# Community health workers and trusted local organisations paid to recruit for trials

Source: https://onco.cc/ideas/idea-tr1-community-health-worker-recruitment/  
OnCo record `idea-tr1-community-health-worker-recruitment` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People join trials when someone they trust explains them. Paying community health workers, churches and local groups to inform and refer people would reach communities that hospitals do not.

## Summary

Trial sponsors and networks contract community health workers and community organisations for outreach, education and referral in under-represented communities, with training in trial literacy and payment per activity rather than per enrolment (to avoid coercion). Evaluated in a cluster-randomised design against standard site-based recruitment.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Communities with paid CHW outreach will contribute at least twice the enrolment of minority and low-income participants compared with matched communities without it, and enrolled participants will have retention equal to others.
- Rationale: CHW models raised vaccination, screening and HIV testing uptake in similar communities; trial participation shares the same trust and information barriers.
- Proposed test: Cluster-randomise 20 community areas around trial sites to CHW outreach or none for 18 months, with enrolment by demographic as the primary outcome.
- Maturity: early-clinical
- Actor: philanthropy

## Sources

- Bottleneck evidence (Trials do not represent the people who get cancer): Loree et al., Disparity of race reporting and representation in trials leading to cancer drug approvals (JAMA Oncology 2019): https://doi.org/10.1001/jamaoncol.2019.1870

## Connected records

- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- bottlenecks: [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)
- key papers: [Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018](https://onco.cc/key-papers/paper-loree-jama-oncol/)

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