- How diverse is your research team?
- How culturally competent is your research team?
- What difference has incorporating diverse perspectives and lived experiences made to your research design?
Research teamThere are many reasons why a diverse research team is a stronger team. Often, people with similar characteristics are drawn to one another. However, idea generation and creativity flourishes when teams include individuals with a mix of life experiences, values and characteristics (Powell 2018; Rock et al. 2016). There are countless examples of what can go wrong when diverse perspectives have not shaped the research. These include devices being designed to suit men’s bodies rather than women’s bodies (Fidler 2020; Hutchison 2019); drugs being less effective for, or having serious side effects on, female patients or patients from particular ethnic groups (Mak et al. 2018; Parekh et al. 2011); and barriers to research participation for people with low socio-economic status or those living in rural areas (Mbuagbaw et al. 2017; Sharrocks et al. 2014). A truly diverse research team is more likely to conceive of, design and conduct research that will meet the needs of a diverse population that includes under-served and under-represented groups.
When researching populations with certain demographic characteristics or who are from an under-served group, it is good practice to ensure that there is a senior researcher or public co-applicant on your team who shares that characteristic. This signals to public contributors and prospective participants that a demographic characteristic which they share is valued and understood. This will strengthen your team’s credibility and the potential for your research to be appropriate and effective. This does not mean that only women can conduct research about women, or only Black people can research Black people’s health. Rather, it questions the acceptability of researching women’s health, or Black people’s health, without a woman or a Black person on your research team. A rallying call from marginalised groups is “nothing about us without us”. Populations with a long history of being oppressed (for example, women; minority ethnic groups; lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) people; and disabled people) may be suspicious of researchers and may be more likely to participate in studies where the researcher shares their characteristic(s) (Vincent 2018).
These are sensitive discussions to have when forming a research team, especially because not all demographic characteristics are visible. Researchers may feel uncomfortable about divulging personal information about their demographic characteristics to colleagues or to a funding panel and should not feel obliged to do so. In addition, the under-representation of researchers from minoritised groups means that it will not always be possible for your team to reflect the population(s) studied. This relies on wider work to break down structural barriers to the career development of under-represented researchers and clinicians (Rollock 2019; Kilne 2014).
Belonging to a particular group or community does not necessarily mean that someone will have a nuanced understanding of the perspectives and barriers within that community or are able to build relationships across that community. For example, some LGBTQI+ people know very little about the historic oppression that their predecessors have faced or may have little understanding of the intersecting challenges facing LGBTQI+ people who are disabled, of colour and/or who practise a faith. They may have prejudiced attitudes towards other groups within the LGBTQI+ umbrella, or no knowledge at all (Riggs and das Nair 2012).
The importance of shared identities will vary depending on the research topic and the methodology. But, regardless of how diverse the team appears to be, all research teams need sufficient cultural competence to engage effectively and respectfully with the populations which they study (Vickers et al. 2012). The idea of ‘cultural competence’ needs to be approached carefully. At its worst it can be overly simplistic, reducing groups to stereotypes or checklists of customs, preferences and behaviours which emphasise what makes a particular group different from the ‘norm’ (e.g. the stereotype of gay men being sexually promiscuous). This can become essentialist and even offensive, ignoring the wealth of differences within groups (Riggs and das Nair 2012). ‘Cultural competence’ also implies that there is an end-point to being competent. Because cultures are ever-changing, some have argued that ‘cultural humility’ is a more appropriate term, placing emphasis on being continually open to learning and self-reflection (Greene-Morton and Minkler 2020).
Whilst it is important not to make sweeping generalisations, your proposal will be stronger if you can demonstrate how your understanding of structural oppression, health inequalities, cultural differences, communication needs and key contacts informs your research design. If your study focuses on an under-served population, it will reassure the funding committee if you can demonstrate experience of successfully engaging with and/or recruiting participants from this group.
There are different ways of maximising how well-placed your team is to design research that is relevant, sensitive and accessible to the communities that you seek to include. It may not always be possible to include investigators who share the same protected or other characteristic(s) of your participants and who have appropriate cultural and linguistic competence in relation to the study population. However, you could employ and train one or more community development workers or community researchers who have the necessary skills and expertise to act as a bridge between the research team and the community (Prinjha et al. 2020; Tuffrey-Wijne et al. 2020). In all cases, diverse patient and public involvement and collaboration with relevant community stakeholders is critical (Vickers et al. 2012).
Whichever approach you adopt, what really matters is that this diversity can make a difference. Having a diverse group of people around the table is meaningless and tokenistic unless there is a willingness to listen to different points of view, learn from the lived experiences of others, and be open to your research design decisions being transformed through such dialogue.
Key messages
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What would it take to meaningfully attend to ethnicity and race in health research? Dr Tanvi Rai, Dr Lisa Hinton, Prof. Richard McManus and Prof. Catherine Pope’s (2022) article in Sociology of Health and Illness candidly reflects on what it meant to include racially minoritised people in an intervention development study. A precursor to a randomised controlled trial, the study sought to optimise a home-based blood pressure monitoring intervention for people who have had a stroke, and to assess the acceptability of the written trial materials. Tanvi is Indian and the only ‘non-white’ member of the team. She quotes from her fieldnotes which capture her feeling of being the “outsider within” (Ford and Airihenbuwa, 2010), despite having lived in the UK for 23 years. This partially ‘outsider’ status meant that Tanvi was sensitised to how racially minoritised participants were being ‘othered’ in the research. They were expected to conform with procedures for generating knowledge that have been designed by, and to suit, white people. Bhambra (2017) describes this as ‘methodological whiteness’. Tanvi witnessed various examples of this when collecting data. Her fellow, white team members were not keen on her employing less conventional recruitment strategies, such as arranging to give talks and demonstrate blood pressure monitors in churches and mosques to recruit a more ethnically diverse sample. She observed that white participants tended be more forthright in their feedback about their health care, including expressing their wishes to see an ‘English’ GP in an interview with her. In contrast, minority ethnic participants seemed reluctant to be critical. Reflecting on a visit to a Caribbean man, she wrote in her field notes:
Tanvi expresses her discomfort in raising these questions as the only member of the team from a minority ethnic group, and as the most junior member of the team. On eventually feeling able to raise these concerns with her co-authors, Tanvi and her co-authors have realised that taking Mr M’s “fine” as confirmation of acceptability is being complicit with ‘methodological whiteness’. They reflect that this is a tokenistic, or even exploitative, way of involving racially minoritised communities in research:
It is because the team included Tanvi, a racially minoritised researcher with lived experience of not fully ‘fitting in’, that their perspectives have shifted to the extent that they have written this very radical reflection and critique. This highlights how transformative it can be to have a diverse research team and how this can prompt all team members to develop more inclusive research practice. |
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Ford, C.L. and Airihenbuwa, C.O (2010) 'Critical Race Theory, Race Equity, and Public Health', American Journal of Public Health, 100(S1): S30-S35).
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Rock, D., Grant, H. and Grey, J. (2016) ‘Diverse Teams Feel Less Comfortable — and That’s Why They Perform Better’, Harvard Business Review. Available online at: https://hbr.org/2016/09/diverse-teams-feel-less-comfortable-and-thats-why-they-perform-better?ab=at_art_art_1x1 (accessed 20/12/21).
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