ArticleResearch square2026
Participation and Refusal in an Implementation Trial: Insights from the Accelerating Cervical Cancer Elimination through the Integration of Screen-and-Treat Services (ACCESS) Study.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Background: Patient recruitment and retention are major challenges in efforts to diversify clinical trials, particularly in resource-limited settings. Understanding factors that influence participation is critical for effective trial implementation. This study explores factors influencing participation and refusal in the Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS) implementation trial among women living with HIV (WLHIV) in Nigeria. Methods: A phenomenological qualitative approach was employed. In-depth interviews were conducted with 21 participants (12 acceptors, 9 decliners), purposively sampled from 12 NISA-MIRC HIV treatment facilities across Nigeria's six geopolitical zones. Interviews were conducted in English, Hausa, or Yoruba and translated for thematic analysis. Data was analyzed using comparative thematic analysis to identify cross-cutting domains influencing decision-making. Results: Nine themes emerged, including comprehension of information, fear and risk perception, perceived benefits and opportunities, logistical barriers, willingness to participate in the future, suggestions for improvement, privacy concerns, and preferred recruitment approaches. Acceptors overcame concerns through clear communication, emotional reassurance, trust, and perceived personal relevance. Decliners experienced "barrier dominance," where unresolved fears, logistical constraints, mistrust, and poorly timed recruitment outweighed potential benefits. Both groups suggested improvements, such as enhanced communication, community outreach, confidentiality assurances, and logistical support. Conclusions: Trial participation decisions reflect distinct cognitive, emotional, and structural pathways. Patient-centered communication, culturally appropriate explanations, trust-building, and logistical support are critical to improving trial recruitment and retention. Addressing these factors can enhance equitable participation and strengthen the quality and generalizability of trial evidence in Nigeria and similar low-resource contexts.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.