Research investigating the relationship between ethnicity and health has revealed that there are considerable and persistent health inequalities experienced by ethnic minority populations. There is general consensus among policymakers, researchers and community members that research should aim to help reduce disease burden and redress such health inequalities. Increasing the diversity of participants enrolled into clinical trials is one way to help achieve these aims. Increased funding, motivation and interest have catalyzed research in this area, resulting in its emergence as a field of enquiry in its own right.Many practical challenges and limitations, however, remain; foremost is that it remains unclear as to what are the most effective strategies for recruiting and retaining ethnic minority populations in clinical trials. Working towards meaningful participation requires a brief consideration of the conceptualizations underpinning this field of study. The prioritization of ethnicity above other important contributors to health, such as socioeconomic status, and the focus on differences also necessitates critical examination. Nonetheless, the gains of enrolling more diverse populations can strengthen our confidence in the generalizability of findings from experimental studies. There are obvious barriers to recruitment that are, we argue, present as a consequence of interactions between multiple players involved in the research process. This means that funding bodies, researchers and community members are implicated as both the problem and the solution. Thus, we believe that genuine improvements to representation of diverse populations in trials depend on their collaborative efforts. A priori definition of the targeted population and potential hypotheses, and the conduct of feasibility studies are important starting points. Ultimately, a diverse set of recruitment strategies should be used, some of which we outline in this article. A balance must be struck in terms of when and how to use population-and community-based recruitment methods, active and passive recruitment approaches and culturally sensitive strategies. Our belief is that meaningful inclusion and participation will occur as funding bodies, researchers and community members work together towards a shared goal of improving health outcomes for all sections of society.
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