From screening to enrollment drop-offs: perspectives of minoritized participants in Indiana.

Vaccine uptake among Black and Latine populations remains persistently lower than among white populations, yet drop-offs between screening and enrollment in clinical trials is underexamined. The current sociopolitical moment, marked by "DEI" rollbacks, disruptions of federally funded health research, and sensitivity to health equity language, heightens the urgency of this work and threatens infrastructure supporting equitable recruitment. This qualitative study investigated non-enrollment among individuals positively screened for a vaccine trial at Indiana University School of Medicine and the Indiana Clinical and Translational Sciences Institute. Seven themes emerged: institutional reputation; communication and awareness; healthcare professionals' role; public and community engagement; recruitment practices; research participant motivation; and barriers to enrollment. From a critical lens, the findings of this study make clear that closing the gap between interest and enrollment in clinical trials requires more than improved recruitment messaging but structural transformation within every step.