Background <p>Clinical trial participation is critical for ensuring new medical treatments are safe and effective for all populations. Native Hawaiian (NH), Pacific Islander (PI), and Filipino individuals experience a disproportionate burden of type 2 diabetes yet remain underrepresented in clinical trials. The primary objective was to generate insights into the motivations, barriers, and communication preferences around clinical trial participation among hospitalized patients from diverse racial/ethnic backgrounds, particularly groups that have been historically underrepresented in research.</p> Methods <p>We conducted in-person, semi-structured interviews with 56 hospitalized patients at a medical center in Hawai‘i. Participants ranked reasons for joining or not joining a clinical trial and responded to open-ended questions. Quantitative data were summarized descriptively. Qualitative responses were analyzed using Rapid Qualitative Analysis and organized by race/ethnicity.</p> Results <p>While 84% expressed willingness to join a trial, most had never been asked. NH participants prioritized helping their community and accessing new treatments. PI participants emphasized helping their doctor and advancing science. Filipino participants valued new treatments and contributing to science. White participants ranked financial incentives and community benefit. Major barriers included concerns about unknown medication risks, lack of understanding, and mistrust—particularly among PI and Filipino participants. Many NH and PI participants noted that helping family members was a key motivator. Across all groups, preferred communication strategies included physician referrals, text messaging, and physical mail.</p> Conclusion <p>Tailored recruitment strategies emphasizing family and community benefits, involvement of trusted local providers, and culturally relevant communication may enhance clinical trial participation among underrepresented populations with type 2 diabetes.</p>