Sara E. Watson, Department of Pediatrics, University of Louisville and Norton Children’s Hospital, Louisville, Kentucky, USA
Paul Smith, University of Montana, Missoula, Montana, USA
Jessica Snowden, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
Vida Vaughn, University of Louisville, Louisville, Kentucky, USA
Lesley Cottrell, West Virginia University, Morgantown, West Virginia, USA
Christi A. Madden, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Alberta S. Kong, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
Russell McCulloh, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA; Children’s Hospital and Medical Center, Omaha, Nebraska, USA
Crystal Stack Lim, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
Megan Bledsoe, Children’s Mercy Hospital, Kansas City, Missouri, USA
Karen Kowal, Nemours Children’s Health System, Wilmington, Delaware, USA
Mary McNally, Dartmouth- Hitchcock Medical Center, Lebanon, New Hampshire, USA
Lisa Knight, University of South Carolina, Columbia, South Carolina, USA
Kelly Cowan, University of Vermont, Burlington, Vermont, USA
Elizabeth Yakes Jimenez, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA

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Children in rural settings are under-represented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (nonclinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for US-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n = 23 articles; 85%); fewer (n = 10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n = 25 studies; 81%) and barriers (n = 19; 61%) versus retention facilitators (n = 15; 48%) and barriers (n = 8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included contacts/reminders, community engagement, and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.

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Clin Transl Sci







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