Insights from the development of an online toolkit to promote community-engaged substance use research in the Southwest Borderlands Region.

Abstract

Background: Underrepresented communities in the Southwestern United States Borderlands region face disproportionate substance use disorder (SUD) burdens yet remain largely excluded from clinical trials. No existing resource integrates health beliefs, research literacy, and vulnerability frameworks to support diverse community engagement in SUD clinical trials.

Methods: We developed the Exploring Health Beliefs for Community Engagement and Diversity in Clinical Trials (EXPLORE) Toolkit through a multi-phase process (2021-2024) including systematic review of existing toolkits, domain development, platform design, individual interviews (n = 10), and two rounds of theater testing with community health workers serving Hispanic communities in Southern New Mexico (n = 60) and American Indian communities in Northern New Mexico (n = 25). Pre/post surveys assessed feasibility, acceptability, community interest, and research literacy. Ripple Effects Mapping evaluated the development process.

Results: Domain-specific toolkit importance ratings averaged 4.48-4.61 on a 5-point scale; 79% of participants rated the toolkit "very important" for promoting culturally competent research, and 64% were "very likely" to recommend it. Post-theater testing scores improved for perceived feasibility of conducting clinical research in participants' communities (pre: 7.19 vs. post: 7.94, 10-point scale) and research terminology understanding (pre: 7.97 vs. post: 8.74). Qualitative themes included cultural appropriateness, the role of community gatekeepers, and confidentiality concerns in rural and border communities.

Conclusions: The EXPLORE Toolkit demonstrates promise for bridging researcher-community gaps in SUD clinical trials. Findings highlight the value of interdisciplinary, community-centered development and the need for ongoing cultural adaptation. The toolkit is freely available at https://www.exploretoolkit.org/.