Purpose: Women are underrepresented in cardiovascular disease management trials. We aimed to explore the contextual, emotional, and relational factors influencing research participation in New Zealand, to better understand why women’s willingness to participate in research may not result in trial recruitment. Methodology: People undergoing small AAA surveillance in two NZ regions were invited to a convergent parallel mixed-methods study via telephone interview. Questions explored emotional responses to their AAA, perceived role of values, cultural beliefs in care and willingness to participate in clinical trials. Interviews were anonymised and analysed using Reflexive Thematic Analysis (Nvivo software) with themes developed inductively and reported using the COREQ framework. Ethical approval was obtained. Results: Between 2023-2025, 49 patients (29 women; 36 Pākehā, 12 Māori) agreed to participate. Three interrelated themes and two subthemes emerged to explain willingness to be randomised in trials. i) 'Trust as Emotional Infrastructure’: Trust served as a relational foundation enabling openness to participation, and was built or eroded through prior clinical interactions. ii) ‘Adapting to aneurysm’: Emotional adaptation was dynamic and shaped by communication, care experiences, family history and the delivery of the initial diagnosis of an AAA. Older participants more often described a sense of fatalistic acceptance. iii) ‘Negotiating participation’: Willingness to enrol in clinical research was negotiated between the patient and clinician, rather than immediately decided, and shaped by information clarity, pre-existing trust, logistic barriers and patient context. Conclusion: Willingness to participate in research depends heavily on pre-existing trust, patient views about their AAA, and negotiation of trial participation. Positive factors can be easily eroded through barriers to participation such as transport. Further work will explore these themes in focus groups.