Connecting Rural Appalachia to Clinical Research: The Ambassadors for Community Health Research Program as a Model for Trust Building

Medical mistrust in rural Appalachia, particularly in West Virginia, originates from a long history of institutional betrayal. Over time, experiences fostered intergenerational skepticism, embedding wariness of health care and research into Appalachian cultural memory. The distrust from structural neglect-hospital closures, provider shortages, and underinvestment-has compounded this mistrust, leaving communities hesitant to engage with outside institutions. Previous initiatives have aimed to build trust through shared decision-making and cultural awareness, but they do not answer all the challenges in Appalachia. To bridge this gap, the West Virginia Clinical & Translational Science Institute (WVCTSI) developed the Ambassadors for Community Health Research (ACHR) program. Adapted from Colorado's Immersion Training, the ACHR is a year-long initiative that trains residents as liaisons between their communities and research teams. Ambassadors receive structured training in research ethics and health communication, not as recruiters but as relationship builders who facilitate two-way exchanges of concerns, insights, and evidence. The ACHR program transforms research participation from a transactional encounter into a collaborative partnership. This sustained, culturally authentic model offers a roadmap for rebuilding trust and enhancing the relevance, ethics, and impact of clinical research in rural or underserved regions.