ORIGINAL PAPER Barriers to Clinical Trial Participation: A Comparison of Rural and Urban Communities in South Carolina Sei-Hill Kim • Andrea Tanner • Daniela B. Friedman • Caroline Foster • Caroline D. Bergeron Published online: 6 December 2013 Ó Springer Science+Business Media New York 2013 Abstract Analyzing data from a telephone survey of rural and urban residents in South Carolina, this study attempts to understand how to better promote clinical trials (CTs) in rural areas. To explore why participation is lower among the rural population, we examine two groups of potential barri- ers: structural and procedural barriers (limited accessibility, lack of awareness, lack of health insurance) and cognitive and psychological barriers (lack of knowledge, mispercep- tions, distrust, fear). We then make a series of comparisons between rural and urban residents to see whether rural resi- dents are significantly different from urban residents in terms of structural/procedural and cognitive/psychological barri- ers they are facing. Findings indicate that there are no sig- nificant differences between rural and urban residents in their willingness to participate in a CT. However, rural residents were more likely to perceive limited access to CT sites and lack of awareness of available trials. Rural residents also indicated greater lack of knowledge about CTs. Finally, we found that distrust and fear were important barriers in shaping one’s willingness to participate in a CT. Implications of the findings are discussed in detail. Keywords Clinical trial Á Rural population Á Medical research Á Public health Introduction The state of South Carolina (SC) remains largely rural, with about 35 % of the population living in rural areas, compared to about 19 % nationally [1]. Research has demonstrated that rural residents experience significant health disparities, with factors such as limited access to health care services, lower rates of health insurance, lower socioeconomic and educational status, and cultural and social differences contributing to these disparities [2, 3]. Given that clinical trials (CTs) can provide patients with the most advanced medical treatments and screening options, the rural population in SC may represent those who need the opportunity the most. Nevertheless, enrollment in CTs tends to be particularly low in rural areas, leaving this underserved population largely underrepresented in medical research [4–6]. A recent survey of SC-based medical researchers [7] shows that it is difficult, overall, to recruit participants in CT research, but particularly difficult to find and recruit participants from rural areas in SC. Research has examined a variety of barriers to CT participation. In this paper, we group these barriers into two general categories: (a) structural and procedural, and (b) cognitive and psychological. Structural and procedural barriers include, for example, lack of public information about available trials, limited accessibility, or insurance issues [8–10]. Perhaps equally important, but largely S.-H. Kim (&) Á A. Tanner School of Journalism and Mass Communications, University of South Carolina, Carolina Coliseum, 600 Assembly Street, Columbia, SC 29201, USA e-mail: seihillkim@gmail.com D. B. Friedman Á C. D. Bergeron Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA D. B. Friedman Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA C. Foster Department of Communication, College of Charleston, Charleston, SC, USA 123 J Community Health (2014) 39:562–571 DOI 10.1007/s10900-013-9798-2