Justice, Equity, Diversity, and Inclusion (JEDI) Research

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.

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

Created by: Matthew Chase, MASP, MLIS

Last updated: May 25, 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

via GIPHY

eBooks

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.

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.