Community Health Representatives as Trusted Sources for Increasing Representation of American Indian Communities in Clinical Research

Samantha Sabo, Naomi Lee, Grant Sears, Dulce J. Jiménez, Marissa Tutt, Jeffersson Santos, Omar Gomez, Nicolette Teufel-Shone, Marianne Bennet, J. T.Neva Nashio, Fernando Flores, Julie Baldwin

Research output: Contribution to journalArticlepeer-review


Indigenous and American Indian Alaskan Native (AI/AN) community members are systematically underrepresented in clinical trial research. This paper focuses on exploratory steps to partner with Native Nations of Arizona to engage Community Health Representatives (CHR) as a trusted source for building COVID-19 clinical trial research, including vaccine trials awareness. CHRs are frontline public health workers who apply a unique understanding of the experience, language, and culture of the population served. This workforce has entered the spotlight as essential to the prevention and control of COVID-19. Methods: Three Tribal CHR programs were engaged to develop and refine culturally centered educational materials and a pre-post survey using a consensus-based decision-making approach. CHRs used these materials in brief education sessions during regular client home visits and community events. Results: At 30 days post CHR intervention, participants (N = 165) demonstrated significantly increased awareness about and ability to enroll in COVID-19 treatment and vaccine trials. Participants also described a significant increase in trust in researchers, decreased perceived barriers related to cost for participation in a clinical trial, and improved belief that participation in a COVID-19 clinical trial for treatment was considered a benefit to American Indian and Alaskan Native people. Conclusion: CHRs as trusted sources of information, coupled with culturally centered education materials designed by CHRs for CHR clients, demonstrated a promising approach to improved awareness of clinical trial research generally and COVID-19 trials specifically among Indigenous and American Indian community members of Arizona.

Original languageEnglish (US)
Article number4391
JournalInternational Journal of Environmental Research and Public Health
Issue number5
StatePublished - Mar 2023


  • American Indian
  • clinical trial participation
  • community health representatives
  • cultural humility
  • equity

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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