Addressing structural racism within institutional bodies regulating research

What factors are associated with the research productivity of primary care researchers in Canada? A qualitative study

BACKGROUND

Research evidence to inform primary care policy and practice is essential for building high-performing primary care systems. Nevertheless, research output relating to primary care remains low worldwide. This study describes the factors associated with the research productivity of primary care researchers.

METHODS

A qualitative, descriptive key informant study approach was used to conduct semi-structured interviews with twenty-three primary care researchers across Canada. Qualitative data were analyzed using reflexive thematic analysis.

RESULTS

Twenty-three primary care researchers participated in the study. An interplay of personal (psychological characteristics, gender, race, parenthood, education, spousal occupation, and support), professional (mentorship before appointment, national collaborations, type of research, career length), institutional (leadership, culture, resources, protected time, mentorship, type), and system (funding, systematic bias, environment, international collaborations, research data infrastructure) factors were perceived to be associated with research productivity. Research institutes and mentors facilitated collaborations, and mentors and type of research enabled funding success. Jurisdictions with fewer primary care researchers had more national collaborations but fewer funding opportunities. The combination of institutional, professional, and system factors were barriers to the research productivity of female and/or racialized researchers.

CONCLUSIONS

This study illuminates the intersecting and multifaceted influences on the research productivity of primary care researchers. By exploring individual, professional, institutional, and systemic factors, we underscore the pivotal role of diverse elements in shaping RP. Understanding these intricate influencers is imperative for tailored, evidence-based interventions and policies at the level of academic institutions and funding agencies to optimize resources, promote fair evaluation metrics, and cultivate inclusive environments conducive to diverse research pursuits within the PC discipline in Canada.

Physicians, prescribe education to address population health equity

Structural barriers embedded within American society contribute to health inequities and social determinants of health (SDOH) in ways that systematically influence one’s ability to succeed and to maintain a healthy overall quality of life in the United States. This article leverages educational attainment as an upstream SDOH factor that can be used to address downstream implications of population health equity. As providers learn to prescribe more innovative treatments that directly influence SDOH, an exploration is made to develop an intervention that integrates education, public health, and medicine as systems in a coordinated process to increase educational attainment for vulnerable populations.

This article develops and analyzes the use of health equity management (HEM) model as a conceptual framework to identify precursors for educational attainment and provide an equitable solution for mending the educational attainment gap. It provides theoretical framing, conceptualizes stakeholder engagement, and creates a conceptual framework for identifying and addressing population health issues with education prescriptions.

Operationalizing an educational prescription intervention will utilize provider-based screening methods to decrease the gaps in educational attainment by fostering partnerships between education, public health, and medicine. HEM identifies ideal partnership relationships to increase educational attainment and address long-standing quality of life issues, with a primary focus on coordinated activities among systems.

Incorporating provider expertise into upstream educational decision-making legitimizes educational attainment as a critical component of population health equity. For many Americans, this is a necessary call to action to demand real structural change to ensure prosperity for all. An educational prescription intervention is a step towards increasing population health equity.

Diversity in IRB Membership: Views of IRB Chairpersons at U.S. Universities and Academic Medical Centers

BACKGROUND

Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons' perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.

METHODS

We surveyed IRB chairpersons leading U.S. boards registered with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).

RESULTS

Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.

CONCLUSIONS

Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets.