When community engagement becomes recruitment, everyone loses

This week: I have been spending more time in conversations with research, access and engagement teams across healthcare, pharma and life sciences and the same issues keep surfacing, but I don’t want to assume they are what you are experiencing.

So if you’re open to it, I’d really value your perspective.

I’ll share what I learn from this in a future Dispatch, because it will directly shape where Unwritten Health focuses next.

Now, to why this question is on my mind.

It was a good conversation. Thoughtful. Well intentioned. The kind of discussion where everyone in the room genuinely wants to do the right thing.

At one point, they said something along the lines of: “We’re really committed to community engagement. We bring people in once the trial is ready so we can support recruitment properly.”

They didn’t mean anything by it.

But that sentence captures one of the biggest structural problems in how patient and community engagement is still understood.

Because what they were really describing wasn’t engagement.

It was recruitment support.

And that distinction matters far more than most organisations realise.

In many healthcare, pharma and research environments, community engagement has become tightly coupled to a single moment in time: enrolment.

Engagement is scoped when health research needs participants. It’s resourced when timelines are under pressure. It’s judged on whether recruitment targets are met.

From an operational perspective, that framing makes sense. Recruitment is visible. It’s measurable. It’s urgent. But what it is doing is reconfiguring the true purpose of communities from partners in experience to being a delivery partner.

When that happens, everyone loses.

Communities experience engagement as transactional.

Teams experience it as hard, slow and unreliable.

And trust erodes, study by study.

The real issue isn’t ethics.

It’s decision quality.

By the time engagement begins, the most important decisions have already been made. Study design. Eligibility criteria. Participation burden. Visit schedules. Endpoints.

At that stage, lived experience can help explain why recruitment might be difficult. But it can’t change the conditions that made it difficult in the first place.

So insight becomes retrospective. Useful, but too late.

This is where many organisations feel stuck. They sense that something isn’t working, but the only lever they think they have is “do more engagement” at the same point in the process.

That rarely fixes the problem. It just repeats it.

I hear you ask….

The teams I’ve seen break this cycle do something deceptively simple. They separate engagement for insight from engagement for enrolment.

They involve communities earlier, before protocols are fixed and momentum takes over. Not to tick a box. Not to appease regulation. But to test assumptions while they can still be challenged.

That early insight changes things that matter. It surfaces barriers that don’t show up in models. It reshapes design choices that later determine whether people can realistically take part.

Recruitment then becomes easier, not because of better messaging, but because the work was designed with real lives in mind.

This is where trust becomes critical.

Trust is not a sentiment. It’s an operating condition.

Without trust, insight is shallow. Participation drops off. Relationships reset with every project. Communities disengage quietly, long before organisations notice.

With trust, engagement compounds. Insight deepens. And participation becomes more sustainable over time.

The difference isn’t intent.

It’s how outreach is done.

In practice, trust-building outreach looks very different from recruitment-led engagement.

First, clarity beats persuasion. Communities need to understand why they are being engaged, what decisions their input could influence, and what will not change. Vagueness erodes trust faster than honesty ever will.

Second, consistency matters more than scale. Showing up once, loudly, is far less effective than showing up quietly and repeatedly. Trust grows when communities recognise you, not just your project.

Third, relationships should outlast individual studies. Outreach should never feel like a one-off transaction. If engagement only exists for the duration of a project, trust resets every time.

Fourth, compensation signals respect. Paying people fairly for their time and expertise isn’t a courtesy. It’s an acknowledgement that lived experience has value beyond goodwill.

Finally, closing the loop is non-negotiable. Communities need to see what changed because they contributed. Even when nothing changes, explaining why builds more trust than silence ever will.

None of this is quick.

But all of it reduces friction later.

This conversation keeps coming up because the stakes are rising.

Global studies. Diverse populations. Greater scrutiny. Less tolerance for failure. More pressure on timelines and cost.

Trying to extrapolate global decisions from small, one-off engagement exercises is fragile. Using engagement only at recruitment is inefficient. And relying on transactional relationships makes every new study harder than the last.

What’s missing isn’t intent.

It’s infrastructure.

Long-term relationships. Decision-ready insight. Robust, diverse data that builds over time instead of resetting with every project.

That’s the gap we’re focused on closing at Unwritten Health.

Not by replacing recruitment.

But by ensuring community engagement does the job it’s uniquely capable of doing: improving the quality of decisions before delivery depends on them.

If community engagement in your organisation only begins when you need participants, what decisions has it already missed the chance to influence?