Grant: Health System Impact Fellowships - PostDoc Central Canada 2-year

Clinical trials are the 'gold standard' of health care evidence. Thus, participation in trials is necessary to improve health care. However, equity-deserving groups are significantly less likely to participate in trials than non-equity-deserving groups. This comes with harms such as variance in standard of care, which may magnify pre-existing health disparities and create health inequities. Co-production and behavioural science can help identify strategies to improve equity, diversity, and inclusion (EDI) in trials. This fellowship will use co-production to improve EDI in multi-site trials in Ontario over three objectives: 1) Describe inequities in trial participation. Clinical Trials Ontario (CTO) has a novel platform ("Stream") that enables ethics review and conduct of multi-site trials from one Research Ethics Board (REB). The Stream database will be analyzed to identify existing questions and develop future questions for EDI. Theory-informed online surveys will quantitatively assess inclusion/exclusion of equity-deserving groups and qualitatively explore determinants of EDI recruitment behaviours. 2) Evaluate EDI in trial recruitment and retention. Using behavioural theory, interviews among patients, trialists, REBs will investigate strategies that support recruitment of equity-deserving groups into trials and equity-deserving groups' barriers and enablers to participating in trials. 3) Co-develop strategies to improve EDI in trial recruitment and retention. A working group of patients, trialists, and REBs will be formed to co-develop a tool(kit) to guide EDI in trials. Behaviour change techniques (BCTs) will be chosen to overcome barriers and enhance enablers in Objective 2; the most relevant BCTs will be encompassed in the tool(kit). A consensus process will inform a final tool(kit) to be housed on CTO's website. Results will help CTO enact province-wide change in trial EDI and meet its priority of engaging patients and the public in trial ethics and conduct.