Health Equity Research Research Articles

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Racial Health Equity and Social Needs Interventions

Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities. To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity. Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity). Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences. In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.

Mapping the distribution of health equity research and practice across a university: a network analysis.

Health equity research spans various disciplines, crossing formal organizational and departmental barriers and forming invisible communities. This study aimed to map the nomination network of scholars at the University of Rochester Medical Center who were active in racial and ethnic health equity research, education, and social/administrative activities, to identify the predictors of peer recognition. We conducted a snowball survey of faculty members with experience and/or interest in racial and ethnic health equity, nominating peers with relevant expertise. Data from a total of 121 individuals (64% doing research on extent and outcomes of racial/ethnic disparities and racism, 48% research on interventions, 55% education, and 50% social/administrative activities) were gathered in six rounds of survey. The overlap between expertise categories was small with coincidence observed between education and social/administrative activities (kappa: 0.27; p < 0.001). Respondents were more likely to nominate someone if both were involved in research (OR: 3.1), if both were involved in education (OR: 1.7), and if both were affiliated with the same department (OR: 3.7). Being involved in health equity research significantly predicted the centrality of an individual in the nomination network, and the most central actors were involved in multiple expertise categories. Compared with equity researchers, those involved in racial equity social/administrative activities were less likely to be recognized by peers as equity experts.

A Dataset on the Dynamic Monitoring of Health and Family Planning of China’s Internal Migrants: A Multi-Wave Large-Scale, National Cross-Sectional Survey from 2009 to 2018

This data article presents data from the China Migrants Dynamic Survey (CMDS), a multi-wave, large-scale national cross-sectional survey of China’s internal migrants from 2009 to 2018. The CMDS is an annual questionnaire survey conducted by the former National Health and Family Planning Commission (NHFPC) of the People’s Republic of China. The respondents included in this survey are internal migrants over IS years old. The sample was drawn from the China Migrant Population Information System, using multi-stage stratified sampling method and the probability proportional-to-size (PPS) cluster sampling strategy. Between 2009 and 2018, there were 1,527,650 internal migrants from 23 provinces, 5 autonomous regions and 4 municipalities participated in the surveys. The survey tools were a series of self-designed questionnaires with high inheritance and consistency designed and implemented by the NHFPC. The questionnaires mainly contain basic information of the respondents and their family members, migration status, healthcare or health behaviors, public health service utilization, social insurance, social integration, and family planning. The dataset is currently the most widely used survey data on China’s internal migrants, offering information on migration patterns, healthcare and health behaviors, use of public health services, access to social security, social integration, and family planning, which are valuable for health planning, health decision-making, and health equity research.

Attitudes towards diversity, equity, and inclusion across the CTSA Programs: Strong but not uniform support and commitment.

This study describes attitudes towards diversity, equity, and inclusion (DEI) among members of the Clinical and Translational Science Awards (CTSA) Program. It also explores associations between program members' roles and their perceived importance of and commitment to improving DEI and assesses the link between perceived importance of and commitment to improving DEI. Lastly, it ascertains barriers and priorities concerning health equity research, workforce development, CTSA consortium leadership, and clinical trials participation among respondents. A survey was administered to registrants of the virtual CTSA Program 2020 Fall Meeting. Respondents reported their roles, perceived importance of and commitment to improving DEI. Bivariate cross-tabulations and structural equation modeling examined associations between respondents' roles, perceived importance of DEI, and commitment to improving DEI. Grounded theory was used to code and analyze open-ended questions. Among 796 registrants, 231 individuals completed the survey. DEI was "extremely important" among 72.7 percent of respondents and lowest among UL1 PIs (66.7%). Being "extremely committed" to improving DEI was reported by 56.3 percent of respondents and lowest among "other staff" (49.6%). Perceived importance of DEI was positively associated with commitment to improve DEI. Institutional and CTSA Commitment, Support, and Prioritization of DEI represented a key theme for improving DEI among respondents. Clinical and translational science organizations must take bold steps to transform individual perceptions of DEI into commitment and commitment into action. Institutions must set visionary objectives spanning leadership, training, research, and clinical trials research to meet the promise and benefits of a diverse NIH-supported workforce.

Abstract A001: Bridging the gap between cancer care service delivery and the sexual and gender minority communities: A scoping review of the literature

Abstract While there has been an increase in health equity research, there is scarcely research focusing on health equity for cancer survivors who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Pansexual and Two-Spirit). This is in part the result of a lack of routine collection of SOGI (Sexual Orientation and Gender Identity) data within the LGBTQIA+ community. Our research aims to analyze and discuss how labelling and terminology have both influenced medical practice and posed barriers and delays in care to the LGBT community over time. Further, examining whether the literature supports increasing LGBT experiences in interprofessional training. By identifying these gaps in the literature and in interprofessional training we hope to decrease barriers to timely and supportive cancer services. To examine the breadth of research on the LGBTQIA+ community and cancer, a scoping review methodology was utilized to identify knowledge and research gaps. This review examines literature published in the U.S, in academic journals between 1913 and 2021 to gain a greater understanding of how historical contexts, policy, and research have evolved alongside the growing visibility of the LGBTQIA+ community. The authors used a scoping review strategy outlined by Arksey and O’Malley (2005) to review the literature employing a comprehensive list of search terms for cancer and LGBTQIA+. Rayyan software was then utilized to organize the data as our team hand-searched the articles for inclusion (cancer, LGBTQIA) and exclusion (non-US, foreign language, prevention, screening) criteria. A total of 3,290 articles were included in the final analysis. Citation Format: Sanford Jeames, Britteny Fernandez. Bridging the gap between cancer care service delivery and the sexual and gender minority communities: A scoping review of the literature [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A001.

Abstract B101: Bridging the gap between cancer care service delivery and the sexual and gender minority communities: a scoping review of the literature

Abstract Purpose: While there has been an increase in health equity research, there is scarcely research focusing on health equity for cancer survivors who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Pansexual and Two-Spirit). This is in part the result of a lack of routine collection of SOGI (Sexual Orientation and Gender Identity) data within the LGBTQIA+ community. Our research aims to analyze and discuss how labelling and terminology have both influenced medical practice and posed barriers and delays in care to the LGBT community over time. Further, examining whether the literature supports increasing LGBT experiences in interprofessional training. By identifying these gaps in the literature and in interprofessional training we hope to decrease barriers to timely and supportive cancer services. Methods: To examine the breadth of research on the LGBTQIA+ community and cancer, a scoping review methodology was utilized to identify knowledge and research gaps. This review examines literature published in the U.S, in academic journals between 1913 and 2021 to gain a greater understanding of how historical contexts, policy, and research have evolved alongside the growing visibility of the LGBTQIA+ community. The authors used a scoping review strategy outlined by Arksey and O’Malley (2005) to review the literature employing a comprehensive list of search terms for cancer and LGBTQIA+. Rayyan software was then utilized to organize the data as our team hand-searched the articles for inclusion (cancer, LGBTQIA) and exclusion (non-US, foreign language, prevention, screening) criteria. A total of 3,290 articles were included in the final analysis. Findings: In 2011, a review of all articles on PubMed demonstrated only 0.3% of all publications pertained to LGBT health-related subject matters, and in a study conducted about U.S and Canadian medical education, research showed that medical students spent &amp;lt; 5 hours, on average, learning about LGBT discrimination and healthcare disparities. 70% of LGBT persons reported discrimination, refusal of care, bias, erroneous assumptions, and derogatory statements during healthcare visits in the United States. Conclusions: There is an urgent need for culturally competent interprofessional care, and we must challenge our approach by not only listening to the needs of the communities we serve but also by being receptive to their feedback. There is an unmet need for education to inform healthcare professionals, health social workers and their community partners of the unique experiences and needs of the LGBTQIA+ community. It is imperative that we use the recommendations and guidelines provided by the LGBTQIA+ cancer patient population to transform their healthcare experiences, improve patient-provider communication, and provide precision-supportive care. Citation Format: Brittany M. Hernandez, Sanford E. Jeames, Lailea Noel. Bridging the gap between cancer care service delivery and the sexual and gender minority communities: a scoping review of the literature [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B101.

Abstract B072: Influence of access to care on cancer diagnoses in the CaPTC Prostate Cancer Familial Cohort Study of African Ancestry in Nigeria, Cameroon, and the United States

Abstract BACKGROUND Black populations are disproportionately affected by prostate cancer globally. The leading countries in prostate cancer mortality are found in Africa and the Caribbean. This data is being presented as part of the Prostate Cancer Transatlantic Consortium (CaPTC) Prostate Cancer Familial Cohort Study of African Ancestry study with the purpose of identifying the various factors that influence prostate cancer risk factors. Access to care, a known cancer risk factor, not only affects a person’s ability to receive treatment but to receive accurate health information, preventative care, diagnoses, and more. Researching exactly how different social determinants, such as this one, affect cancer risk factors for specific populations is imperative to reducing their cancer burden. METHODS: This ten-year prospective study started in 2017 and has been conducted in Nigeria, Cameroon, and the United States. Participants have been recruited in clinics and different community settings. Upon consent, participants were asked to complete a validated survey with a unique identifier on epidemiological, behavioral, clinical, and anthropometric variables. They were then asked to provide a saliva sample that was also given a unique identifier. Associations of characteristics from the survey were evaluated using logistic regression models. Others were tested for statistical significance using a Chi-Squared test. RESULTS: A total of 803 responses are included in this dataset. Of these participants, 9.6% were from Cameroon, 82.6% from Nigeria, and 7.3% from the United States. More than half of the participants (54.9%) shared they did not have healthcare coverage. In addition, a chi-squared test showed 10.2% in the United States, 13.9% in Nigeria and 35.1% in Cameroon were unable to see a physician due to cost with a p-value of less than .001 indicating statistical significance. While participants in the United States did not report any cancer diagnoses, logistical regression found a significant inverse relationship between health literacy and increased risk of a cancer diagnosis. CONCLUSION Research shows a relationship between health access factors and cancer risk factors, but little research is done for specific populations. Further research should be done to measure the exact impact access to care has on cancer diagnoses for specific communities. It is very important that health equity researchers assess exactly how these factors affect the specific populations they work with to tailor evidence-based interventions to their needs. Citation Format: Jessica Otero, Emeka Iweala, Ademola Popoola, Paul Jibrin, Mohammed Faruk, Anthonia Sowumi, Omolara Fatiregun, Nkegoum Blaise, Catherine Oladoyinbo, Ifeoma Okoye, Abdulkadir Ayo Salako, Abidemi Omonisi, Iya Eze Bassey, Kayode Adenji, Nggada Haruna Asura, Ernest Kaninjing, Oluwole Kukoyi, Parisa Fathi, Ruth Enuka, Oluwaseyi Toye, Jennifer Crook, Folakemi Odedina. Influence of access to care on cancer diagnoses in the CaPTC Prostate Cancer Familial Cohort Study of African Ancestry in Nigeria, Cameroon, and the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B072.

Abstract A042: Addressing prostate cancer disparities through the Inclusive Cancer Care Research Equity (iCCaRE) for Black men consortium

Abstract Background: The prostate cancer (CaP) disparities experienced by Black men (BM) in the US is a microcosm of the burden of CaP seen in BM globally. The complexity of CaP disparities and the need for a unique approach to better understand and address a complex chronic disease, such as CaP, underscores the need for consortium research that is multilevel, collaborative, translational, and global. In response to this need, we brought together CaP survivors, advocates, scientists and clinicians to form the inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium. Aim: Our overall goal is to optimize CaP diagnosis experiences, treatment and survivorship based on the Science of Survivorship (S.O.S). Our primary aim was to develop a consortium co-led by CaP scientists and survivors with multiple S.O.S research projects supported by research cores/services across multiple institutions. Methodology: The consortium was developed to comprise multiple individuals with complementary expertise and resources working collaboratively to achieve the common purpose of eliminating CaP disparities globally. Building on the expertise, resources, and relationships of collaborating CaP investigators, survivors and advocates, the iCCaRE Consortium was proposed to “advance health equity and reduce disparities in CaP” by studying the within-group differences among ethnically diverse BM and comparing US-born BM to their ancestral populations, including West African immigrant men in the US and indigenous West African men. Results: Through the Department of Defense Health Equity Research and Outcomes Improvement Consortium (HEROIC) Award, the iCCaRE Consortium was launched in 2022. There are five pilot projects (PPs), each co-led by a scientist PI and community PI: PP1 will plan and develop a Virtual Robot Assistant (ViRA) that will provide SDOH navigation services, psycho-oncology support and emotional support for BM newly diagnosed with CaP. PP2 will develop and analyze the impact of a patient-centered home cancer care system on health-related Quality of Life (HRQOL), access to healthcare, and PROs. PP3 will plan and develop a ViRA to improve HRQOL in Black CaP survivors. PP4 will employ the social determinants of migrant health framework to understand and address the needs of sub-Saharan African immigrant CaP survivors. PP5 will explore how biological factors induced by cancer cells contribute to poor mental health of CaP survivors. The PPs are supported by an Administrative Core, Translational Research &amp; Clinical Intervention Service, Data Management and Analytics Services, Partnership Engagement Services, Pathology Resource &amp; Biospecimen Core, Methodology and Measures Services and Digital Health &amp; Human Services. Conclusion: The iCCaRE Consortium will “improve HRQOL to enhance outcomes and overall health and wellness for those impacted by CaP” by developing and implementing Artificial Intelligence interventions that address social determinants of health, psycho-oncology support and emotional support for newly diagnosed CaP patients. Citation Format: Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Ernest Kaninjing, Solomon Rotimi, Che Ngufor, Arnold Merriweather, Jennifer Crook, Manisha Salinas, Fathi Parisa, Sha’Reff Rashad, John McCall, Ebenezer Erefah, Ayinde Yahaya. Addressing prostate cancer disparities through the Inclusive Cancer Care Research Equity (iCCaRE) for Black men consortium [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A042.

Building Research Infrastructure: The Development of a Technical Assistance Group-Service Center at an RCMI.

As one of the Research Centers for Minority Institutions (RCMI), the Southwest Health Equity Research Collaborative (SHERC) worked over the first five-year period of funding to foster the advancement of Early Stage Investigators, enhance the quality of health disparities research, and increase institution research capacity in basic Biomedical, Behavioral, and/or Clinical research; all priorities of RCMIs. In year 4, the Technical Assistance Group-Service Center (TAG-SC) was created to help achieve these goals. The TAG-SC provides one-on-one investigator project development support, including research design, data capture, and analysis. Successful implementation of the TAG-SC was tracked using Research Electronic Data Capture (REDCap), a secure, web-based software platform allowing for immediate tracking and evaluation processes. In the first two years, 86 tickets were submitted through the REDCap system for methodological support by TAG-SC experts (faculty and staff) for assistance with health-equity related research, primarily SHERC and externally funded Social/Behavioral research projects. The TAG-SC increased the research capacity for investigators, especially within the SHERC. In this manuscript, we describe the methods used to create the TAG-SC and the REDCap tracking system and lessons learned, which can help other RCMIs interested in creating a similar service center offering an innovative way to build methodological infrastructure.

ADDRESSING SYSTEMIC RACISM ACROSS LONG-TERM SERVICES AND SUPPORTS

Abstract Long-term services and supports (LTSS) are some of the most racially segregated healthcare services in the U.S. today. Marginalized users (e.g., Black and Latino older adults) have disproportionate access to high-quality care and subsequently report poorer health outcomes when compared to White users. It is important to acknowledge racism as a fundamental cause of these inequities to LTSS access. As the U.S. works to expand LTSS, it is critical to diversify and strengthen the LTSS workforce, increase Medicaid reimbursements along with efforts to improve accountability and transparency, reconsider payment models and the use of public reporting, improve quality metrics, implement effective support systems for patients of color, expand access to care, and increase promotion of integrated care. Health equity researchers, Drs. Tetyana Shippee, Shekina Fashaw-Walters, and Jasmine Travers will share 7 actionable evidence-based recommendations for LTSS policy change aimed to dismantle racism and advance health equity.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Practical Strategies for Health Equity Researchers to Enhance Analytic Rigor and Generate Meaningful Insights From Qualitative Data.

Researchers and public health practitioners increasingly need to leverage diverse methodologic approaches in health equity research that will lead to innovations in the assessment of health inequities and development of interventions to decrease health inequities. One well-suited approach is the use of robust qualitative methods (alone or in combination with quantitative methods). As more health equity researchers employ qualitative methods in their study designs, additional guidance is needed on how to conduct robust and rigorous qualitative data analyses. We share a 4-step analytic strategy for health equity researchers and practitioners - particularly those with limited training in qualitative data analysis - that can be used to effectively execute qualitative analysis to inform health equity-driven efforts. These strategies will guide those less experienced in qualitative methodology to employ a pragmatic approach to analysis that is sound, reasonable, and produces meaningful insight that can be used to inform efforts to advance health equity for communities with the greatest needs.

A Systematic Approach to Developing Virtual Patient Vignettes for Pediatric Health Equity Research.

The aim of this study was to describe a systematic approach to developing virtual patient (VP) vignettes for health equity research in pediatric pain care. VPs were initially developed to depict the body posture and movements of actual children experiencing pain. Researchers and clinicians with expertise in pediatric pain worked closely with a professional animator to portray empirically supported pain expression in four, full-motion, virtual male characters of two races (i.e., White and Black). Through an iterative process, VPs were refined to (1) appear realistic in a clinical setting and (2) display archetypal pain behavior and expression during a 1-min video clip without sound. Text vignettes were developed with consultation from experts in pain care and presented alongside VPs to assess clinical decision-making. VP vignettes were piloted in a sample of pediatric providers (N=13). Informed by the literature and expertise of stakeholders, several revisions were made to improve VPs' facial grimacing and realism before piloting. VPs appeared to accurately capture important aspects of pain expression and behavior common among pediatric patients with pain disorders. Additional refinements to the text vignettes were made based on provider feedback to improve clarity and clinical relevance. This article presents a working framework to facilitate a systematic approach to developing VP vignettes. This framework is a first step toward advancing health equity research by isolating psychosocial and interpersonal factors affecting provider behavior and decision-making. Future research is needed to validate the use of VP vignettes for assessing provider behavior contributing to health inequities for youth with pain disorders.

Theorising health equity research for people with intersex variance through new materialism.

Health inequalities impact sex-variant people in highly differentiated ways. This is evidenced in much academic and activist intersex research documenting the highly specific forms of inequalities arising from misrecognition, discrimination and human rights abuses inherent to pathologised accounts of non-normative bodies. Important theoretical work further interrogates the implications of sex variant subjectivities, identities and bodies for static or binary notions of both sex and gender. In this paper, we aim to contribute further to this scholarship. We draw upon feminist materialist and Deleuzean-informed understandings of materials or matter to rethink debates over sex-variant subjectivities, identities and bodies in relation to inequalities in health. We argue 'the turn to matter' and associated new materialist theories draw attention to the complex, dynamic relational assemblages and entanglements mutually constituting the affective, embodied and socio-material worlds of intersex people. Informed by these theories, we propose that inequalities can be more fully addressed through a new health equity research agenda that is co-produced with sex-variant people. This agenda will enable a fuller exploration of the unsettling but transformative capacities of intersex matters and meanings with the contextually specific understandings of equity in relation to health and health care.

Satcher report examines economic burden of MH inequities

Observing a goal to close an important gap in behavioral health and health equity research related to mental health inequities, a four‐year analysis of data from the Satcher Health Leadership Institute at Morehouse School of Medicine (SHLI) estimates that there were nearly 117,000 preventable deaths among minority groups between 2016 and 2020. The startling find by SHLI also estimates that the total cost of those disparities reached $278 billion over that four‐year span.

Participant compensation in health equity research: How equitable is it?

In this article, the authors highlight their experience in navigating outdated, inequitable policies at institutions and in advocating for changes that support health equity research with a focus on participant compensation. As two new assistant professors establishing their programs of health equity research, they call on colleagues to examine their practices of participant compensation while consider an intersectional and systems-level framework. Their goals are to develop culturally responsive interventions that bolster well-being and ameliorate harm caused by continuous exclusion or poor research methods. They highly recommend health equity researchers evaluate their institutions' research and financial practices to promote equitable payment options that are inclusive of everyone. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adjustment.

The adult spine, aka backbone, is composed of 24 segments. Separately, each segment is incapable of animating our bodies. Communities of color, low-income communities, and other marginalized groups represent the backbone of the health equity research enterprise-it literally cannot exist without our bodies and what they are subjected to in the face of structural inequality. And more often than not, researchers believe they can break our bodies into discrete segments and somehow animate a body of literature capable of healing a whole us. This poem, as counternarrative and enactment of public health critical race praxis principles of "voice" and "disciplinary self-critique", engages the spine as metaphor to name and render visible the epistemic and symbolic violences that prop up public health's body of evidence/knowledge. In doing so, it challenges the field's dominant knowledge production paradigm (e.g. positivist reductionism), and draws attention to the settlercolonial, racial-capitalist, and extractivist logics of racial and health equity discourses dominated by narratives produced by mostly White scholars and "health equity tourists", often using complex statistical techniques to complete secondary quantitative analyses about health in communities they've never stepped a single foot in. Under this paradigm, scores of researchers/practitioners are led to believe that they can somehow come to "know" us via variables and models alone. This poem suggests that-more than anything else-this model of practice is what's most in need of adjustment, and warrants a greater degree of ethical scrutiny than historically/presently afforded. To view the original version of this poem, see the supplemental material section of this article online.

Ownership of change: Participatory development of a novel latent construct for neighborhoods and health equity research

Processes of neighborhood change are important determinants of health. One salient dimension of the experience of neighborhood changes is a person's evolving sense of empowerment over the changes around them, such as development of new housing or shifts in economic opportunity. Community residents collaborating on a Participatory Action Research study developed the novel construct “ownership of change” to capture this psychosocial process, and hypothesized that it may help explain the relationship between neighborhood change and health. In this paper, we describe our participatory process for developing a way to measure ownership of change, explore the construct's validity, test the hypothesis that it is associated with health, and analyze qualitative data to understand the process through which one's sense of ownership of change is produced. We argue that the construct is useful for studying the role of neighborhood changes in shaping health, and that building ownership over neighborhood change must be a key dimension of urban planning and policy for health equity.

Redesigning culturally tailored intervention in the precision health era: Self-management science context

BackgroundNurse scientists have significantly contributed to health equity and ensuring cultural tailoring of interventions to meet unique needs of individuals. Methodologies for cultural tailoring of self-mangament interventions among marginalized populations have limitedly accommodated intersectionality and group heterogeneity when addressing health needs. PurposeIdentify methodological limitations in cultural tailoring of interventions among priority populations and issue recommendations on cultural elements that researchers can target to ensure valid cultural tailoring approaches. MethodsSynthesis of literature on health equity, self-management, and implementation and dissemination research. FindingsAmong priority populations, intersectionality and group heterogeneity has made group-based cultural tailoring approaches less effective in eliciting desirable health outcomes. Precision health methodology could be useful for cultural tailoring of interventions due to the methodology's focus on individual-level tailoring approaches. DiscussionWe offer ways to advance health equity research using precision health approaches in cultural tailoring through targeting unique elements of culture and relevant psychosocial phenotypes.