Multilevel Barriers to Clinical and Nutritional Research in Latin America: A Socioeconomic Comparative Analysis

Evelyn Frias-Toral^1,2Jaime Angamarca^3,4Isabel Calvo⁵Diana Cardenas⁶Guillermo Contreras^7,8Raquel Franco-Nuñez⁹Rosa Larreategui Arosemea¹⁰Claudia Maza¹¹Javier Restrepo¹²Jorge Carriel-Mancilla¹³Claudia Reytor-González^4*Daniel Simancas-Racines^4*

• ¹Escuela de Medicina, Universidad Espíritu Santo, Samborondón, 0901952, Ecuador, Samborondon, Ecuador
• ²Division of Research, Texas State University, 601 University Dr, San Marcos., TX 78666, United States
• ³Universidad UTE, Quito, Ecuador
• ⁴Universidad UTE. Facultad de Ciencias de la Salud Eugenio Espejo. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Quito 170527, Ecuador
• ⁵Hospital General Tijuana, Tijuana, Baja California, Mexico
• ⁶Nutrition, Institut Gustave-Roussy, Villejuif, France
• ⁷Departamento de Emergencia Hospital Guillermo Almenara, Lima, Peru
• ⁸Saint Ignatius of Loyola University, Lima, Peru
• ⁹Facultad de Ciencias Médicas, Hospital de Clinicas, Departamento de Nutrición, Universidad Nacional de Asunción, San Lorenzo, Paraguay
• ¹⁰Hospital Quirúrgico de Alta Complejidad de Ciudad de la Salud de la Caja de Seguro Social de Panamá, Ciudad de Panamá, Panama
• ¹¹Division of Education and Research, Centro Médico Militar, Guatemala, Guatemala
• ¹²Research and Development Pharmaceutical Products, World Health S.A.S Center, Poblado, Medellin, Colombia
• ¹³School of Medicine, Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil, Ecuador

Introduction: Clinical and nutritional research in Latin America faces significant challenges that limit scientific development and evidence-based healthcare. Understanding these barriers is essential for developing effective strategies to enhance research capacity in the region. This study aimed to identify multilevel barriers to clinical and nutritional research in Latin America and compare them between countries of different socioeconomic levels. Methods: A cross-sectional study was conducted with 327 healthcare professionals involved in clinical and nutritional research across Latin America. Data collection occurred via an online survey in which participants rated the importance of 16 potential barriers on a 3-point Likert scale. Analysis included descriptive statistics, chi-square tests to compare barriers between upper-middle and lower-middle-income countries, logistic regression to identify predictors of research participation, and k-means cluster analysis to identify researcher profiles. Results: Funding (84.4%), research materials (71.6%), and time constraints (70.9%) emerged as the most significant barriers across all countries. Three barriers showed statistically significant differences between income levels: participant commitment (73.6% vs. 42.6%, p<0.001), frequent appointments (56.6% vs. 37.8%, p=0.02), and language barriers (39.6% vs. 22.9%, p=0.02), all of which were higher in lower-middle-income countries. Logistic regression identified the importance of research materials (OR=0.36, p=0.002) and telemedicine (OR=1.74, p=0.044) as significant predictors of research participation. Cluster analysis revealed three distinct researcher profiles based on barrier perception patterns. Conclusions: Multilevel barriers to research in Latin America are dominated by universal resource constraints (funding, materials, time), with lower-middle-income countries facing additional challenges in participant engagement and study logistics. The relative homogeneity of most barriers across income groups suggests that regional and institutional factors may be more influential than national income levels. These findings provide a foundation for developing targeted strategies to strengthen research capacity and infrastructure across Latin America.