Supporting Antiracism Through the Thoughtful Conduct, Evaluation, and Use of Research.

The crisis in maternal morbidity and mortality in the United States is well known, particularly the much higher impact on Black and Indigenous women.1 The sequencing of the human genome has led to the recognition that humans have more similarities than differences and that race is generally not helpful in explaining differences in health outcomes.2 Understanding race as a social construct versus being biologically determined, and therefore examining racism to explain inequities in health outcomes, has been recommended.3, 4 What guidance can the Journal of Midwifery & Women's Health (JMWH) provide to authors and peer reviewers through the process of scholarly publication to ultimately guide midwifery practice? How can midwives and other perinatal clinicians best interpret research to inform practice? Assembling an effective research team is the first step. This requires careful consideration of the disciplinary background, cultural orientation, strengths, and motivations of each member. The balance and composition of the team must be appropriate to achieve the stated research goals. Community-based participatory research (CBPR) is increasingly used by researchers and community partners to promote health equity and address social determinants of health. Although there is no consensus about what constitutes a successful CBPR research team, the most successful teams are diverse, committed, open, and transparent; are willing to share power and accountability; and embrace cultural differences. Successful community partnerships require flexibility; strong, shared leadership; effective communication processes; and ownership in the partnership. These characteristics of CBPR teams and partnerships are essential to effect system and policy change.5 A research team that values diversity, equity, inclusion, and belonging enhances the rigor and transferability of research. Researchers are a product of societal systems and institutions; therefore, a process of reflexivity, or the examination and disclosure of social background, assumptions, and positionality, is essential to account for biases that could impact the findings and interpretation of the research. Reflexivity acknowledges the researcher's perspective and position in the research and research process and acknowledges the perspective and voices of research participants. It also acknowledges the intersectionality of multiple overlapping systems of oppression such as racism, sexism, and classism.6 Examples of reflexivity and positionality statements can be found in the American Psychological Association Equity, Diversity, and Inclusion Toolkit for Journal Editors7 and the JMWH Manuscript Preparation and Style Guide.8 The use of race as an explanatory research variable warrants careful consideration. Race and ethnicity represent social experiences, not biological constructs, and should not be used as proxies for inequity. Instead, the systemic context of inequity should be addressed in the study design and methodology. If race and ethnicity are used as variables in research, an explicit rationale for the decision to report race and ethnicity should be provided. In addition, authors should explain in the research report how race and ethnicity were assigned—either through the research participant's self-identification or by other means. Guidance for using race as an explanatory research variable can be found in the JMWH Manuscript Preparation and Style Guide.8 and has been updated for the American Medical Association Style Guide, which is used by JMWH.9 The importance of qualitative research to advance health policy and practice cannot be understated. Qualitative research allows the researcher to gather substantial insights into participants’ lived experiences of policies, programs, and power dynamics. When it comes to advancing equity in policy, qualitative research can be useful to understand how programs or interventions work, and how they can be improved based on the perspective of stakeholders. The trustworthiness and rigor of qualitative research depends on the credibility or confidence in the findings, transferability or applicability in other contexts, dependability that the findings are consistent, and confirmability, which is the degree to which the findings of a study are informed by the respondents and not researcher bias.10 Mizock et al11 studied the influence of researcher race in deviations from the interview script in a qualitative research study. The authors found that the off-script communication between Black and white participant-research dyads differed in that Black participants communicated a shared understanding with Black researchers about the emotional burden and lived experience of racism, whereas white researchers acknowledged and expressed awareness of the experience of racism. If researchers and participants differ in racial and cultural identity, they must be cognizant of tensions or misunderstandings that arise from a history of misrepresentation, exploitation, and silencing of people of color.12 Best practices in publishing include documentation of author reflexivity and for researchers to engage in reflective practice around positionality and is encouraged for all research published in JMWH.13-15 To avoid bias in literature reviews, the rationale for selection of the topic and the methods used to analyze and interpret the data should be disclosed by authors. Literature reviews are presented in several ways, depending on the subject and nature of the inquiry. Systematic reviews are based on a formal protocol developed and made publicly available before conducting the review. Any deviations from the protocol can result in reporting bias and must be explained in the methods section of the research report.16 Five main criteria for evaluation of a potential source of data for literature reviews include currency of the publication, relevance to the topic or research question, credibility of the author on the subject matter, accuracy, and whether the source of information presents a biased point of view.17 Authors are advised to consider the reference list of potential sources and whether there is diversity in authorship of the research articles cited. Health equity researchers of color have reported that their previous work has not been acknowledged and is now increasingly being used by others, often without citation.18 When evaluating health equity research for application to clinical practice, ask if the authors have examined racism and structural inequities. Make sure the language used to define racial and sociopolitical structures is consistent with the publisher's guidance and with the evolution of racial and sociopolitical terms. Be critical of research that describes a biological basis for racial differences in health outcomes and ask if that approach has been well justified.19 Black researchers are less likely than their white counterparts to achieve independence in research due to racial disparities in grant funding, particularly in the National Institutes of Health grant funding system.20 These inequities result in less research by Black scientists and a vicious cycle that contributes to the ongoing underrepresentation of Black researchers. We advocate for transparency in funding based on racial and ethnic identity for all funding agencies. Amid the maternal and perinatal health crisis, we must improve the quality of research and other scholarly work to reverse current trends and achieve health equity.4, 19 An antiracist approach using the principles described herein, supporting systemic change, with support for researchers of color at the highest levels of funding is necessary. This Journal will be examining these hallmarks of quality research and publishing in our ongoing support of research, practice, and policy. We applaud the release of the report of the National Academies of Science, Engineering, and Medicine Committee on the Use of Race, Ethnicity, and Ancestry as Population Descriptors in Genomics Research and look forward to its translation for use in other types of health research.21 Our responsibility is to carefully evaluate and publish the best research and scholarship supporting the clinical practice of our colleagues. Each of us can do our part as clinicians, researchers, and consumers of research.