Healthcare professionals’ perspectives on the barriers and enablers of cancer clinical trial participation among Arabic-speaking cancer patients in Australia: a qualitative study

Background: Culturally and ethnically diverse communities are underrepresented in cancer clinical trials, further contributing to existing health inequities. Research often overlooks how upstream social determinants of health (SDOH) might contribute to these inequities, instead focusing on individual-level barriers. Arabic is the third most spoken language in Australia and is the focus of this study. This study aims to explore how upstream SDOH influence clinical trial participation among Arabic-speaking cancer patients (ASCPs), as perceived by healthcare professionals (HCPs). Methods: A qualitative study comprising virtual focus groups with HCPs with experience recruiting ASCPs into clinical trials. Participants were recruited via professional networks and social media using snowball sampling. The Sociocultural Framework for Health Service Disparities was used to identify perceived barriers and enablers to cancer clinical trial participation relating to structural, healthcare provider, and environmental factors. Focus groups were analysed using the Best Fit approach by two independent coders. Results: Fourteen participants were recruited (ten medical specialists, two nurses, one clinical trial coordinator and one researcher). Structural and healthcare provider barriers centred on English-language proficiency. Structural barriers included limited consultation time, restrictive trial eligibility criteria, lack of translated study materials, and a lack of workforce diversity. Language discourse reduced HCPs’ confidence in patient understanding of trial information and consequently the informed consent procedure. By advocating for translated materials, booking longer consults, and engaging interpreters, HCPs became enablers to trial participation. Family support networks were identified as environmental enablers by facilitating trial-related conversations; however, they also acted as barriers by compromising patient autonomy in decision-making. Perceived scepticism and distress emerged as environmental barriers that shaped attitudes toward cancer diagnosis and trial participation. Conclusion: Findings highlight how upstream SDOH can create barriers to cancer clinical trial access, thereby reducing opportunities for participation among ASCPs in Australia. Although the barriers were described in terms of language, they may reflect a broader lack of cultural competency. Further research into strategies integrating enablers such as time, workforce diversity, interpreter engagement and translated resources is essential to inform inclusive healthcare systems and research design, with potential implications beyond the Arabic-speaking community. Trial registration: Ethical approval for this study was granted by the University of Technology Sydney Human Research Ethics Committee (ETH21-6506, 14/01/2022).