Formulating the right question is often one of the most difficult, yet the most important part of any research endeavor. This is further complicated when studying structural racism and its generational impacts on health due to the intersecting and reinforcing nature by which racism is embedded in social systems and policies. When developing a research question centered on racial equity, grounding the question in a racial equity framework can guide the ways in which community strengths are emphasized and structural barriers are disrupted through research.
Considerations that must be balanced when crafting a racial and health equity research question range from understanding historical contexts and their impacts within communities, to identifying the needs and strengths of the communities burdened by the inequity, to balancing power dynamics within and around the study team. While each research question is subject to its own unique set of considerations, in this blog we offer a broad overview of the importance of grounding research questions in racial equity and using aligned theoretical frameworks to guide the research approach.
Considerations
Through the Innovative Research to Advance Racial Equity Call for Proposals, E4A supports research that specifically focuses on disrupting systems- or structural-level racism. The appropriate research approach and methods should be aligned with the research question, which should be situated within a framework that accounts for the ways in which racism is influencing health, and for how racism and health may be impacted by the solution being studied. For example, a question about how a program is being rolled out across multiple sites would likely lend itself to an implementation science approach. In this instance, the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which centers racial and health equity in understanding, planning, and sustaining evidence-based programs, policies, and practices, could be used.
Analyzing differential impacts of a policy by race and ethnicity is another key way to assess systems-level racism. Although history suggests that “race neutral” policies are rarely effective in promoting equity, many policies in the U.S. are still universal in nature, making research about the impacts of such policies on health and racial equity, and a nuanced interrogation of the heterogeneous impacts of policies, all the more important. Ecosocial theory and Critical Race Theory offer examples of theoretical frameworks that could be applied to situate the policy and its impacts within the historical context that are driving health inequities and to center the lived experiences of the policy-affected and historically marginalized groups, and to improve the relevancy of the research question(s) and subsequent policy solutions.
Research in Practice
One of our grantees is assessing the impacts of anti-displacement housing redevelopment programs in Nashville, Tennessee on social cohesion and health outcomes for Cayce neighborhood families. The team adapted and informed their study aims based on Roux and Mair's framework for the effects of neighborhood environments on health inequalities. For their research, specific underlying mechanisms of health impacts, using the Roux and Mair’s frameworks, are emphasized through the (1) mutual reinforcement of residential segregation and inequitable resource distributions, and (2) long-term disinvestment in neighborhood social and physical environments. The racial-equity centered research questions that the team will address in this project are:
How does redevelopment affect residents’ perceptions of social cohesion, connectedness, and neighborhood norms following relocation to new housing units
What are the impacts of the anti-displacement redevelopment on the physical health, mental health, and health-related behaviors of low-income residents?
How do social cohesion and connectedness moderate the relationship between redevelopment and health outcomes?
Guiding research questions, methods, and dissemination processes with the Roux and Mair’s framework set clear pathways for the project in which structural racism operates through residential segregation and the Cayce neighborhood physical and social environments.
Conclusion
Although there is not an exact formula for selecting the appropriate racial equity framework, we offer few steps that may be helpful in guiding development of research questions centering racial equity:
Situate the research question within a framework or theory in which systemic racism operates to impact the health outcome of the study population.
Ensure the research question is focused on actionable change based on the mechanism(s) identified in the framework.
Reflect on the positionality of the researchers and how the study team’s individual identities, experiences, and biases may inform the research question. Although we did not delve into positionality in depth in this blog, there is a clear need to deeply investigate and state how our subjectivity may consciously or unconsciously influence each phase of research. (Stay tuned for a future blog focused on positionality in research!)
The above steps are not necessarily linear; the process of forming a research question is, in fact, cyclical, and we must keep revisiting the centrality of racial equity in the study. Racial equity frameworks must be a driver of not only our research question, but all study aspects, including our methods, analyses, and dissemination.