Health equity via inclusive communications: self-censorship of marginalized health needs in qualitative research

Abstract

ABSTRACT Based on a multi-phase study conducted on the World Health Organization’s (WHO) age-friendly cities program, healthy-cities program, and global sustainable-cities initiatives, this paper assesses how older adults – particularly those living with chronic health conditions and disabilities – discuss mobility challenges in qualitative research. Initial results indicate that demobilizing levels of travel cost and travel risk are implied, with older adults refraining from direct discussion. Reflective analysis is performed on marginalized older adults’ conceptual associations, ideologies, and response to social norms, to identify sources of pressure which may lead to downplaying or self-censorship on transport disadvantage. Results highlight that inequalities may arise from both the built environment and how research trainees communicate in research. Despite literature which suggests severe impacts of transport disadvantage, older adults may face difficulties in voicing their needs when research trainees adhere to the following social norms. First, physical access and feasibility may be minimized as mere matters of convenience to the able-bodied individual; second, overcoming transportation barriers may be seen as based on one’s effort – as opposed to the disabling effects of the built environment; third, health and fitness in general may be also associated with one’s effort, and increasingly also to one’s commitment to environmental-sustainability; fourth, older adults may feel pressure to align perspectives with more privileged stakeholders, or with the general public; fifth, money and income may be delegitimized as apt research topics, regardless of how inability to overcome travel costs may impact daily-wellbeing. Implications for educating future gerontology-research trainees conclude the study.