Intersectionality: looking beyond single identities to make trials more inclusive
What is intersectionality in trials?
There is a growing focus on ensuring that clinical trials are inclusive of under-served groups, such as minority ethnic groups or those experiencing socio-economic disadvantage.
However, in real life, people’s identities and experiences overlap and interact, which is sometimes referred to as intersectionality.
Intersectionality is a concept that can help us to understand that ” multiple forms of inequality or disadvantage sometimes compound themselves and create obstacles that often are not understood among conventional ways of thinking” (Kimberlé Crenshaw)
Where can you begin with intersectionality in trials?
If you would like to start bringing intersectionality more into your own work to improve inclusion in trials:
- Watch Alan’s story and, if possible, Mariam’s story with your team.
- Complete the reflexivity exercise, best to do individually and ask others in your team to do the same.
- Try the Intersectionality Action Matrix with a trial you are planning or running.
Scroll down to find these resources. Small, concrete steps taken early in the design process are how an intersectional approach becomes part of routine trial practice, rather than an add on.
What do you understand about intersectionality?
Research has found that very few people working in trials felt they really understood what is meant by intersectionality or how it relates to their day-to-day work. Many recognised the idea once it was described but did not feel confident using the term.
Meet Alan
In this video, you will meet Alan, whose life does not fit neatly into one category. Different parts of his identity and situation come together to shape whether he can join a trial and stay in it.
The video invites you to notice:
- Which overlapping parts of Alan’s life make it harder for him to take part
- What could the trial team realistically do to make it easier for someone like Alan to take part
- How many people in your own trials might sit at the meeting point of several forms of advantage and disadvantage in real life
Watch the video: An introduction to intersectionality in trials
With thanks to ScienceSplained for video production.
Meet Mariam
In this video, you’ll meet a second fictional character, Mariam. Her story shows a different combination of characteristics and circumstances and how these can influence someone’s ability to take part in a trial.
The video invites you to notice:
- Which aspects of Mariam’s life may usual eligibility criteria, visit schedules, information materials and reimbursement policies overlook
- What small changes in design or delivery could make a trial more possible for someone like her
Watch: Mariam’s story
How do you really feel about intersectionality?
Research has found that although knowledge sharing is important, attitudes and beliefs can quietly hold us back from acting on incorporating an intersectional lens to make trials more inclusive. Examples include:
- A worry that paying attention to and addressing intersecting disadvantages will be too complex
- A sense that inclusion is important in principle, but too difficult to prioritise once timelines and targets take over
- A belief that thinking about inclusion and which intersectional groups need to take part in a trial sits outside the remit of some trial roles
These are understandable pressures and concerns. However, they can make it difficult to see where design choices and planning may unintentionally work better for some groups than others.
A reflexivity exercise
To recognise these assumptions and beliefs, it could be helpful to reflect on your own intersecting positions and those of your team. This is not about personal criticism. It is about understanding how your experiences shape what feels “normal”, “reasonable” or “feasible” in your trials.
How can you actually apply intersectionality in a trial?
Applying intersectionality in practice is challenging. Common difficulties include:
- Knowing which intersections to focus on for a particular trial or setting
- Limited data on relevant social factors in the disease area or population
- Uncertainty about methods and best ways to approach intersectional factors in trials
- Lack of time and resource to formally plan and document an approach
Use the Intersectionality Action Matrix
The Intersectionality Action Matrix was developed as a practical planning tool. It can help you to:
- Consider which intersecting factors are most relevant for a specific trial and context
- Map where exclusion might be happening across the trial pathway, from initial design to closure
- Note existing strengths as well as gaps in the current design
- Identify practical actions that are proportionate and realistic for the team
- Record decisions and reasoning in a transparent way that can be revisited later
Use the Intersectionality Action Matrix (download here)
The matrix is not a checklist, and it is not a cure for structural inequality. It is a starting point to bring an intersectional lens into everyday trial design decisions in a way that is visible, practical and open to improvement.
About the authors
Azar Alexander Sefre is a doctoral researcher at the University of Aberdeen, completing a PhD that explores how intersectionality is understood in clinical trials and what is needed to support more inclusive study design. She has also previously worked across roles in clinical operations in industry. Her motivation is driven by a commitment to research that places patients at the centre, with the aim of generating evidence that is both representative and able to deliver meaningful impact for the people and communities intended to benefit.
Dr. Frances Sherratt is a trials methodologist at The University of Liverpool, UK. Her research focuses on improving trial communication to enhance informed consent and recruitment. She holds an NIHR Advanced Fellowship, which aims to make trials more inclusive by using behavioural science to improve communication
Dr Victoria Shepherd is
Prof Shaun Treweek is a trial methodologist and health services researcher at the Universities of Aberdeen, UK, and Uppsala, Sweden. He is very interested in trying to make it easier for trial teams to think about designing the most useful trials they can, especially by thinking carefully about who should be in the trial.
Dr. Heidi Green is
- Published on: [28/11/2025]
- Keywords: inclusive | intersectionality | design | research | equality | trials
- To cite this resource:
Azar Alexander-Sefre, Frances Sherratt, Victoria Shepherd, Shaun Treweek, Heidi Green. (2025). Intersectionality: looking beyond single identities to make trials more inclusive. Trial Forge. Available at https://www.trialforge.org/trial-diversity/intersectionality/ [accessed: today’s date]
