Knowledge and attitudes toward cancer clinical trials: a multi-national cross-sectional study in the Middle East and North Africa

BACKGROUND: Clinical trials (CTs) play a crucial role in developing new cancer treatments and enhancing patient outcomes. However, being part of these trials remains low across many regions, including the middle east and north Africa region (MENA). This study aims to evaluate the knowledge and attitudes of the general population regarding cancer clinical trials and to examine determinants of limited awareness and unfavorable attitudes. METHODS: A multinational cross-sectional study was conducted from March 1 to May 31, 2024, initially involving 5,528 participants, with a final sample of 5,422 respondents after data cleaning. Data was collected using a standard population-based cross-sectional survey, distributed both online via Google Forms and in-person. Convenience sampling was employed, with Countries and centers were selected based on accessibility, willingness to participate, and representation of different healthcare systems across the MENA region. Data analysis was conducted using Jamovi 2.3.28 software. RESULTS: Of the 5,422 responses, significant participation was observed from Egypt (22.9%) and Bahrain (20.9%). Knowledge of CTs was moderate overall, with 63.5% of participants being familiar with the concept; however, only 9.1% exhibited a high level of knowledge. Attitudes toward CT participation were largely unfavorable, with 83.8% of respondents expressing reluctance to participate, despite 77.6% indicating an interest in receiving more information about CTs. Multinomial logistic regression indicated that private and governmental employees had higher knowledge levels compared to unemployed individuals(OR = 1.65, p = 0.007, and OR = 1.87, p < 0.001, respectively). Participants with chronic illnesses and those with prior research participation also demonstrated high knowledge(OR = 2.92, p < 0.001). Attitude scores, on the other hand, were significantly correlated with age and gender (p < 0.003). Sperman's revealed a positive correlation between knowledge and attitude indicating that higher knowledge levels are associated with more favorable attitudes. CONCLUSION: This study provides insights into the general knowledge and attitude toward cancer clinical trials among the MENA population while identifying significant gaps in understanding and willingness to participate. The findings highlight the necessity of targeted educational interventions and public awareness campaigns to enhance knowledge about clinical trials and encourage a more favorable attitude toward participation.