Section Lead: Rachel Shelton, ScD, MPH
Conducting IS research focused on promoting health equity requires ongoing self-reflection on how issues of equity are addressed and considered in one’s own research, research teams, and institutions. Such reflection helps recognize the economic, cultural, racial, and other biases and assumptions we bring to the work, as well as how the broader historical and social context in which we live and conduct research shapes how we approach health inequities and our explanations for why they exist.
In the context of racial equity research, The Public Health Critical Race Praxis has been used to help guide consideration and analysis of how racism-related factors influence research questions, assumptions, methods, frameworks, and the unequal power and resources in shaping the research agenda and what is valued as solutions.1,2,3,4Such grounding can help understand and contextualize the broader systems that create inequities in our research and research institutions.
Aligned with the section in this toolkit on Community and Partner Engagement, this includes reflection on whose voices are represented at the table, how community values are being centered, how community partners benefit from participation in IS research, and potential unintended consequences. Additionally, in the context of implementation science, Stanton and colleagues5 have put forth suggestions on how to identify and analyze three types of power working through implementation:
Reflexivity and positionality are always important in the conduct of equity-focused research. Reflexivity relates to the perspective that all researchers influence all aspects of the research process,6,7 and positionality refers to the potential biases based on the researcher’s position, which may include social position and characteristics within a social context. Such reflection can help researchers acknowledge their own positions and their understanding of how they approach phenomena of inquiry, and it can help facilitate a research environment that supports and promotes respect for a range of voices and values in the context of IS research.
Woodward and Ball8 provide an excellent example of consideration of reflexivity for managing power imbalances and effective collaborative work to promote equity when conducting implementation science as a team new to community engagement. The authors describe and reflect on their application of methods to practice reflexivity in applying CBPR principles as part of a new community-academic partnership for and with US veterans living in rural Arkansas. They provide guidance and discuss the value and some considerations in applying these five methods to practice reflexivity, which included identifying positionality, writing field notes, obtaining mentorship on technical aspects, comparing headnotes, and consulting reference materials.
Reflectivity Questions in the Context of Teams
Shelton and colleagues9 propose a series of key questions for considering positionality and reflexivity in the context of their research, research teams, and institutions, which are provided below. While focused on racism and racial inequities, such questions can be extended to include and address other forms of social inequities and oppression (e.g., sexism, classism, heterosexism):
- In considering positionality and reflexivity, how is racism, power, and privilege operating here — on my research team, in my research, within my research institution and within funding institutions?
- How are racist policies and processes operating in the context of my research and research environment?
- How has racism influenced the research questions that I ask or not?
- How has racism influenced the solutions and interventions that I select, and the methods I prioritize?
- How are we framing and explaining health inequities (their causes and solutions)?
- How are we being accountable to communities experiencing racism?
- Am I using my voice and privilege to address racism? If so, how am I doing so?
- How can research findings be used to inform collective action?
- How can research and knowledge be shared with communities? And have I done this equitably?
- What is the extent to which we are prioritizing the inclusion of populations and settings experiencing inequities and what are the impacts of structural racism in these contexts?
10 Simple Rules for Building an Antiracist Lab
Relatedly, Chaudhary and Berhe10 propose 10 simple rules for building an antiracist lab:
- Lead informed discussion about antiracism in your lab regularly.
- Address racism in your lab and field safety guidelines.
- Publish papers and write grants with Black, Indigenous, and people of color (BIPOC) colleagues.
- Evaluate your lab’s mentoring practices.
- Amplify voices of BIPOC scientists in your field.
- Support BIPOC colleagues in their efforts to organize.
- Intentionally recruit BIPOC students and staff.
- Adopt a dynamic research agenda.
- Advocate for racially diverse leadership in science.
- Hold the powerful accountable and don’t expect gratitude.
Questions for Considerations for Antiracist Approaches in Community and Partner Engagement
Additionally, Shelton et al.9 provide reflection questions and considerations related to health equity and antiracism in the context of community or partner engagement in implementation science. These questions include:
- Who are the community members, researchers, and stakeholders that would benefit from or be influenced by the proposed research?
- How do we (researchers and their teams) engage with racially/ethnically diverse communities?
- How are communities defined (e.g., geography, racial identity, sexual and gender identity)?
- How often and how early in the process are we engaging with communities?
- Who is included and who is excluded when important decisions are made?
- How are power and resources distributed among researchers and communities?
- What unintentional biases do researchers bring to the research with community partnerships?
Implementation science researchers can shift the culture of academic workplaces to intentionally implement equitable and inclusive policies, set norms for acceptable workplace conduct, and provide opportunities for mentorship and networking.
- Ford CL, Airhihenbuwa CO. Critical race theory, race equity, and public health: Toward antiracism praxis. Am J Public Health. 2010;100(S1):S30-S35. doi10.2105/ajph.2009.171058
- Ford CL, Airhihenbuwa CO. The public health critical race methodology: Praxis for antiracism research. Social Science and Medicine. 2010;71(8):1390-1398. doi:10.1016/j.socscimed.2010.07.030
- Ford CL, Griffith DM, Bruce MA, Gilbert KL, eds. Racism: Science and Tools for the Public Health Professional. American Public Health Association Press; 2019.
- Ford CL, Airhihenbuwa CO. Commentary: Just what is Critical Race Theory and what’s it doing in a progressive field like public health? Ethn Dis. 2018;28(1):223-230. doi:10.18865/ed.28.S1.223
- Stanton MC, Ali SB; SUSTAIN Center Team. A typology of power in implementation: Building on the exploration, preparation, implementation, sustainment (EPIS) framework to advance mental health and HIV health equity. Implement Res Pract. Jan 2022. doi:10.1177/26334895211064250
- Creswell JW, Poth CN. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 4th ed. Sage; 2018.
- Patton MQ. Qualitative Research & Evaluation Methods. 4th ed. Sage; 2015.
- Woodward EN, Ball IA. Perspectives on learning to practice reflexivity while engaging communities in implementation science. Front Health Serv. 2023;2:1070444. doi:10.3389/frhs.2022.1070444
- Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. Implement Res Pract. 2021;2. doi:10.1177/26334895211049482
- Chaudhary VB, Berhe AA. Ten simple rules for building an antiracist lab. PLoS Comput Biol. 2020;16(10):e1008210. doi:10.1371/journal.pcbi.1008210