English language ability as an exclusion criterion in emergency research taking place in the East Midlands, its impact on recruitment and a survey of the views of research professionals

Background English language ability is commonly used within eligibility criteria in research, despite limited strategies to assess it objectively. Improving inclusion of underserved groups in research is an important and ongoing priority for the research community, including funding bodies such as the National Institute for Health and Care Research (NIHR). We asked how excluding those who cannot communicate in English impacts recruitment in Trauma and Emergency Care trials taking place in the East Midlands (UK) and explored drivers behind including such eligibility criteria. Methods We reviewed Trauma and Emergency Care studies with at least one site in the East Midlands, which completed in the 5 years prior to November 2020 and included English language ability within their eligibility criteria. We obtained screening data where available (numbers screened and excluded, and reasons for exclusion) to estimate exclusions due to language. We conducted an online survey of research professionals based in East Midlands’ Research & Development departments, Clinical Trials Units and Research Ethics Committees, to explore views on the use of this criterion. Results We found that 18% of the 129 studies reviewed directly excluded those unable to communicate in English. Screening data were available for 5/15 studies included in the analysis; 2–7% of screened patients were excluded due to language. Those we surveyed showed an awareness of the ethical and scientific issues raised by this exclusion among respondents and perceived the drivers behind this exclusion to be linked to costs. Conclusions A lack of available screening data meant that we were unable to determine the true scale of exclusion based on English language ability in publicly funded emergency medicine research in the East Midlands, but our findings indicate that it may impact on overall recruitment to studies, as exclusion rates were higher than that reported in the population. Given the importance of improving inclusivity and diversity in research, more work is needed to understand this at a national level and determine if strategies to overcome language barriers can support inclusivity and overall recruitment rates.