Teal background. White text on left, "JEDI Research". On right, a photo of students sitting together and studying

This guide is designed to provide a starting point to advance evidence-based practice toward health equity and justice for all patients and communities. 

This guide is created in response to how racism, homophobia and transphobia, settler colonialism, and other systems of inequity are present not only in the personal spheres of our lives, such as prejudice and behavioral patterns of hate, but also in the routines and policies of institutions, including healthcare. Systemic health disparities are one such manifestation of this inequity at the institutional level. Examples exist and pervade medical research and clinical practices, as black, indigenous, and people of color (BIPOC), LGTBQIA+ communities, women, and people in poverty experience among the highest health disparities, with poor health outcomes and healthcare barriers often linked to socioeconomic and educational disparities as well as discrimination. Also consider how race, class, gender, sexuality, and other identities overlap to reinforce these systemic disparities.

You will find resources and techniques available through the Library and elsewhere to support the journeys of USAHS students, staff, and faculty in their commitment to healthcare justice and intersectional medicine. You can find recommended eBooks, scholarly literature, and other resources on the topics of topics ranging from racism in medicine to LGBTQIA+ health disparities, search strategies for finding relevant literature for your evidence-based practice, and ways to contextualize your research approach under an intersectional and inclusive framework.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Created by: Matthew Chase, MASP, MLIS

Last updated: April 8, 2022

What is Intersectionality?


Kimberlé Crenshaw coined the concept of intersectionality in 1989, addressing the oppression of black women, and it has developed to encompass how justice as well as injustices often engage across race, gender, class, and sexuality simultaneously. Intersectionality reveals that systems of inequity such as racism and sexism cannot be easily detangled and isolated from each other.

"Intersectionality is a lens through which you can see where power comes and collides, where it interlocks and intersects. It’s not simply that there’s a race problem here, a gender problem here, and a class or LBGTQ problem there. Many times that framework erases what happens to people who are subject to all of these things."Kimberlé Crenshaw (2017)

 

Synthesize the Literature with Intersectionality


Given that health disparities are products of social systems of oppression, your search for the evidence may extend beyond the domains of life sciences and medicine. You may be required to explore the scholarly literature covered across various disciplines and fields, including the humanities, the social and behavioral sciences, ethics and politics, and culture. Keep in mind that other disciplines outside of the health sciences may be examining similar issues, but use different terminology, conceptual frameworks, and search tools.

Critically Appraise the Evidence with Intersectionality


There are a variety of well-established critical appraisal tools and strategies, such as GRADE and PRISMA. You can advance an intersectional lens in your critical appraisal of the existing evidence. Health research tends to study relatively homogenous populations, which are predominately white and male. You can include well-defined criteria to evaluate the article’s methodological and theoretical approach to health equity. Create criteria to evaluate an article’s sampling representation and procedures, definitions of concepts relating to health equity, and any discussions of health at the intersections.

Assess Therapeutic Interventions for Health Equity


While an intervention is shown to be applicable or targeted at a general population, it is important to critically understand how it affects different populations and patients. As we have discussed, health research has not equitably covered the experiences of marginalized patients. It follows then that evidence-based practice is greatly impacted by these inequities in the research landscape. As a practitioner, it is essential to evaluate and synthesize the existing literature to address any variations among different communities and populations. Consider, for example, how the evidence has shown that a common seizure medication can have damaging and even fatal side effects for some Asian and Asian American communities. Without nuancing our approach to finding, evaluating, and producing research with these marginalized experiences and voices, patient care and health outcomes can suffer.

eBooks


Pictures of diverse peoples and persons. Text states, "Insights on Intersectionality"

Book cover of "Intersectionality : Origins, Contestations, Horizons" Book cover of "Critical Race Theory (Third Edition) : An Introduction" Book cover "Disability and Intersecting Statuses" Book cover of "Queer Latinidad : Identity Practices, Discursive Spaces"
Book cover of "The Intersectional Approach : Transforming the Academy Through Race, Class, and Gender" Book cover of "Presumed Incompetent : The Intersections of Race and Class for Women in Academia" Book cover of "Emerging Intersections : Race, Class, and Gender in Theory, Policy, and Practice"  

eBooks


A crowd of activists on a bridge and highway. Text states, "Antiracism 101"

Book cover of "Why We Won't Talk Honestly About Race" Book cover of "Race Talk and the Conspiracy of Silence : Understanding and Facilitating Difficult Dialogues on Race" Book cover of "The Souls of Black Folk" Book cover of "Critical Race Theory (Third Edition) : An Introduction"
Book cover of "The White Racial Frame : Centuries of Racial Framing and Counter-Framing" Book cover of "The Half Has Never Been Told : Slavery and the Making of American Capitalism"    

 

A black man ready to run at the track

Book cover of "An American Health Dilemma : A Medical History of African Americans and the Problem of Race: Beginnings To 1900" Book cover of "Breathing Race into the Machine : The Surprising Career of the Spirometer from Plantation to Genetics" Book cover of "Reclaiming Our Health : A Guide to African American Wellness" Book cover of "Breaking Ground : My Life in Medicine"
Book cover of "Precarious Prescriptions : Contested Histories of Race and Health in North America" Book cover of "Wrong Place, Wrong Time : Trauma and Violence in the Lives of Young Black Men" Book cover of "Beside the Troubled Waters : A Black Doctor Remembers Life, Medicine, and Civil Rights in an Alabama Town"  

                         

An Asian health practitioner. Text states, "Health Perspectives of Asian Americans and Pacific Islanders"

Book cover of "Cultural Considerations in Asian and Pacific Islander American Mental Health" Book cover of "Asian American and Pacific Islander Children and Mental Health : Development and Context : Prevention and Treatment" Book cover of "Restoried Selves : Autobiographies of Queer Asian / Pacific American Activists : Autobiographies of Queer Asian / Pacific American Activists" Book cover of "Japanese American Midwives : Culture, Community, and Health Politics, 1880-1950"
Book cover of "Asian American Communities and Health : Context, Research, Policy, and Action" Book cover of "As the Leaves Turn Gold : Asian Americans and Experiences of Aging" Book cover of "Potent Mana : Lessons in Power and Healing" Book cover of "The Healthy Ancestor : Embodied Inequality and the Revitalization of Native Hawai'ian Health"
Book cover of "Pacific Identities and Well-Being : Cross-Cultural Perspectives"      

 

Image of a lab coat. Text states, "Conversations about Race and Racism in Medicine"

Book cover of "Black and Blue : The Origins and Consequences of Medical Racism" Book cover of "Mapping Race : Critical Approaches to Health Disparities Research" Book cover of "Reproducing Race : An Ethnography of Pregnancy As a Site of Racialization" Book cover of "Sick and Tired of Being Sick and Tired : Black Women's Health Activism in America, 1890-1950"
Book cover of "Race, Ethnicity, and Health : A Public Health Reader" Book cover of "Under the Strain of Color : Harlem's Lafargue Clinic and the Promise of an Antiracist Psychiatry" Book cover of "African American Bioethics : Culture, Race, and Identity" Book cover of "Body and Soul : The Black Panther Party and the Fight against Medical Discrimination"
Book cover of "Infectious Fear : Politics, Disease, and the Health Effects of Segregation" Book cover of "Examining Tuskegee : The Infamous Syphilis Study and Its Legacy"    

                                   

Inside a canyon. Text states, "Indigenous Peoples' Health and Knowledge in the Americas"

Book cover of "The Inconvenient Indian : A Curious Account of Native People in North America" Book cover of "Yakama Rising : Indigenous Cultural Revitalization, Activism, and Healing" Book cover of "Indigenous Women and Work : From Labor to Activism" Book cover of "Therapeutic Nations : Healing in an Age of Indigenous Human Rights"
Book cover of "Diagnosing the Legacy : The Discovery, Research, and Treatment of Type 2 Diabetes in Indigenous Youth" Book cover of "I Am Where I Come From : Native American College Students and Graduates Tell Their Life Stories" Book cover of "Clearing the Plains : Disease, Politics of Starvation, and the Loss of Aboriginal Life" Book cover of "Red Medicine : Traditional Indigenous Rites of Birthing and Healing"
Book cover of "Braiding Sweetgrass : Indigenous Wisdom, Scientific Knowledge and the Teachings of Plants" Book cover of "Coming Full Circle : Spirituality and Wellness among Native Communities in the Pacific Northwest" Book cover of "Hollow Tree : Fighting Addiction with Traditional Native Healing" Book cover of "Working with Indigenous Knowledge : A Guide for Researchers"
Book cover of "Firewater : How Alcohol Is Killing My People (and Yours)" Book cover of "Under the Rattlesnake : Cherokee Health and Resiliency"    

 

                                  

Clinical Resources


DiversityRx - DiversityRx informs, educates, and supports health care providers, policymakers, researchers, and advocates who share our goals. They facilitate the exchange of knowledge and information among professional colleagues. They provide professional development opportunities and resources on key practice and policy issues. They also spearhead research and policy development, and advocate for culturally responsive care. They have a comprehensive database of cultural resources available for researchers and clinicians to use for culturally responsive care.

Ethnomed - The objective of the website is to make information about culture, language, health, illness and community resources directly accessible to health care providers who see patients from different ethnic groups. EthnoMed was designed to be used in clinics by care providers in the few minutes before seeing a patient in clinic. For instance, before seeing a Cambodian patient with asthma, a provider might access the website to learn how the concept of asthma is translated and about common cultural and interpretive issues in the Cambodian community that might complicate asthma management. A practitioner could also download a patient education pamphlet in Khmer (Cambodian language) to give to the patient.

MedlinePlus for Population Groups - Presents high-quality, relevant health and wellness information that is trusted, easy to understand. Of particular note, you can gain access to information about cultural, racial, and ethnic groups in addition to other populations. These population profiles include encyclopedic information, statistics, research, and other relevant information.

Research Tools


Do you have a resource to recommend? Let us know by emailing your library staff at library@usa.edu.

AHRQ Health Care: Minority Health - The Agency for Healthcare Research and Quality (AHRQ) is the leading federal agency charged with improving the safety and quality of the U.S. health care system. They provide minority health fact sheets that cover activities for participatory research as well as other research activities relevant to indigenous peoples in the United States.

Native Health Database - Contains bibliographic information and abstracts of health-related articles, reports, surveys, and other resource documents pertaining to the health and health care of American Indians, Alaska Natives, and Canadian First Nations. The database provides information for the benefit, use, and education of organizations and individuals with an interest in health-related issues, programs, and initiatives regarding North American indigenous peoples. Does not necessarily give free full text access. Please check Search USA for USAHS's access to a particular article.

Native Voices: Native Peoples' Concepts of Health and Illness - An online exhibition that explores the interconnectedness of wellness, illness, and cultural life for Native Americans, Alaska Natives, and Native Hawaiians. You can discover how Native concepts of health and illness are closely tied to the concepts of community, spirit, and the land.

Racial Equity Tools - Designed to support individuals and groups working to achieve racial equity. This site offers tools, research, tips, curricula and ideas for people who want to increase their own understanding and to help those working toward justice at every level – in systems, organizations, communities and the culture at large, and that also include healthcare and health disparities. You can find population and issues statistics, research, and teaching materials.

Finding Answers Intervention Research (FAIR) Database - A searchable tool containing 388 journal article summaries, distilled from 11 systematic reviews of the published health disparities literature. The database allows individuals to find targeted research that applies to their area of interest, and specific to their patient population, disease, and intervention. Use this database to generate ideas for disparities reduction interventions, and to collect ideas of research questions and interventions that have already been explored. Does not necessarily give free full text access. Please check Search USA for USA's access to a particular article.

Genderbread Person showing different dimensions of gender and sexual diversities

Clinical Resources


MedlinePlus for Population Groups - Presents high-quality, relevant health and wellness information that is trusted, easy to understand. Of particular note, you can gain access to information about cultural, racial, and ethnic groups in addition to other populations. These population profiles include encyclopedic information, statistics, research, and other relevant information.

Research Tools


GASP Measures Database - A free public resource that basically provides "one-stop shopping" for researchers seeking measures designed for lesbian/gay/bisexual issues or populations. Information about each measure can include its general intent, length, original citation, detailed psychometric information, contact information for the author, etc. The scale itself is included, when possible. 

LGBTData.com - An open-access clearinghouse for the collection of sexual orientation & gender identity data and measures. This site also provides knowledgeable analysis, commentary and expert "how to" information on gathering such data effectively in scientific surveys, questionnaires and studies. You will find numerous datasets and links to rich data sources that are essential to LGBT health research, researchers, students, advocates and anyone interested in scientific-based information about LGBT people and populations.

eBooks


Pavement painted in rainbow colors. Text states: "LGBTQI+ in the Clinic"

Book cover of "LGBTQ Cultures : What Health Care Professionals Need to Know About Sexual and Gender Diversity" Book cover of "Gender Affirmation : Medical and Surgical Perspectives" Book cover of "The Health of Lesbian, Gay, Bisexual, and Transgender People : Building a Foundation for Better Understanding" Book cover of "Transgender Mental Health"
Book cover of "Intersectionality, Sexuality and Psychological Therapies : Working with Lesbian, Gay and Bisexual Diversity" Book cover of "Health Care Disparities and the LGBT Population" Book cover of "Lesbian, Gay, Bisexual, and Transgender Aging : Research and Clinical Perspectives" Book cover of "Caring for Lesbian and Gay People : A Clinical Guide"
Book cover of "Affirmative Counseling with LGBTQI+ People" Book cover of "Affirmative Counseling with LGBTQI+ People" Book cover of "Trans Bodies, Trans Selves : A Resource for the Transgender Community" Book cover of "Sexual Minority Research in the New Millennium"

                                             

Common Biases among Researchers and Practitioners


  • Attribute substitution - This bias essentially results from the researcher simplifying a complex topic or question in a way that leaves out important information. While simplification can be very useful in literature search, as demonstrated by the PICO technique, it becomes problematic when the simplification alters the topic or question. For example, the researcher may not consider the patient's cultural or ethnic background as they generalize their literature search.
     
  • Automation bias - This bias is demonstrated when the researcher places too much faith in their tools, or databases and search engines in this case. The strong faith in the reliability of internet search engines is one example of this bias. The researcher would do well to remember and acknowledge that each resource comes with limitations and biases.
     
  • Blindspot bias - A very problematic bias in which the researcher believes they are somehow less susceptible than others to experiencing any of the above cognitive biases, placing too much faith in their own ways of thinking.
     
  • Confirmation bias - The tendency to search for, focus on, and remember information in a way that affirms and reinforces the researcher's prior beliefs and attitudes. If the researcher has particularly strong feelings toward an issue (e.g., vaccination, alternative and complimentary medicine, reproductive matters), they may overlook evidence that contradicts their approach.
     
  • Focusing effect - The bias in which the researcher over-prioritizes one aspect of the topic or question at the expense of considering other relevant facets such as the patient's history or background.
     
  • "Not-invented-here" bias - This bias manifests when the researcher places more value on information written and published in their own country. Yet the researcher may be missing out on crucial evidence that exists in another part of the world where there is a higher incidence of the given disease or they offer alternative interventions and approaches, and where more published evidence would likely be found as a result. Particularly for U.S. researchers, it is important to realize that several countries are farther ahead in the domains of evidence-based medicine and practice.
     
  • Overconfidence - A very common bias in which the researcher believes they know more than what they actually do. When we assume that we know the potential answer to the topic or question, then we are likely to fail to conduct a comprehensive and systematic search for evidence. Overconfidence can make it more difficult to address other biases as the researcher may proceed in their search unheeded, only finding evidence that matches exactly what they put into their search query and only what they found from their preferred database.
     
  • ​​Preconceived notions - The bias in which the researcher informs their search with their own prior beliefs and attitudes, thereby limiting the success of their search. A researcher, for example, might believe that they will find all the information they require in one perfect peer-reviewed article in PubMed, published in English in a highly regarded journal within the last 3 years. This "unicorn" article rarely exists, as the information might be found in the gray literature or perhaps parts of the answer can be found across several different articles.
     
  • Premature closure - This bias occurs when the researcher concludes the literature search when they find very little information or no information at all. The researcher assumes that if they did not readily find the information, then it must not exist. This bias is particularly likely if the researcher is hurried or inexperienced, or if they are only familiar with using one database.
     
  • Search satisficing - This bias occurs when the researcher concludes the literature search as soon as they find any information that meets the criteria of their topic or question. While the information might be relevant, it may not constitute the best possible answer to the question. For example, a researcher might only consider the first few sources listed on the first page of the search results.

Debiasing Techniques


While it could be argued that it is impossible to debias your own thinking, as you are trying to do so with the very same brain making the mistakes, there are a number of available techniques to help mitigate the impact of cognitive bias.

  • Awareness of bias - The first step for a researcher to work toward debiasing a literature search is to acknowledge that everyone is prone to bias, including themselves.
     
  • Consider the alternatives - The researcher should not limit themselves to using only preferred resources. There are likely other tools to consider for conducting a comprehensive search of the literature. The researcher and the clinician will serve themselves well by looking outside the self-referential worlds of filter bubbles and discipline-specific databases.
     
  • Feedback - Because the brain is inherently biased as discussed in this guide, it can be incredibly difficult to debias our own thinking. Seeking out feedback from colleagues and experts can be crucial. It might even be essential to involve the community under study in the research process from the very beginning to ensure respectful research practices.
     
  • Metacognition - The technique that essentially involves thinking about thinking. The researcher should reflect on their search, considering the query itself as well as the strategies and resources being used (and not used). Ask themselves: Are they not considering the patient's specific needs and if so, what are those needs? It may require the researcher to take a step back from the search, for a few hours or over a good night's sleep, returning with refreshed clarity.
     
  • Mental simulation - This technique engages the researcher to imagine themselves in the place of the patient. Think critically about the topic or question and its intended use. This technique is key to practicing cultural competence and conducting inclusive research.
     
  • Minimize obstacles - Make the tasks of the literature search easier. Perhaps look up concepts and terminology by referring to general sources such as a reference book or an online summary to develop a better understanding. If you are a clinician, ask the patient clarifying questions to consider for factors across race, gender, etc.
     
  • Self-care - The act of taking care of oneself is certainly relevant here. Sleep deprivation and even mild dehydration can affect our mental acuity, leaving us more prone to cognitive biases.
     
  • Self-work - It is important for the researcher to address areas for improvement. Seek out specific, targeted training. Perhaps the researcher or clinician is not familiar with finding evidence about marginalized patients and populations, either through avoidance or a lack of awareness. Reviewing and applying lessons from guides such as this one, as well as consulting with your librarian, can help your practice of this technique.