Community-engaged Research Research Articles

Wildfire Smoke Exposure During Pregnancy: Consensus-Building to Co-Create a Community-Engaged Study

Relative to other Oregon counties, Klamath County experiences worse air quality due to wildfire smoke, as well as elevated rates of infant mortality and low birthweight. Klamath County Public Health (KCPH) raised concerns that wildfire smoke is a contributor to poor infant health. Thus, we built a multidisciplinary team and designed a community-engaged research (CEnR) project to capture community and individual-level exposure to wildfire smoke contaminants, alongside perinatal health outcomes. Through partnerships, we identified 24 individuals across academic, public health, and community organizations that met five times over three months to develop a study design. We initially used a modified Delphi method, but adjusted our approach to find multidisciplinary areas of agreement across a highly diverse team. Our team used structured meetings, surveys, and iterative feedback to build consensus on a study design. KCPH and our community partners reviewed and approved all proposed activities to ensure community input was integrated. The resultant study, trialed in Klamath County, included the use of environmental, residential, and personal samplers and health surveys with a cohort of pregnant individuals during the wildfire season. We discuss the advantages and challenges of building a multidisciplinary CEnR study in a rural county disproportionately impacted by wildfire smoke and infant mortality.

Abstract 4136822: Implementation of a Community-Engaged Amputation Prevention Intervention in Rural Appalachia

Amputation is a devastating complication of diabetes and peripheral artery disease and a marker for health inequity. Implementation Science (IS) and Community Engaged-Research (CenR) allow for real-world adaptation of evidence-based interventions and provide critical frameworks for reproducibility and sustainability. However, few amputation interventions use these approaches. We describe the feasibility and acceptability of an IS and CEnR driven amputation intervention in a high-risk rural community. A Pre-Post mixed methods design was used (Fig 1). Intervention components were mapped to the Social-Ecological Model (Fig 2) and guided by the CFIR. Community and Project Advisory Boards collaborated on needs assessment, mobilizing resources, intervention adaptation, data review and dissemination. A 3-component intervention was implemented in 2 clinics to improve local foot care. Components included diabetic foot exams (DFEs), a multidisciplinary limb preservation team, and a “hot-foot” hotline. Pre-implementation, a retrospective chart review was performed along with focus groups. DFE training was then conducted at each site. After training, a prospective chart review was performed with clinic check-ins for 12 months. Focus groups were held 6- and 12-months post-implementation. Concurrently, monthly multidisciplinary teleconferences were held, and a “hot-foot” phoneline connected providers to specialty nurses. At baseline, 155/224 (69.2%) patients received an annual DFE, 17% had all four exam components, 15.6% had foot abnormalities identified and 3.6% were referred to specialists. At 12-months 212/268 (79.1%) patients received a DFE, 84.7% had all components, 54.9% had abnormalities and 20.1% were referred. All findings were statistically significant. Clinically there was a significant decrease in patients with foot wounds, infection, and foot-related hospitalization/ED visits. There were no changes in amputations. (Table 1) The virtual teleconference completed 12 sessions. The hotline was used once with clinicians reporting they did not need it. We demonstrate successful, sustained implementation of an amputation prevention intervention in a high-risk rural community using IS and CEnR. This approach was crucial for overcoming barriers to intervention implementation in a resource poor environment. Additional research to assess patient experience, understand key components of the intervention and study scalability and clinical effectiveness is planned.

Nats'eji (healing): Examining patient and provider experiences with hospital-based Indigenous wellness services in Northwest Territories, Canada.

This study aimed to examine how Indigenous patients and biomedical healthcare providers understand and experience the Indigenous wellness services at a hospital in the Northwest Territories. The qualitative study (May 2018-June 2022) was overseen by a regional Indigenous Community Advisory Committee. Guided by Two-Eyed Seeing and post-colonial theory, the study employed a community-engaged research design, and included two strategies for data generation: (1) interviews with Indigenous Elders, patient advocates, biomedical healthcare providers, policy makers, and hospital administrators (n = 41), and (2) iterative sharing circles with Indigenous Elders (n = 4). Data from the interviews and first sharing circle were transcribed, thematically analyzed, and presented to the sharing circle Elders for validation. The study revealed three overarching and related themes: (1) Elders and patient advocates emphasized that while the Indigenous wellness services at the hospital play a pivotal role connecting patients with cultural supports, the hospital was still not effectively bringing Indigenous healing practices into hospital care; (2) participants identified that structural factors (i.e., policy and governance decisions) shaped patients' experiences with the wellness services; and (3) participants underscored that deeply rooted forces (i.e., racism, colonialism, and biomedical dominance) inhibit the integration of Indigenous healing practices. The findings extend understandings of hospital-based Indigenous wellness services by surfacing relationships between deeply rooted forces, organizational structures, and Indigenous patients' experiences. Altogether, they suggest that to advance care for Indigenous patients and improve the integration of Indigenous healing practices, a system-wide transformation is necessary, which includes Indigenous governance at the hospital and a recognition of the value of Indigenous healing practices.

Geosocial Tools for Community Diagnosis and Health Promotion.

Growing research highlights the role of local community contexts in health and well-being. Communities function as central arenas for health promotion as individuals and community spaces interact in daily life. To better communicate the linkages between community and health, we demonstrate the use of a set of geosocial tools for community diagnosis and health promotion, conceptually grounded in the framework of geosocial embeddedness, using data from community surveys and participatory research conducted with local inhabitants to engage their competency. Through a web-based interactive map generated using a geographic information system, we identified public territories in the municipality where greater policy attention is needed to enhance health. Through an intersectional matrix produced using multilevel analysis, we identified precise social groups by intersectional categories that are most at risk of loneliness for targeted intervention. A health radar chart on multidomain indicators illustrated information on group dynamics and longitudinal comparisons for health promotion. Overall, these tools offered not only diagnoses of the most vulnerable social groups for tailored interventions but also insight for policymakers to improve infrastructure and material resources to promote health. We conclude that geosocial tools offer a promising approach toward sharpening health communication and improving health in the community.

A quasi-experimental study assessing the effectiveness of a community-based egg intervention in the nutritional and health status of young children from rural Honduras.

This community-public-private-academic coalition project implemented and evaluated the effectiveness of a rural, community-based egg intervention that aimed to support the nutrition and health of children living in rural, poor communities from Intibucá, Honduras, during the COVID-19 pandemic. This investigator-blind, non-randomized, controlled study was informed by a community health improvement process and participatory research. Women from 13 communities were given a microloan to start an egg farm that supplied 1 egg daily to 201 children ages 6-24 months for 1 year (intervention group). Control communities (n = 14) were selected from neighboring municipalities with similar sociodemographic backgrounds based on size. Sociodemographic-, anthropometric-, and morbidity data were collected biannually between January 2021 to January 2022. Outcome changes were compared with linear-, generalized- or Poisson- mixed models adjusted by sex, age, maternal education, breastfeeding status, assets, adults living at home, baseline outcomes, and community-cluster. Baseline to 6- and 12-month weekly frequency of egg intake significantly increased in the intervention vs. the control group: 6-month change = 1.86; 95%CI (1.61, 2.14); 12-month change = 1.63; 95%CI (1.42, 1.87 p<0.001), respectively. Baseline to 12-month changes in the intervention group were not significant for length/height-for-age-z-scores = 0.12, p = 0.187; weight-for-length/height-z-scores = -0.02, p = 0.78; and diarrhea prevalence, AOR = 1.69; 95%CI (0.53, 5.42), p = 0.378. Lower odds of respiratory infections were observed for the intervention vs. the control group at 6- and 12-month post: AOR = 0.28; 95%CI (0.12, 0.63), p = 0.002; AOR = 0.30; 95%CI (0.12, 0.75), p = 0.010, respectively. Children in the intervention group reported consuming eggs more days per week relative to the control group. Lower odds of respiratory infections were observed in the intervention group throughout the study. Ongoing follow-up will offer more insights on the intervention's effectiveness in linear growth, dietary diversity, food security, and other nutritional outcomes.

Designing and Implementing a Community-Engaged Research e-Library: A Case Study for Adapting Academic Library Information Infrastructure to Respond to Stakeholder Needs.

The Duke University Clinical and Translational Science Institute Community Engaged Research Initiative (CERI) created an e-Library in 2018. This e-Library was developed in response to requests from academic researchers and the community for reliable, easily accessible information about community-engaged research approaches and concepts. It was vetted by internal and external partners. The e-Library's goal is to compile and organize nationally relevant community-engaged research resources to build bi-directional capacity between diverse community collaborators and the academic research community. Key elements of the e-Library's development included a selection of LibGuides as the platform; iterative community input; adaptation during the COVID-19 pandemic; and modification of this resource as needs grow and change.

Asking Why Is Necessary to Address Health Disparities: A Critical Approach for Solution-Oriented Environmental Epidemiological Research.

In environmental epidemiology, we use an array of tools from various, related disciplines to answer key questions about environmental exposures in relation to health outcomes. Typically, we ask questions related to what, who, where, when, and how. We value these questions because they contribute to novel scientific discovery and our understanding of disease etiology linked to environmental exposures. In addition, these questions help us better understand who might be at highest risk of exposure and subsequent risk of disease. Although necessary for the goals of environmental epidemiology, these questions are insufficient for addressing environmental health disparities. Specifically, these questions may be able to help us describe exposure-health outcome associations but are limited in their ability to move beyond identification to intervening on observed disparities to achieve environmental health equity. We sought to emphasize the need to value and routinely add the key question of "Why?" in environmental epidemiological studies. In asking this additional critical question, we can identify and incorporate the structural determinants and drivers of environmental exposure disparities and determine whether these factors are linked to existing and historically recalcitrant health disparities. Further, we can design effective studies that build on existing frameworks to address the fundamental causes of environmental health disparities. This commentary underscores the need to routinely incorporate "why" questions in the practice of environmental epidemiology. By asking and addressing "Why?" we can employ better, more solution-oriented study designs, improve data collection, and enhance our ability to collaborate with diverse study populations through trust-building and community-engaged research. Incorporating these approaches will move environmental epidemiology forward from mostly documenting to actively addressing environmental health disparities. https://doi.org/10.1289/EHP14513.

On the Journey: a qualitative study of a community-based, client-centred eating disorder recovery group

BackgroundCommunity-based eating disorder (ED) treatment frequently includes manualized group-based psychoeducation facilitated by a mental health clinician. Body Brave, a non-profit ED organization, developed a novel, participant-guided, community-based virtual healthcare provider (HCP)-facilitated support program called On the Journey (OtJ). The program was designed for people with longstanding EDs who had previously participated in group or individual ED programs but require continued support in their recovery. The purpose of the study was to describe the development and components of OtJ and to understand participant perceptions of the program and its effect on their recovery.MethodsUsing a formative and community-engaged research design, we conducted semi-structured interviews with three OtJ facilitators and focus groups with twelve OtJ clients. Transcripts were analyzed using Braun and Clarke’s six-stage approach to reflexive thematic analysis.ResultsFour main themes were generated from the data (1) “Designing and Evolving OtJ” (2) “Is OtJ a Treatment or Support Group?” (3) “Fostering a Safe Environment throughout Program Delivery” and (4) “The Power of Lived Experience.” Clients noted several strengths of the OtJ program: fostering a sense of community, valuing client autonomy, and providing accessible ED support.ConclusionsKey considerations for other organizations looking to offer programming similar to OtJ include having skilled and clinically trained facilitators and prescreening discussion topics to ensure that conversations are productive towards recovery. OtJ supports people with longstanding EDs, and other organizations could consider adopting a similar model of care. This study contributes to the growing body of including lived ED experience in research.

Participation With Compensation: Ethical Considerations for Research Payment Practices With People Who Are Incarcerated.

The participation of incarcerated individuals in research is necessary to appropriately address the health disparities that affect them and to adapt and implement health services for the carceral setting. Incarceration significantly impacts health, leading to negative outcomes including accelerated aging and increased mortality, with these effects disproportionately impacting communities of color. The U.S. Department of Health and Human Services' Office for Human Research Protections outlines ethical approaches to compensating individuals who participate in research activities, yet lacks specific guidance for payment within carceral settings. Historical abuses in carceral research underscore the persistent need for robust protections for incarcerated research participants. Existing regulations offer some protection but inadequately address ethical payment practices. Substantial variability in payment policies across carceral systems and vague national guidelines pose ethical challenges in ensuring equitable treatment for incarcerated research participants. We outline the ethical concerns related to compensating incarcerated individuals for participating in research and present a framework of approaches to payment. We argue for payment parity between incarcerated and community research participants. More community-engaged research is needed to understand the perspectives of incarcerated individuals on ethical payment.

The Intersection of Community Engagement and Team Science Research: A Scoping Review

The Intersection of Community Engagement and Team Science Research: A Scoping Review

Key themes of community-oriented primary care projects from a longitudinal, rural interprofessional health professions curriculum (1997–2023)

BackgroundThe Community Oriented Primary Care Project Model (COPC) has been well studied globally as well as in the United States as a way to provide both community-centered primary care and to engage in community based research. Rural trainees through the University of Illinois College of Medicine’s Rural Medical Education Program (RMED) and Rural Pharmacy Education Program (RPHARM) students through the University of Illinois Chicago College of Pharmacy have participated in a COPC project as a capstone to a four month longitudinal, immersive community-based experience in a rural primary care setting. The purpose of this study was to assess the type of projects implemented through a rural health professions curriculum over a 30 year project period. .MethodsA research team reviewed projects on 30 elements; including topic and demographics. Patterns in COPC topics and rurality of the location in which the COPC project were also examined by using 2021 U.S. Census Bureau population data and Rural Urban Commuting Area (RUCA) Code.ResultsCOPC projects were categorized into 31 main topic areas with mental health being the most prevalent topic area covered by projects (n = 67, 15.7%) followed by 43 (10.1%) projects that focused on nutrition/exercise, and 41 (9.6%) focused on substance use (presented as a separate category from mental health in this analysis).ConclusionsFor three decades, COPC themes reflect priority health issues in rural communities while providing a scholarly activity for health profession student trainees Past projects have also been implemented in highly rural areas where research is not often conducted. The COPC research process can be easily replicated in other trainee models such as to fulfill ACGME requirements of scholarly activity and can provide a template for trainees of this model to implement community-engaged research in the future.

The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) Engagement Core: A culturally informed, community-engaged research (CI-CER) model to advance brain health equity.

The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) Engagement Core was launched to advance Alzheimer's disease (AD) and AD-related dementia (ADRD) health equity research in underrepresented populations (URPs). We describe our evidence-based, scalable culturally informed, community-engaged research (CI-CER) model and demonstrate its preliminary success in increasing URP enrollment. URPs include ethnoculturally minoritized, lower education (≤ 12 years), and rural populations. The CI-CER model includes: (1) culturally informed methodology (e.g., less restrictive inclusion/exclusion criteria, sociocultural measures, financial compensation, results disclosure, Spanish Language Capacity Workgroup) and (2) inclusive engagement methods (e.g., the Engagement Core team; Hub Sites; Community-Science Partnership Board). As of April 2024, 60% of ADNI-4 new in-clinic enrollees were from ethnoculturally or educationally URPs. This exceeds ADNI-4's≥50% URP representation goal for new enrollees but may not represent final enrollment. Findings show a CI-CER model increases URP enrollment in AD/ADRD clinical research and has important implications for clinical trials to advance health equity. The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) uses a culturally informed, community-engaged research (CI-CER) approach. The CI-CER approach is scalable and sustainable for broad, multisite implementation. ADNI-4 is currently exceeding its inclusion goals for underrepresented populations.

The Importance of Sustainable Wetland Management

Wetlands have faced a global reduction from 64% to 71% during the 20th century, and it is estimated that habitat loss could lead to the extinction of around 1,700 vertebrate species by 2070. This study analyzed data from SCI, Scopus, Web of Science, Google Scholar, and a range of theses to explore sustainable wetland management. While previous research focused on the consequences of wetland degradation, this study highlights the critical need for sustainable management. Wetlands are biodiversity hotspots, home to numerous endemic and endangered species, making their conservation vital for protecting global biodiversity. Wetlands also contribute significantly to climate change mitigation by sequestering carbon, regulating water flow, and reducing catastrophe risk. Sustainable wetland management is essential to harness these benefits, particularly in light of growing environmental challenges. Wetlands also provide crucial ecosystem services, such as water purification, flood control, and recreational opportunities, emphasizing their socio-economic importance. Despite these benefits, wetlands face ongoing threats from habitat destruction, pollution, and unsustainable use. Effective management requires a comprehensive approach, incorporating conservation, community engagement, policy development, and scientific research. Embracing sustainable practices is essential to preserve wetlands for future generations, reaffirming their role as critical ecosystems that support life and resilience. This abstract calls for global action to prioritize sustainable wetland management as a key aspect of environmental protection and sustainable development.

Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

In February 2022, a fertilizer plant fire burned for four days and displaced thousands of residents, who were mainly low-income and Black or Latino, from their homes in Winston Salem, NC. In partnership with Black and Latino residents and nonprofit organizations, we sought to understand Black and Latino resident perceptions of the chronic and acute health risks, as well as the emotional and financial effects that resulted from the fire, which included the release of nitrous dioxide. We used the Environmental Health Disparities Framework to guide this community-engaged research study, capturing through semi-structured interviews: 1) how residents perceived their community before and after the fire, 2) how the fire impacted physical and mental health, and 3) how individuals coped with stress. We used thematic analysis to analyze the data and identified seven major themes. Participants: 1) perceived their neighborhood positively, 2) were unaware of the potential dangers of the fertilizer plant before the fire, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city's response to the fire, and 7) provided recommendations for future city response.

Collective Capabilities Complete a Neighbourhood

This article argues for the need for attention to agency as well as structure in planning for complete neighbourhoods and communities, drawing upon collective capabilities theory and driven by a community-engaged research approach. While complete communities planning proposes to provide more fulsome social and physical infrastructure to residents in a context of urban growth and change in Canadian cities, contemporary efforts tend to neglect or disdain the agency and empowerment of residents. This logic and rationale for complete communities planning has shifted compared to the origins of neighbourhood planning in Canada, as will be exemplified here drawing upon the case of Vancouver. The application of the theory of collective capabilities in complete communities planning offers a path forward that is not naïve to the challenges posed by participatory planning and that views organizations other than the government as having collective capabilities to plan. We demonstrate the potential of this through the case of our community-engaged research partnership based at the South Vancouver Neighbourhood House. The project mobilized spatial and statistical research to document the extent of inequities and needs experienced in South Vancouver neighbourhoods as well as the collective capabilities of residents working through the neighbourhood house hub to provide essential services and do effective neighbourhood planning.

Community-engaged research: Bringing the science of developmental psychopathology into the real world.

The science of developmental psychopathology has made outstanding progress over the past 40 years in understanding adaptive and maladaptive developmental processes across the life span. Yet most of this work has been researcher driven with little involvement of community partners in the research process, limiting the potential public health significance of our work. To continue to advance the field we must move beyond the physical and conceptual walls of our research laboratories and into the real world. In this article, we define and describe the importance of community-engaged research, and present our overarching principles for engaging the community including practicing respect, shared power and decision-making, prioritizing the needs of the community, and engaging in consistent and transparent communication. We present several associated recommendations for best practice and highlight examples from our own research that is grounded in a developmental psychopathology perspective to illustrate these practices. Recommendations for the future of the discipline of development and psychopathology, with emphasis on training and continuing education, are described.

Engineering hydro-anxiety: agrarian urbanisation and water in peri-urban Delhi

ABSTRACT The paper traces water-related social concern, or hydro-anxiety, on Delhi’s rural periphery. It follows Matthew Gandy’s assertion that ‘the history of cities can be read as a history of water’, even as it expands the urban to encompass its extensions, including the surrounding rural belt. Building on community-engaged research, the paper describes the persistent anxieties around water since the 1950s, even as their specific articulations have changed in terms of both abundance and sensory qualities. Relating the shifts with local responses to the state’s civil works since the mid-1960s, it argues that as these villages become incorporated into urban systems, historical relations with water are brought within the patchy and uncertain ones that characterise engineered hydrologies of the Global South. The paper contributes to the debate on urban change in the metropolitan shadow by empirically underlining the agrarian entanglements of peri-urban experiences.

Building a community-academic partnership to expand services for childhood cancer survivors in a rural, low-income region in California.

360 Background: Community-engaged research is an effective approach to address health disparities that is well-established in the public health domain and has not been widely applied in childhood cancer survivorship. We present our multi-year experience building a community-academic partnership and community-engaged childhood cancer survivorship research portfolio. Methods: We have developed a partnership between Jacob’s Heart Children’s Cancer Support Services, a nonprofit community-based organization (CBO) and an academic pediatric cancer survivorship team, with the goal of improving health outcomes for childhood cancer survivors and their families in the Salinas Valley, a rural, low-income region in California with majority Hispanic/Latino/a/e residents. Our partnership process is guided by principles of community-based participatory research, prioritizing trust and involving community members as equal partners in all phases of research. Results: In year 1 (2021-2022), we held successive meetings which identified common goals and shared values, established the collaboration, and sought funding to advance our goals. In year 2 (2022-2023), with internal grant funding, we conducted a qualitative needs assessment interviewing childhood cancer survivors, parents, and CBO staff. Teamwork enriched the data analysis and allowed us to identify problems in communication as an area of need, which directly informed subsequent grant proposals. In year 3 (2023-2024), with external funding we began a multi-year study to understand and improve survivorship-related communication among Hispanic/Latino/a/e young adult childhood cancer survivors, their parents, and clinicians. Current and future projects include collaborative design and pilot testing of a novel communication intervention, formation of a dedicated community advisory board, and a CBO-driven program evaluation. Findings from our community-engaged studies have prompted new sets of research questions and illustrate opportunities for institutional change in the clinic setting. In parallel, the CBO has leveraged research findings in real-time to identify barriers to seeking support among childhood cancer survivors and families, and adapted and improved programming for families in response. Through our joint research portfolio, we have incorporated training and mentorship for staff at the CBO and medical trainees at the academic center. Conclusions: A community-academic partnership in a rural, low-income region has the potential to reduce health disparities and improve childhood cancer survivors’ health outcomes through collaborative program development and community-engaged research. Fueled by mutual investment and strong momentum, our partnership facilitates an interconnected cycle of research and practice change that is grounded in community needs.

TOWARDS JUSTICE, EQUITY, AND COMMUNITY EMPOWERMENT IN GENOMICS STUDIES ON BEHAVIORAL, PSYCHIATRIC AND NEURODEVELOPMENTAL TRAITS

Genomics research on sensitive traits such as neurodevelopmental, psychiatric, and behavioral traits poses numerous conceptual, methodological, ethical, legal, and social challenges. Community engagement and participatory research have been proposed as tools to increase the relevance, rigor, and acceptability of research, including genetic and biomedical studies. Informed by a growing body of research and lessons learned from recent and ongoing efforts to engage communities affected by genomics studies, I set a vision for more just, equitable, and collaborative genomics where primary stakeholders are included in research and decision-making as peers and collaborators, not solely as objects of study. Further, considering recent debates, lapses, and successes, I propose frameworks to promote respectful and productive engagement, communication, and collaboration between diverse stakeholders.

Supporting Research Staff Working With People Experiencing Homelessness: Integrating Trauma-Informed and Resilience-Building Approaches Into Community-Engaged Research Studies.

Traumatic experiences are highly prevalent among people experiencing homelessness who face structural inequities, which may impact engagement in research. Research staff ("staff") working with people experiencing homelessness are under-equipped to cope with structural inequities and the trauma present in participants' lives, even if they are well-trained in the regulatory aspects of the research process. Six staff involved in tobacco cessation intervention research with people experiencing homelessness described their experiences and highlighted areas of training to integrate trauma-informed and resilience-building approaches to support field staff and people experiencing homelessness. We identified three themes: (a) impact of trauma on the research process; (b) the importance of engagement with community partners and participants; and (b) the need for a field worker's guide. Staff described being the bearers of participants' traumas, while also coping with their own vicarious traumatization. Staff believed they would benefit from a fieldworker's guide that includes best practices for engagement with community partners as well as trauma-informed approaches like training in trauma-informed care and tools to address vicarious traumatization. Resilience-building approaches include real-time debriefing to celebrate successes and troubleshoot problems in the field. Training in resilience-building can be integrated as part of the general training required of all research staff prior to conducting intervention research studies with people experiencing homelessness. These approaches may need institutional support to be integrated into standard research workflows. In doing so, they may not only safeguard research staff and participants but also promote research as a means to dismantle inequities by being inclusive, safe, and empowering.