiences that they believed were due to their gender and ethnicity.

There is an awareness in the pharmaceutical industry that these experiences act as a barriers to clinical trial participation. Not enough is being done to overcome this.

Cultural training efforts

Some healthcare and pharma organisations have implemented cultural competency training for their staff. This helps improve people’s understanding of different cultures, which in theory should increase their ability to deliver care across a wider spectrum of different people. However, these training programs have several limitations:

  • People can falsely believe they are equipped to deliver culturally safe care purely from learning about other cultures
  • People remain unaware of their own biases that exist in all of us, ethnicity is often the only aspect considered (without any mention of age, gender and more)
  • Cultural competency often fails to mention systemic processes or privileges, and only focusses on the individual.

While understanding other cultures is important, healthcare professionals and site staff also need to be aware of their own culture, attitudes, biases and stereotypes. Cultural safety training allows people to be introspective, to evaluate how their own cultural identity can impact their interactions with patients. Importantly, being culturally safe doesn’t just mean regarding ethnicity. Culturally safety training covers other terms in the cultural umbrella too, such as sexual orientation, physical ability, religion, education, and gender, amongst many other influential factors.

Cultural safety training can help to improve the diversity in clinical trials, as well as the likelihood of people continuing to take part. By giving clinical trial teams the right foundation, by providing materials in local languages with cultural considerations, and by engaging with people in their preferred way, patients from diverse backgrounds can be given an equal chance at taking part and can make an informed decision, with fewer barriers in place. To achieve real change in this area, the industry has to work on removing barriers that are unique to certain ethnic groups or cultures. If people already associate healthcare with negative experiences, they are unlikely to be motivated to join a clinical trial. That’s why it’s also important to ensure that no one has a negative interaction with clinical trials.

Together, we need to support healthcare professionals and clinical research terms to deliver care in a culturally safe manner. If you’re interested in getting involved in our mission to Demand Diversity, get in touch at ash@demanddiversity.co. And if you want to read more of our US research, access the full report here.

27th July 2021

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