Inequity in clinical research access within alcohol treatment settings: a focused ethnography study
Background: While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural factors still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease (ARLD).
Methods: A focused ethnography approach was employed to explore the challenges in the access to and implementation of research within clinical settings. Data were collected through an iterative-inductive approach, using field notes and interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels.
Results: At the micro-level, alcohol-related barriers included hepatic encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the ‘cost of living crisis’ and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a ‘domino effect’ across all levels, demonstrating an interplay between individual, organisational and structural factors influencing access to clinical research.
Conclusions: A combination of individual, organisational and structural factors, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and ARLD, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population.
