Addressing racial inequity and antiracism as determinants of health inequalities: an antiracism lens on research design, conduct and dissemination

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. Implementation Research and Practice. January 2021. doi:10.1177/26334895211049482

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This case study highlights the importance of applying an antiracism lens to research.   It includes discussion of study design and dissemination and has a strong focus on the role of community engagement as co-creators of research. Accordingly, it appears as a case study in Sections 3 and 4 of the HIAT.

Shelton and colleagues argue that despite growing interest in health equity within implementation science (IS) research can inadvertently exacerbate disparities  by using frameworks, methods and interventions that do not prioritise racial inequity and antiracism.

The paper does not report on empirical research. Rather informed by existing literature and scholarship on health equity and antiracism the authors develop an antiracism lens, make recommendation for how this can be applied in IS research.   Their antiracism lens involves changes in each of the key elements of implementation science – stakeholder engagement; theories, methods and frameworks, focus on evidence-based intervention, evaluation and implementation strategies.   They also provide details of a number of other resources that can support the development of IS research that is sensitive to racial inequities.

In relation to stakeholder engagement, for example, they recommend the creation of structures and co-creation processes to enable meaningful engagement and the incorporation of community perspectives and priorities.   As they note:  “ Bringing an antiracism lens to stakeholder engagement in implementation research involves transparency, consideration of power dynamics, equitable sharing of resources, respect of community values, and inclusion of racially/ethnically diverse partners as equitable decision-makers early and often” P3 They acknowledge that community engagement is not inherently antiracist – to achieve this they call on researchers to reflect on racism and power, confront hard truths and be open to shifting how research is done.

In relation to methods and framework they argue that IS research has to widen its focus beyond organisational ‘inner’ context impacting on intervention outcomes to include structural racism operating extra organisationally: social context/processes such as racism, stigma, bias, system norms. They note that even if a study’s research question does not directly focus on societal context, an antiracist approach would acknowledge, assess, or address how structural racism may shape implementation and modify downstream determinants of intervention outcomes. Furthermore, they argue that the interventions being developed or adapted should explicitly address racism as a determinants of health inequities.

In relation to evaluation approaches they acknowledge the challenges of measuring racism. However, they argue that studies must include metrics and measures aligned with the inclusion of racism as a contextual determinant of health inequities and inequitable implementation and they describe a number of promising approaches. Finally, they suggest that research needs to apply and test implementation strategies that seek to advance spread and scale up antiracist equity focused solutions within and beyond health care.