Abstract
Disproportionate and persistent inequities in quality of healthcare have been observed among persons of color in the United States. To understand and ultimately eliminate such inequities, several public health institutions have issued calls for innovative methods and approaches that examine determinants from the social, organizational and public policy contexts to inform the design of systems change interventions. The authors, including academic and community research partners in a community-based participatory research (CBPR) study, reflected together on the use and value of the critical incident technique (CIT) for exploring racial disparities in healthcare for women with breast cancer. Academic and community partners used initial large group discussion involving a large partnership of 35 academic and community researchers guided by principles of CBPR, followed by the efforts of a smaller interdisciplinary manuscript team of academic and community researchers to reflect, document summarize and translate this participatory research process, lessons learned and value added from using the CIT with principles of CBPR and Undoing Racism. The finding of this article is a discussion of the process, strengths and challenges of utilizing CIT with CBPR. The participation of community members at all levels of the research process including development, collection of the data and analysis of the data was enhanced by the CIT process. As the field of CBPR continues to mature, innovative processes which combine the expertise of community and academic partners can enhance the success of such partnerships. This report contributes to existing literature by illustrating a unique and participatory research application of CIT with principles of CBPR and Undoing Racism. Findings highlight the collaborative process used to identify and implement this novel method and the adaptability of this technique in the interdisciplinary exploration of system-level changes to understand and address disparities in breast cancer and cancer care.
Highlights
Critical incident technique in the quality of healthcare that are not due to accessrelated factors or clinical needs, preferences, and appropriateness of intervention’ [1]
We first provide an overview of our participatory research partnership, the process used to identify the critical incident technique (CIT) followed by a description of the application of CIT to explore racial disparities in breast cancer care
We found that the flexible CIT approach, together with consistent and transparent communication structures allowed our community-based participatory research (CBPR) team to swiftly and effectively address some of the time and training barriers experienced previously by others using CIT
Summary
Critical incident technique in the quality of healthcare that are not due to accessrelated factors or clinical needs, preferences, and appropriateness of intervention’ [1] Findings from their meta-analysis showed that, even after controlling for income, insurance coverage, and healthcare access, racial and ethnic disparities in quality of healthcare persisted. The reasons for such disparities have not been well conceptualized or documented, and have varied by type of condition, socio-demographic variables, economic factors and various cultural preferences, attitudes and ideas about disease etiology, prevention and treatment [2, 3]. Racial and ethnic disparities in healthcare may involve organizational factors within facilities and health plans or systems, including complex appointment or referral systems or long waiting times; simple lack of providers within any reasonable traveling distance or time; poor understanding of how best to mobilize local, community organizations that principally serve African American residents; and matters such as the racial and ethnic concordance (or lack thereof) between patients and clinicians that may have effects on patient care-seeking behaviors or satisfaction with care [5,6,7,8,9,10].
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