Ensuring equity considerations are embedded within research questions: a critical imperative

In the pursuit of advancing knowledge and improving health outcomes, research plays a vital role. However, to address health disparities and promote equitable healthcare, it is essential to embed equity considerations within research questions.

Equity in research involves acknowledging and addressing the social, economic, and structural determinants of health that contribute to health disparities and inequities. It goes beyond equal treatment to strive for fairness and justice in healthcare. By embedding equity considerations within research questions, researchers can ensure that their work actively seeks to understand and tackle inequities, ultimately guiding the development of interventions and policies that promote equitable healthcare for all individuals and communities. By consciously incorporating equity as a guiding principle from the outset, researchers can ensure that their work generates evidence and contributes to a more just and fair healthcare system.

GIMBE Foundation, a founding member of the Guidelines International Network (G-I-N) and the International Society for Evidence-based Health Care, has been dedicated to enhancing healthcare quality since its foundation in 1996. Over the years, GIMBE has actively engaged in various activities, including developing clinical practice guidelines and adapting and implementing care pathways locally, all aimed at improving the delivery and equity of healthcare services.

With this blog post, we aim to explore the significance of embedding equity considerations within research questions, providing practical insights and recommendations to promote equitable research practices. The following recommendations represent the result of a wealth of expertise gained through the GIMBE Foundation’s activities. As an example, in 2016, the GIMBE Foundation launched the GIMBE Observatory on the National Health Service, undertaking a continuous and systematic monitoring of all stakeholders' responsibilities and actions. The primary objective was to maximise the public investment's returns in terms of health and equity while ensuring the effective utilisation of resources.
 

The importance of embedding equity considerations

Identifying health disparities and inequities

• Uncovering inequities: Embedding equity considerations within research questions calls for a deeper understanding of the underlying causes of health disparities and inequities in the first place. It helps, for example, to identify populations or groups disproportionately affected by adverse health outcomes.
• Shaping research objectives: By explicitly addressing equity in research questions, researchers can explore how social, economic, and structural factors contribute to health disparities and develop strategies to mitigate them.

Promoting equitable research practices

• Ethical imperative: Research that fails to consider equity may perpetuate or exacerbate health disparities, creating ethical concerns. Embedding equity considerations ensures that research practices align with justice, fairness, and human rights principles.
• Guiding data collection and analysis: Incorporating equity in research questions helps to guide the collection and analysis of data, ensuring that information on marginalised populations is adequately represented and analysed.

Informing policy and practice

• Policy relevance: Research questions grounded in equity considerations provide evidence that informs the development of policies and interventions to reduce health disparities and promote equitable healthcare.
• Translating research into action: By embedding equity in research questions, the findings can be more effectively translated into actionable strategies, programs, and interventions to address health disparities at both the individual and government level.

Recommendations for embedding equity considerations in research questions

Conducting a systematic literature review

• Identify existing gaps: Review existing literature to identify gaps in knowledge related to health disparities and inequities. Use these gaps to inform research questions that explicitly address equity concerns.
• Explore intersectionality: Pay attention to intersecting factors, such as race, ethnicity, gender, socioeconomic status, and disability, to understand how multiple forms of disadvantage intersect and contribute to health disparities.

Collaborative approach 

• Engage stakeholders: Involve diverse stakeholders, including community members and policymakers, in the research question development process. Their input ensures research questions align with the needs and priorities of marginalised populations.
• Co-creation of research questions: Collaboratively develop research questions with input from communities affected by health disparities. This process helps to ensure that questions reflect the lived experiences and perspectives of those most impacted.

Considerations for research design

• Sample selection: Purposefully include diverse and marginalised populations in research to ensure representation and increase understanding of health disparities.
• Data collection methods: Use qualitative research methods, participatory approaches, and community-based participatory research to capture rich data reflecting marginalised communities' experiences and insights.

Analysis and interpretation

1. 1. Equity lens: Apply an equity lens when analysing research findings to examine how health outcomes differ across diverse population groups and to identify factors contributing to disparities.
2. 2. Contextual understanding: Interpret findings considering the broader social, economic, and political contexts in which health disparities persist. This understanding can inform recommendations for interventions and policies.

Knowledge dissemination

1. 1. Targeted messaging: Tailor research dissemination efforts to effectively reach diverse audiences, using culturally appropriate and accessible language and communication channels.
2. 2. Collaborative dissemination: Engage with community partners, advocacy groups, and knowledge users to disseminate research findings and ensure they reach those most affected by health disparities.
    

Conclusion
Embedding equity considerations within research questions is a critical step toward addressing health disparities and promoting equitable healthcare. By identifying disparities, informing policies and practices, and adopting a collaborative approach, researchers can contribute to a more just and fair healthcare service. By integrating equity considerations throughout the research process, from question development to knowledge dissemination, research can serve as a powerful tool for promoting social justice, reducing health disparities, and improving health outcomes for marginalised populations.

Key Take-Home Messages:

1. 1. Embedding equity considerations within research questions is crucial for identifying health disparities, promoting equitable research practices, and informing policies and interventions to address health inequities.
2. 2. It is an ethical imperative to address equity in research, ensuring that data collection, analysis, and interpretation encompass marginalised populations and guide the development of interventions that promote fairness and justice.
3. 3. Recommendations include conducting literature reviews to identify gaps, adopting a collaborative approach involving stakeholders, considering diverse populations in research design, applying an equity lens in analysis, and disseminating research findings to target diverse audiences effectively. We can contribute to a more just and equitable healthcare system by integrating equity throughout the research process.

Authors
Tiziano Innocenti¹ and Nino Cartabellotta¹

1. GIMBE Foundation, Bologna, Italy.

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.