By Deborah Borfitz 

February 11, 2025 | Incorporating the lived experience of patients into strategic planning around clinical trials, and outreach to historically under-represented communities, are central features of the operational model of Walgreens Clinical Trials, according to Kendal Whitlock, head of digital optimization and community engagement for the business unit of the retail pharmacy chain. The key, she says, is to foster a sense of trust and long-term connection with different population groups—not show up suddenly and unexpectedly with a flashy recruitment campaign that is destined to “fall flat.”  

Whitlock was speaking at last week’s Summit for Clinical Operations Executives (SCOPE) in Orlando on bridging the barriers to patient recruitment. Doing better requires actively listening to understand the communication preferences of different communities while raising awareness about clinical trials well in advance of inviting them to click or call to participate in their first one. 

Community engagement plays a role in the “readiness” of people on the receiving end of the invitation to make an informed decision rather than reflexively saying no out of fear, Whitlock says. To that end, Walgreens Clinical Trials recently announced it had launched its inaugural patient advisory board to amplify the voice of 10 patient experts. 

This came on the heels of $25 million in funding from the Biomedical Advanced Research and Development Authority to run a COVID-19 vaccine correlate of protection clinical study now underway in 20 of its pharmacy stores. Across locations, from Chicago to Houston and beyond, same-day recruitment was driven by a patient panel at community activation events, says Whitlock.  

Walgreens Clinical Trials has not yet hit its third anniversary but seems to have found its stride on the recruitment front. Its operational model for patient identification and outreach is focused on stratification of enrolled populations beyond whether they’re eligible for any one study, she says. 

‘Ideal Place’

Challenges to clinical trial participation for patients include distrust, fear of receiving a placebo, the average two-hour driving distance to a study site, and, as a survey by Walgreen Clinical Trials has found, a surprisingly “glaring” lack of awareness, says Whitlock. The healthcare providers of those people, the first voice they may trust, are typically not clinical investigators—only about 4% of them are, a figure that has not budged in 20 years. That means conversations about trials don’t happen much when patients see their doctor. 

For sponsors, the ramp-up period in starting a trial is one to two years, and recruitment can be both the most costly and time-consuming part of the process, she adds. For-profit study sites may not have the operating reserves to establish continuity with communities, making invitations to participate feel transactional. “People may come into your trial, but they may not stay.” 

Contrast that with Walgreens, a “friendly entity that is on the corner between happy and healthy,” Whitlock continues, reciting the company’s famous tagline. “Almost 80% of the country is within five miles of a Walgreens store... you can’t hardly miss [one] going one place to the next.” More than half of those stores serve socially vulnerable populations facing unique barriers to clinical trial recruitment. 

When the pandemic hit, people sought out care at retail pharmacies both because of the physician shortage and the difficulty in getting an appointment with their doctor, she says. In fact, 79% of people, when asked, said they would trust their pharmacist to respond to their needs and those of their family. 

In the U.S., pretty much everyone goes into a pharmacy more often than their physician’s office, points out Whitlock. The frequency of those visits tends to go up as people age and are filling multiple prescriptions. “What an ideal place to... gain awareness about what clinical trials you may be eligible for.” 

Removing the Friction 

The role of Walgreens in addressing the barriers to patient recruitment is to “take some of the friction out of [the] process,” says Whitlock. Patients are encumbered enough in trying to manage their medical conditions without the added burden of deciphering the complexity of a clinical trial.  

That Walgreens stores are ubiquitous makes them convenient places for people to learn about trials and which studies they might be eligible for, including ones being conducted at their local bricks-and-mortar location and hyper-decentralized trials they can participate in virtually, she continues. Since clinical trials can be “a bridge to care” in the community, it is better for people living there to know what a clinical trial is in advance of the invitation to join one.  

Email and text messages are routinely used in patient recruitment campaigns because it’s an economical way to reach many patients, says Whitlock. But many of them go unread and unopened because they seem irrelevant and could be perceived as spam. 

Study sponsors have the option of partnering with Walgreens to identify eligible individuals, but a traditional email and text campaign may not be sufficient to convert those people into study participants, she says. Walgreens’ tactics include in-store and digital marketing, a website (for credibility), and even direct mail. The approach used is individualized based on the preferences of different patient populations, as revealed by Community Health Action Talks (CHAT) surveys. 

This helps explain why about 44% of patients that have been recruited by Walgreens Clinical Trials are from historically under-represented populations. The business unit doesn’t take a “one-size-fits-all” approach, says Whitlock. 

“Just because we have an email address for someone doesn’t mean the recipient uses their email,” she adds, citing her 90-year-old mom who recently passed. “She also had a cell phone, and did she know how to text? No, she did not.” 

CHAT Surveys

The practice of Walgreens Clinical Trials is simple: actively listen to people and apply what is learned, says Whitlock. “When people discover their voice, they use [it] more often” to communicate their needs and “interrogate” recruitment materials. 

Unlike email and text, the CHAT surveys serve as a two-way communication exchange with people, so they feel a sense of belonging in the research ecosystem, she says. One survey of close to 2,500 people resembling the U.S. population—only 500 of them were Walgreens loyalty customers—found that only one in 10 people has had a conversation with a healthcare professional about clinical trials. 

In a separate representative survey of roughly 3,000 women, 87% reported that they had never had a conversation with a healthcare professional about clinical trials. For people whose first exposure to the concept was during the development of vaccines in the height of the pandemic, Whitlock says, the term “clinical trial” was too often interpreted to mean “guinea pig.” 

CHAT surveys have identified three broad groups of people as being most willing to participate in a clinical trial—those who understand what they are, those who have been asked, and people who had previously participated, says Whitlock. Given that the retail pharmacy setting is a novel innovation as a location for access to a clinical trial, only the most entrepreneurial 2.4% can be expected to “dip their toe in the water first” in the context of an innovation adoption curve. 

At a minimum, those innovators should be approached about the opportunity in front of them, she says, adding that she’d lump them with the early adopters to reach a 13.6% target market. “We already know who comes into clinical trials—those whose physicians may have told them about the opportunity and those who are proximate to where they are.” 

Who is not recruited into trials may not be discovered until “way downstream,” she says. The reality is that African Americans represent 13.6% of the population but only 5% of clinical trial participants. Likewise, Hispanics account for 18% of the population but only about 1% of trial participants.     

Historically under-represented groups are not numbers to be counted at the end, says Whitlock. “We need to... think about people before we want to do business with them.” Industry must be motivated to learn more, she stresses. “This is an invitation from them to us, not the other way around.” 

‘Going Upstream’

The approach of Walgreens Clinical Trials is “going upstream and maintaining a rapport with people” to reduce the recruitment barriers among under-represented groups, which are not all the same. “It’s an education for us... to interrogate the assumptions that [can] get made.”   

Email may be the most preferred method of communication overall, but direct mail is favored by people who have already participated, she says. The Asian population wants to go to a website to read about clinical trial opportunities while the Hispanic population prefers to hear about opportunities face to face. 

“We have to look in the mirror and figure out what we’re not capturing and then design for it... with the population,” Whitlock says. “It may be shocking to us today, after the pandemic... [but] the first order of business is to raise awareness.”  

At the 20 retail locations where Walgreens Clinical Trials is currently conducting the vaccine study, community engagement is via what Whitlock calls “surround sound” to ensure information gets repeated enough times in enough formats to become knowledge that can be used competently and confidently. The goal is to empower communities with a readiness to respond to the trial opportunity, tapping into community-based data sources about diseases and health disparities. 

The patient advisory board has added the missing voice in the room to aid recruitment efforts, she says. The group will continue to be tapped for consults moving forward.