Cultural Considerations to Speed Up Patient Recruitment in Clinical Trials Conducted in Asia

Recruiting and retaining patients for clinical trials in Asia requires a deep understanding of not only country-specific regulatory requirements, but also the region’s diverse cultural, linguistic, and religious nuances.

From communication styles to religious obligations, a variety of cultural attitudes and beliefs significantly shape the perceptions of clinical trials in the region. These factors greatly influence a population’s ability or willingness to participate in clinical trials.

Trial sponsors and clinical research organisations (CROs) looking to conduct studies in Asia must prioritise culturally sensitive and locally adaptable recruitment approaches to ensure inclusive and ethical patient participation.

Below are some key cultural factors that are vital to ensuring effective patient recruitment, engagement, and retention in clinical trials across Asia.

Factors that CROs Must Consider for Clinical Trials in Asia Pacific (APAC)

1.   Language and Communication Barriers During Clinical Trials

As a region known for its vast linguistic diversity and varying levels of health literacy, it can be difficult to develop standardised trial documentation and communication strategies.

Linguistic Challenges

Dozens or even hundreds of languages and dialects may be spoken within a single Asian country. Effective localisation efforts must go beyond using only the official language, ensuring that communication is tailored to the regional and linguistic diversity of different locations.

Furthermore, poor translation or misinterpretation of medical terminology can cause confusion or misinformation. This is especially true in instances where a medical term may not have a direct equivalent in the target language.

Even when language barriers are overcome, low health literacy can still be a concern. In China, for example, it was reported that only 33% of adults have basic health-literacy proficiency — leaving roughly seven in ten people who may struggle to grasp a clinical trial’s purpose, procedures and potential benefits.

Building strong health literacy will allow trial participants in Asia to give fully informed consent, follow trial procedures accurately, recognise and report any adverse effects, build trust with research staff, and make overall better choices for their health.

Communication Styles

Additionally, while cultural attitudes in Asia towards communication with authority figures, such as physicians and other medical professionals, can enhance patient compliance during clinical trials, it can also create obstacles to open dialogue between patients and investigators.

In many Asian cultures, patients may hesitate to ask questions, express concerns, or challenge medical advice from professionals. This is due to the nature of communication styles in Asian countries like Japan or South Korea, which focus on avoiding confrontation and prioritising harmonious relations with others.

This deference to authority can impact informed consent processes and patient engagement throughout the clinical research period. It is, therefore, important to select clinical trial sites in Asia that understand this challenge and are experienced in bridging this cultural communication gap between patients and medical professionals.

Some approaches that trial sponsors can consider to address these issues when planning and executing clinical trials in Asia include:

• Provide Translated Materials: All patient-facing materials, including informed consent forms, must be translated into the local language. These translations should be culturally appropriate, easy to understand, and must be translated professionally by certified interpreters.

• Leverage Technology: Digital tools, such as mobile apps with multilingual support, can facilitate communication and streamline the recruitment process.

• Simplify the Process: Use visuals or videos to explain complex medical terms and procedures in an easily understandable manner.

2.   Religious Considerations

With the rich diversity of faiths and belief systems across Asia, taking religious factors into account when recruiting and managing patients for clinical trials in the region is crucial.

Dietary Restrictions

Dietary restrictions are a major issue for clinical trials involving drugs with animal-derived or non-halal ingredients. Pork-based ingredients are prohibited for Muslims, while strict adherents of Hinduism and Buddhism may be opposed to drugs that either contain animal-derived ingredients or were tested through research on animals.

Religious fasting periods also add a layer of complexity to clinical research in Asia. For instance, Muslim patients who fast during the month of Ramadan may refuse to consume medication during daylight hours. Fasting can also alter the effectiveness of treatments, which is a factor that researchers must take into account.

Issues of Modesty

Just as important as dietary needs are religious gender norms and expectations of modesty. Conservative practitioners of Islam, Christianity, and other religions in Asia may have particular misgivings about participating in clinical trials.

Women, especially, may be reluctant to receive medical care from male professionals, be unable to travel alone without a male guardian, or be worried about the need to remove head coverings or modify their attire during treatment.

Some approaches that trial sponsors can consider to address these issues when planning and executing clinical trials in Asia include:

• Collaborating with local leaders, doctors, and religious figures to build trust and improve outreach.

• Providing gender-sensitive healthcare options and respecting religious views on certain medical procedures.

• Ensuring that all medication is compliant with religious dietary laws.

3.   Family Influence on Healthcare Decisions in Clinical Trials

In many Asian cultures, healthcare decisions are made collectively, rather than solely by the individual patient.

Family Dynamics

Family members, particularly elders and spouses, play a crucial part in approving or rejecting participation in clinical trials in Asia. The hierarchical set-up of Asian families may lead to patients feeling obligated to defer to older family members’ wishes regarding whether or not to join or continue a clinical research programme.

Gendered dynamics also come into play in certain Asian communities, where a husband’s or father’s consent may be needed before a woman can access medical treatments, including in the context of clinical research trials.

Community Stigma

Furthermore, extended family may raise concerns about the social stigma of participating in clinical trials.

Certain health conditions are associated with negative social perceptions, leading to reluctance in clinical trial participation. In some Asian cultures, diseases like cancer, HIV, and mental health disorders carry stigma, making families reluctant to publicly acknowledge a diagnosis.

They may fear that trial participation could expose the patient’s condition, thus affecting job opportunities, marriage prospects, or the family’s collective social standing within the community.

Some approaches that trial sponsors can consider to address these issues when planning and executing clinical trials in Asia include:

• Include Family Members: Acknowledge the role of family in decision-making and involve them in discussions about the trial.

• Engaging trained community health educators to facilitate communication with trial patients.

• Highlight Ethical Standards: Emphasize adherence to international guidelines, such as Good Clinical Practice (GCP) and local regulatory requirements.

4.   Aversion to Risk-Taking Behaviour

Many Asian cultures tend to exhibit a cautious approach toward risk-taking, especially when it comes to health-related decisions. This cultural mindset can significantly impact participation in clinical trials, as patients may perceive experimental treatments as too uncertain or potentially harmful to their health.

In a study on female breast cancer patients’ willingness to join clinical research trials, participants expressed fear that the investigative drugs used in trials may be worse than the side effects of chemotherapy.

As a result, many participants preferred to continue treatment with their trusted physicians, opting for established medications and proven therapies over the experimental options offered in a clinical trial.

The reluctance to make risky decisions also ties back to the influence of one’s family members and concerns about how personal actions can jeopardise the reputation of the entire household should anything go wrong.

Some approaches that trial sponsors can consider to address these issues when planning and executing clinical trials in APAC include:

• Educate Patients: Clear and transparent communication about the purpose of the trial, its safety measures, and the benefits of participation is essential.

• Share Success Stories: Providing examples of successful trials that benefited patients in the region can help build confidence.

5.   Influence of Traditional and Alternative Medicine

In some Asian countries, trust in traditional medicine such as Ayurveda, Traditional Chinese Medicine (TCM), or herbal remedies may coexist or even compete with conventional Western medicine.

In China, 90% of general hospitals provide specialised TCM services, while the Indian government actively promoted the integration of Ayurvedic treatments in dealing with COVID-19. These examples reflect the enduring popularity of traditional medicine in Asian countries.

As a result, patients who believe traditional healing methods are safer or more reliable may be unwilling to participate in clinical trials that test new pharmaceutical treatments. This reluctance can be compounded by concerns that new or unfamiliar drugs could cause potentially harmful side effects.

However, many individuals in Asia also adopt a hybrid approach, incorporating both traditional and modern medicine for their health needs. For example, herbal supplements like garlic or licorice root are typically taken for digestive problems, while ginkgo is used in the treatment of age-related dementia.

By understanding these treatment preferences and the reasoning behind them, trial sponsors and researchers can develop patient strategies that better acknowledge and respect local medical beliefs.

Drive Culturally Sensitive Clinical Trials with a Trusted Regional CRO Partnership in APAC

Successful patient recruitment for clinical trials in the Asia-Pacific (APAC) region requires culturally sensitive strategies that address diverse beliefs, communication styles, and cultural differences to build trust and encourage participation.

Clinical research organisations (CROs) play an indispensable role in helping biotech and pharmaceutical sponsors navigate the cultural nuances of clinical trial conduct in the APAC region.

By leveraging local expertise, building relationships with the community, and implementing culturally sensitive, patient-centered communication approaches, CROs can enhance trust, improve trial accessibility, and optimise recruitment efforts. This ultimately leads to safer, more inclusive, and more successful clinical studies.

At ClinActis, we specialise in culturally informed clinical trial solutions tailored for pharmaceutical and biotech companies looking to conduct clinical trials in APAC. Our in-depth expertise in APAC’s regulatory frameworks, linguistic diversity, patient engagement strategies, and regulatory landscapes ensures that clinical trials are conducted with cultural sensitivity and ethical integrity at all stages. 

We also specialise in site management, clinical staffing, and data management, helping streamline clinical trial operations and enhance the outcomes of conducting research in APAC. 

Explore our full range of services to learn more about how ClinActis can support your efforts in the region as your trusted CRO partner.