Attitudes, beliefs, and motivating factors associated with increased willingness to participate in clinical trials among American Indian and Alaska native adults.

To examine American Indian/Alaska Native (AI/AN) adults' attitudes and beliefs on research and clinical trial participation, we administered surveys at four AI/AN cultural events in Seattle, WA and Denver, CO, between 2022 and 2024. Surveys assessed familiarity with, attitudes towards, and beliefs about clinical trials, as well as health behaviors, research participation, and demographic characteristics. A total of 1287 AI/AN adults completed surveys. We performed logistic regression to examine the association between each attitude or belief and willingness to participate in clinical trials. Overall, 75% of participants reported familiarity with clinical trials and 61% reported at least some willingness to participate in a clinical trial. Most participants (74%) agreed that clinical trials are important to improving health and healthcare; however, two-thirds said they would participate only if they thought that their community and future generations would benefit from the research. Participants who believed representation in clinical trials was important to ensure that treatments work for people like them had greater odds of reporting willingness to participate (OR: 6.81; 95% CI: 5.25-8.84). Attitudes and beliefs varied according to gender and urbanicity. Some attitudes and beliefs are more prevalent among individuals willing to participate in clinical trials. Findings may not generalize beyond powwow attendees, and reported willingness may not translate into actual clinical trial enrollment. Engaging communities to determine acceptable procedures may improve recruitment efforts. Moreover, researchers should work with communities to ensure that community members and future generations benefit from research to help increase AI/AN representation in clinical trials.