Clinical trials are the gold standard for the scientific evaluation of the safety, effectiveness, and tolerability of medical interventions, whether they involve drugs, medical devices, or public health strategies. They are a key driver of evidence-based medicine and the continuous improvement of care quality [1,2].

Globally, clinical research is experiencing steady growth, with a significant increase in the number of trials conducted in low- and middle-income countries. This trend is largely explained by the need to have context-specific data tailored to the epidemiological, genetic, and socio-environmental profiles of local populations [3,4].

In sub-Saharan Africa, conducting clinical trials has become a strategic issue of scientific sovereignty and health system strengthening [5].

However, the implementation of clinical trials in low-resource countries poses specific challenges, particularly regarding human capacity, governance, regulatory framework, and ethical acceptability [6,7].

Healthcare professionals play a central role in this process. They are involved at every stage of clinical trials, from identifying and informing participants to ensuring compliance with Good Clinical Practice (GCP) and monitoring safety [8].

Insufficient knowledge, negative perceptions, or inadequate practices of healthcare professionals can compromise the scientific quality of trials, the protection of participants, and the trust of communities [9,10].

Several studies conducted in West Africa have highlighted significant gaps in clinical research training, as well as ongoing ethical concerns related to the risk of exploiting vulnerable populations [11–13].

In Senegal, the number of clinical trials has increased over the past decade, particularly in the areas of infectious diseases, vaccination, and more recently, non-communicable diseases. However, empirical data on the knowledge, attitudes, and practices of healthcare professionals remain scarce and are often limited to specific institutional contexts [14].

The Thiès region, located in the west of Senegal, is of particular interest for the study of clinical trials. It combines healthcare facilities of various levels (regional hospitals, health centers, peripheral structures), a diverse population, and proximity to the university and research hubs of Dakar. These characteristics make it a relevant setting for analyzing the CPAs of healthcare professionals and identifying levers for improvement at the national level.

This study aims to comprehensively assess the knowledge, attitudes, and practices of healthcare professionals regarding clinical trials in the Thiès region, and to identify the factors associated with good practices, in order to guide training, governance, and capacity-building policies in clinical research in Senegal.

Méthodology

Type and framework of the study

This was a descriptive and analytical cross-sectional study conducted between March and June 2025 in the Thiès medical region. The study was carried out in five public and semipublic health facilities, including a regional hospital, two departmental-level hospitals, and two health centers.

Study population and sampling

The target population consisted of all healthcare professionals working in the selected facilities, including doctors, pharmacists, nurses, midwives, and health technicians who agreed to participate in the study.

Healthcare professionals working in the facility and who gave their informed consent were included. Trainees and administrative staff were excluded.

420 healthcare professionals were recruited through stratified convenience sampling according to professional category.

Recruitment was done on a voluntary basis, thanks to:

• A structured questionnaire, self-administered online via a link created on KoboToolbox, shared with healthcare professionals in WhatsApp groups, LinkedIn, …
• Individual interviews with certain healthcare professionals recorded directly using the KoboCollect mobile app version 2025.2.3.

Data collection tool and procedure

The data were collected using a structured, self-administered CAP questionnaire, developed based on literature and international recommendations. The questionnaire included four sections: sociodemographic characteristics, knowledge (10 items), attitudes (10 items on a Likert scale), and practices (8 items). A pretest was conducted with 30 healthcare professionals to assess the clarity and consistency of the tool.

Variables and operational definitions

A good level of knowledge was defined by a score of ≥ 7/10. A favorable attitude corresponded to an average score of ≥ 4 on the Likert scale. Good practices were defined by participation in at least one activity related to clinical trials (research, monitoring, or training).

Statistical analysis

The data were analyzed using R software version 4.4.0. Descriptive analyses were performed in the form of means, standard deviations, and proportions. Associations were explored through bivariate analyses, followed by multivariate logistic regression to identify factors independently associated with good practices. The results are presented as adjusted Odds Ratios (aOR) with their 95% confidence intervals. The level of statistical significance was set at p-value < 0.05.

Ethical considérations

The study received approval from the National Health Research Ethics Committee of Senegal (CNERS). Participation was voluntary, and informed consent was obtained from all participants. Anonymity and data confidentiality were strictly maintained.

Results

Sociodemographic characteristics of the participants

Among the 420 healthcare professionals surveyed, 383, or 91.19%, responded directly to the online questionnaire, and 37 (8.81%) were interviewed individually, with data collected using the KoboCollect application.

The majority of participants were women, with a sex ratio (M/F) of 0.78. Figure 1 shows the distribution by gender.

Table I presents the distribution of profession of the participants. The majority were women (56.2%) and the average age was 36.8 ± 7.4 years. Physicians accounted for 40% of the sample.

Table I: distribution of profession of the participants (n = 420).

Overall, less than half of the participants had a good level of knowledge. Concepts related to the objectives of clinical trials were better understood than those concerning the regulatory framework (table II).

Table II: Level of knowledge about clinical trials.

Overall attitudes were favorable, although ethical concerns persist, particularly regarding the risk of exploiting vulnerable populations (table III).

Table III: Healthcare professionals' attitudes towards clinical trials.

Practices and associated factors

Practical participation in clinical trials remained limited. Training in clinical research and professional category were the main determinants of good practices (table IV).

Table IV: Factors associated with good practices in clinical trials.