{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T20:53:42Z","timestamp":1788468822284,"version":"build-2803163510"},"reference-count":68,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"American Heart Association","award":["946222"],"award-info":[{"award-number":["946222"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: There is significant underrepresentation in clinical trials across diverse populations. Less is known about how health system-related factors, such as relationships and trust, mediate the motivation for clinical trial participation. We aimed to investigate whether health system-related factors explain the association between sociodemographic factors and motivation for participation. Additionally, we explored whether the mediating effects differ by gender. Methods: We used the Health Information National Trends Survey 2020 cycle-4 data. Motivation for clinical trial participation, assessed through eight items, was the outcome variable (range 1\u20134). Predictors included age, race, ethnicity, education, general health, and depression. The health system-related explanatory variables were health information distrust, having a regular provider, and the frequency of healthcare visits. Gender was the moderator. A structural equation model (SEM) was used for the overall and gender-stratified analyses. Results: Among the 3865 participants (mean [SE] age of 48.4 [0.53] years, 51.4% women, and 24.3% non-White), older age (\u03b2 = \u22120.170; p &lt; 0.001) and non-White race (\u03b2 = \u22120.078; p &lt; 0.01) were negatively associated, and higher education (\u03b2 = 0.117; p &lt; 0.001) was positively associated with motivation. Higher distrust (\u03b2 = \u22120.094; p &lt; 0.01) decreased motivation, whereas having a regular provider increased motivation (\u03b2 = 0.087; p &lt; 0.01). The gender-stratified SEM revealed that women, but not men, with higher distrust showed lower motivation (\u03b2 = \u22120.121; p &lt; 0.01), and men, but not women, with a regular healthcare provider showed higher motivation (\u03b2 = 0.116; p &lt; 0.01). Conclusions: Our study found that women with higher distrust showed lower motivation, while men with a regular healthcare provider demonstrated higher motivation. These gender differences highlight the need for tailored recruitment approaches that account for their distinct relationships with the health system.<\/jats:p>","DOI":"10.3390\/jcm14020485","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T06:13:07Z","timestamp":1736835187000},"page":"485","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Motivation to Clinical Trial Participation: Health Information Distrust and Healthcare Access as Explanatory Variables and Gender as Moderator"],"prefix":"10.3390","volume":"14","author":[{"given":"Rifath Ara Alam","family":"Barsha","sequence":"first","affiliation":[{"name":"Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5054-6250","authenticated-orcid":false,"given":"Shervin","family":"Assari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA"},{"name":"Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA"},{"name":"Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9165-0348","authenticated-orcid":false,"given":"Samuel","family":"Byiringiro","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin D.","family":"Michos","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9992-9597","authenticated-orcid":false,"given":"Timothy B.","family":"Plante","sequence":"additional","affiliation":[{"name":"Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT 05405, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6045-6542","authenticated-orcid":false,"given":"Hailey N.","family":"Miller","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl R.","family":"Himmelfarb","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA"},{"name":"Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0256-880X","authenticated-orcid":false,"given":"Payam","family":"Sheikhattari","sequence":"additional","affiliation":[{"name":"School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s13063-017-2402-9","article-title":"Fair inclusion of pregnant women in clinical trials: An integrated scientific and ethical approach","volume":"19","author":"Oudijk","year":"2018","journal-title":"Trials"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.whi.2022.06.004","article-title":"Exclusion of Reproductive-aged Women in COVID-19 Vaccination and Clinical Trials","volume":"32","author":"Kons","year":"2022","journal-title":"Women\u2019s Health Issues"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1108\/14777260310476177","article-title":"Ethnic minority under-representation in clinical trials. 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