Moving clinical trials from diversity to inclusion

When you think of diversity, how would you define it? It’s likely that your definition draws upon a model called the Diversity Wheel, produced by Marilyn Loden in the early 1990s.

If you’ve not heard of this before, it’s a great tool that’s still used today. In a nutshell, it’s a wheel that was created to help people better understand how group-based differences contribute to people's social identities. Today, it can be used in many different ways, for people and organisations, for personal and professional development. The wheel is made up of different dimensions, which suggests how much influence the factors in each dimension exert on a person’s beliefs, expectations, and life experience. Essentially, it’s a self-reflective tool that encourages you to think about you or your organisation’s values and beliefs and is a great way to begin to address diversity in clinical trials.

As times have changed since the early 1990s, the Diversity Wheel has had to go through some changes too, in order to stay relevant in today’s society and on a global level. Let’s take a closer look at the history of the Diversity Wheel.


The traditional Diversity Wheel

The original version of the Diversity Wheel was published in 1991, and by 1996 it had already gone through some changes, where Loden added first language, family status, work style, and communication style into the second version. So, in 1996, the Diversity Wheel looked something like this:

COUCH Health Diversity Wheel 1

The primary dimension is said to be made up of the most powerful and sustaining differences. The secondary dimension is defined as other important differences that are acquired later in life, and presumably have less influence in defining who we are.

Now, you might be thinking this looks great, as it doesn’t just typically present ethnicity, religion, and race which is often what comes to mind for a lot of people when they think of diversity. The wheel brings into play gender, sexuality, income, physical abilities, work experience, and much more.

But today’s societies across the world bring much more than that, and that’s why some updates have been needed.


The updated Diversity Wheel

Loden has made several changes to her Diversity Wheel model since the original publication in 1991. And while most of the latest additions were implicit in the earlier versions, Loden decided that several factors needed further emphasis to validate people’s experiences who felt certain issues were more central to their core identities. Now, it’s looking something like this:

COUCH Health Diversity Wheel 2

Some of the changes that have appeared since the 1991 version include:

  • The replacement of religion as a secondary dimension, with spiritual beliefs as a primary one
  • The addition of class to the primary dimension
  • The addition of political beliefs to the secondary dimension

Why is the Diversity Wheel important?

You might have read some of our previous blogs around cultural safety, and the Diversity Wheel certainly comes into play here.

In healthcare, we’re responsible for maximising patient health outcomes, regardless of a patient’s age, gender, ethnicity, race, sexuality, and many other individual factors. But the truth is, unconscious bias still exists within healthcare today, and many companies are set up with a narrow understanding of culture.

As societies become more diverse, it’s more important than ever for healthcare professionals to be able to effectively communicate with and provide care for those with a different culture to their own. And that’s where cultural safety and the diversity wheel comes in. Cultural safety helps people become more self-aware and reflective of what makes up their own identity and culture, and the diversity wheel can help to work on this. In turn, by enabling healthcare professionals and organisations to reflect on all of the aspects on the diversity wheel, and bringing culture to the forefront of their mind, cultural safety training will ensure they deliver care in the most appropriate way for all patients.

If you’d like to learn more about cultural safety training and how to ensure your clinical trials are more diverse and inclusive, reach out to us at or explore our website for more insights.


Patient Recruitment Companies


Diversity in Clinical Trials

Katie Rishi

As our CEO and co-founder, Katie’s ultimate goal is to make sure there’s always seat at the table for patients in our industry. Kindness is at the heart of everything we do, and this determination and positive mindset is what drives her to make a positive impact on healthcare.

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