Inclusive clinical research does not begin with a protocol. It begins with how we show up, how we listen, and whether the work is culturally safe for the people it is intended to benefit. In Aboriginal and Torres Strait Islander health, that starting point matters because research has too often been experienced as extractive: designed elsewhere, delivered briefly, and leaving communities with little control over decisions, data, or outcomes. If we want clinical trials to contribute to health equity, we need to move from engagement as an administrative step to partnership as the core method.

One way Victoria is pursuing that shift is through the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the principles of marra mgarrgoo, marra goorri: The Victorian Aboriginal Health, Medical, and Wellbeing Research Accord (the Accord). The Accord is not simply a statement of intent. It is a practical guide for how research should be governed, designed and conducted when Aboriginal communities are involved, with a clear emphasis on self-determination. It challenges the default assumption that institutions automatically “own” the research process and instead centres Aboriginal community priorities, decision-making and benefit.

The need for such an accord is not theoretical. A common barrier to participation is trust, and trust is shaped by histories that many people in the research workforce were never taught. When we acknowledge that history, we are not dwelling on the past. We are recognising why communities may approach research cautiously, and why relationship-building takes time. Truth-telling, Treaty conversations, and ongoing reform efforts in Victoria are part of the broader environment in which research happens. Researchers who understand this context are better positioned to work respectfully, avoid harm, and build partnerships that last beyond a single project.

VACCHO’s focus now is implementation. Translating principles into routine practice takes structure: clear expectations, accountability, and mechanisms that reinforce cultural safety rather than leaving it to individual goodwill. In practice, this includes efforts such as strengthening ethics mechanisms and supporting reflective processes that help institutions examine their own systems. The objective is to make culturally safe research the standard, not an exception negotiated project by project.

The importance of these principles becomes very clear when looking at real-world clinical research. The Flash GM study provides a strong example of “how” inclusive trials can be done. The study focuses on diabetes care and examines the acceptability and effectiveness of continuous glucose monitoring for Aboriginal and Torres Strait Islander peoples. Diabetes remains a substantial burden, with Aboriginal and Torres Strait Islander communities experiencing significantly higher prevalence than non-Indigenous Australians. Technology may offer benefits, but only if it is acceptable, accessible, and implemented in ways that respect community needs.

What stands out in Flash GM is that feasibility and acceptability were treated as foundational questions, not afterthoughts. The work started with early conversations in community settings and a pilot that asked, plainly, whether the approach made sense to community. From there, the model was built around co-design, collaboration, and connection, supported by Aboriginal leadership. Importantly, delivery has been structured to avoid “parachuting in” external trial staff. Local clinicians and health workers at participating sites deliver the trial alongside their usual roles, strengthening capability where it matters most and reducing the sense that research is something imposed from outside.

Practical adjustments also mattered. Participant information is often written in institutional language that makes true informed consent difficult for anyone, let alone people navigating cultural or historical barriers to trust. The Flash GM team addressed this by translating dense written content into an image-based consent video. This approach recognises that comprehension is not a box to tick; it is the ethical heart of consent. It also exposes a gap in research systems, because video consent methods are not always well understood or consistently supported within traditional ethics pathways. In inclusive research, improving consent processes may require educating ethics committees as well as participants.

Across these examples, the thread is consistent: respect is not symbolic. It is operational. It changes timelines, governance, recruitment models, workforce design, and how we communicate. It asks researchers to approach Country and community as partners, not as settings for data collection. It also asks institutions to share power in ways that can feel unfamiliar, particularly when deadlines, budgets, and conventional metrics are driving project delivery.

For researchers and sponsors looking to strengthen inclusion, the message is both challenging and hopeful: start small, but start. Be curious, seek guidance, and invest in relationships early. Take cultural safety seriously enough to change how the work is done, not just how it is described. When research is co-designed, community-led, and grounded in self-determination, it not only becomes more ethical, it becomes more rigorous, more relevant, and more likely to deliver outcomes that communities actually want and can use.