Decolonial framework for applying reflexivity and positionality in global health research.

Contemporary research practices link to colonial and imperialist knowledge creation and production and may promote harmful perspectives on marginalized and oppressed groups. We present a framework for a decolonial approach to research in global health and health promotion applicable across research settings. This framework is aimed at anticipating and alleviating potentially harmful practices inherent in dominant research methods. The framework focuses from a macro- and micro-level perspective on three critical dyads: 'context' and 'accountability'; 'researcher identity' and 'positionality'; and 'procedural ethics' and 'ethics in practice' considerations. We present guidance for how to consider reflexivity and positionality as they apply in this framework in global health and health promotion research practice.

The future of childhood maltreatment research: Diversity and equity-informed perspectives for inclusive methodology and social justice.

A long-standing practice in clinical and developmental psychology research on childhood maltreatment has been to consider prospective, official court records to be the gold standard measure of childhood maltreatment and to give less weight to adults' retrospective self-reports of childhood maltreatment, sometimes even treating this data source as invalid. We argue that both formats of assessment - prospective and retrospective - provide important information on childhood maltreatment. Prospective data drawn from court records should not necessarily be considered the superior format, especially considering evidence of structural racism in child welfare. Part I overviews current maltreatment definitions in the context of the developmental psychopathology (DP) framework that has guided maltreatment research for over 40 years. Part II describes the ongoing debate about the disproportionalities of minoritized children at multiple decision-making stages of the child welfare system and the role that racism plays in many minoritized families' experience of this system. Part III offers alternative interpretations for the lack of concordance between prospective, official records of childhood maltreatment and retrospective self-reports, and for the differential associations between each format of data with health outcomes. Moving forward, we recommend that future DP research on childhood maltreatment apply more inclusive, diversity and equity-informed approaches when assessing and interpreting the effects of childhood maltreatment on lifespan and intergenerational outcomes. We encourage future generations of DP scholars to use assessment methods that affirm the lived experiences of individuals and families who have directly experienced maltreatment and the child welfare system.

Organizational and social justice paradoxes in EDI.

This perspective article positions social justice as an addition to the aims of organizational justice, and core to diversity, equality, and inclusion (DEI). It problematizes simplistic DEI rhetoric and positions paradoxes within DEI, as experienced by employers, based on an explanation of key justice concepts and the introduction of fairness, equality, desert, and need. The paper broadens perspective-taking beyond a sole focus on beneficiaries of DEI, towards tensions that employers experience in working towards the aims of workplace justice, including the embeddedness of social justice within both organizations and social systems. The paper concludes with avenues for future research and a call to carefully examine simplistic notions of organizational justice in effecting DEI, suggesting a paradoxical lens on embracing, rather than avoiding, multiple and often conflicting workplace justice imperatives.

Exploring Firearm Access, Carriage, and Possession among Justice-Involved Youth.

Firearm carriage and possession predicts youth firearm violence victimization and perpetration. This study describes self-reported factors associated with firearm access, carriage, and possession among justice-involved youth. We conducted an exploratory, mixed-methods study. Participants were recruited from May 2022 to February 2023 from the Juvenile Justice Collaborative, a diversion program for justice-involved youth. We used online anonymous surveys to investigate exposures related to firearm access, carriage, and possession. We performed semi-structured interviews using the phenomenology framework. We used descriptive statistics to examine firearm exposures by participant demographics. We performed qualitative analyses using an iterative approach with constant comparison to identify key themes. We completed 28 surveys and 5 interviews. Most survey participants identified as male (57%) and Black (61%) with a median age of 18 years. Interview participants described the socialization and cultural normalization of firearms, most prominently among peers. Survey participants reported whether they had ever carried (25%) or possessed (21%) a firearm. Survey and interview participants endorsed protection in the context of increasing violence exposure over time as the primary motivation for firearm possession. Interview participants describe accessing firearms primarily through social networks while survey participants also reported access from strangers (25%) and licensed sellers/gun dealers (18%). In conclusion, justice-involved youth believe firearm carriage and possession may be needed for protection due to increasing violence exposure. Further investigation is necessary to determine interventions that may decrease firearm access, carriage, and possession among justice-involved youth.

Centering diversity, equity, and inclusion in a regional professional nursing organization.

BACKGROUND: Professional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI). PURPOSE: Describe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN). METHODS: In 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change. DISCUSSION: These initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI. CONCLUSION: The work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Racial Microaggressions and Anti-Racism: A Review of the Literature with Implications for School-Based Interventions and School Psychologists.

Many racial-ethnic minoritized individuals are repeatedly exposed to subtle actions reflecting racial slights, termed racial microaggressions (RMAs), which are associated with adjustment problems in early adult and adult populations. Early adolescence represents a unique developmental period when minoritized youth begin their racial-ethnic identity exploration and are subjected to stereotypes and prejudice, thereby making them vulnerable to RMAs. Based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, a systematic literature search, screening and review of RMA literature focusing on high schoolers and younger youth was conducted and yielded 54 publications. This paper reviewed the publications and identified gaps in the field such as the need for systematic research on early adolescents including the frequency and severity of RMAs and the important contributions of peers, parents and teachers for RMA victims, and the need for more evidence-based programming for middle schoolers. Findings suggest that developing school-based microaggression anti-racism programs is clearly needed for minoritized and White youth.

Diversity supplements: An underutilized opportunity to improve the diversity of the health sciences research workforce.

Purpose: This paper describes the process developed at the University of Pittsburgh to increase the number of NIH-funded Diversity Supplements. Method: The authors formed a Diversity in Academia Workgroup where we created the infrastructure and process to increase the number of Diversity Supplements. Each year, the Office of Sponsored Programs provided a list of grants that would be eligible to submit a Diversity Supplement. We surveyed the Principal Investigators inquiring about their interest in working with a trainee on a Diversity Supplement. If yes, we included their information in a database we built so that trainees could search for eligible research studies. The Diversity Deans then identified underrepresented faculty and postdoctoral researchers. We invited Program Officers from NIH to participate in a panel presentation for trainees, which was well attended. Results: The number of Diversity Supplements awarded to Pitt researchers has significantly increased from 7 in 2020 to 10 in 2021 and to 15 in 2022. Six more have been awarded in the first half of 2023. Conclusions: We created the Diversity in Academia Workgroup with the goal to increase the number of Diversity Supplements at the University of Pittsburgh and in so doing, increase the diversity in the biomedical research workforce. While challenging, we know the critical importance and benefits of increased diversity at the University, and we have made significant strides toward this goal.

Construction and validation of a scale for assessing critical social justice attitudes.

Two large studies (combined n = 5,878) set out to construct and validate a scale for assessing critical social justice attitudes. Studies assessed the reliability, factor structure, model fit, and both convergent and divergent validity of the scale. Studies also examined the prevalence of critical social justice attitudes in different populations and the scale's correlations with other variables of interest, including well-being variables: anxiety, depression, and happiness. Participants for Study 1 (n = 848) were university faculty and students, as well as non-academic adults, from Finland. Participants responded to a survey about critical social justice attitudes. Twenty one candidate items were devised for an initial item pool, on which factor analyses were conducted, resulting in a 10-item pilot version of critical social justice attitude scales (CSJAS). Participants for Study 2 were a nationwide sample (n = 5,030) aged 15-84 from Finland. Five new candidate items were introduced, of which two were included in the final, seven-item, version of CSJAS. The final CSJAS scale had high reliability (α = 0.87, ω = 0.88) and a good model fit (comparative fit index [CFI] = 0.99, TLI = 0.99, root mean square error of approximation [RMSEA] = 0.04, standardized root mean residual [SRMR] = 0.01, χ2 (14, 5024) = 132.8 (p < 0.001)) as well as convergent and divergent validity. Overall, the study sample rejected critical social justice propositions, with strong rejection from men. Women expressed more than twice as much support for the propositions (d = 1.20). In both studies, CSJAS was correlated with depression, anxiety, and (lack of) happiness, but not more so than being on the political left was. The critical social justice attitude scale was successfully constructed and validated. It had good reliability and model fit.

Through the Looking Glass: Diversity, Equity, Inclusion, and Belonging: A Call for Action from the National Association of Pediatric Nurse Practitioners.

In response to growing health disparities, social inequities, structural racism, and discrimination, the National Association of Pediatric Nurse Practitioners established a Diversity, Equity, and Inclusion Taskforce. In 2020, this group transitioned into a national committee to infuse equity across the organization and empower pediatric-focused advanced practice registered nurses as agents of change to address health disparities. Emphasizing the critical need for understanding health disparities in the context of racism and discrimination, this committee champions a paradigm shift, transcending educational initiatives, advisory roles, advocacy efforts, leadership strategies, and community services to illuminate an equitable future for all children and families.

Application of an Antiracism Framework to Improve Pediatric APRN Education.

Poor health outcomes for children are directly tied to poor social determinants of health and systemic, embedded health care inequities. To prepare the next generation of pediatric advanced practice registered nurses (APRNs), nursing schools must educate students to address inequities through innovative curricular models and teaching modalities. The purpose of this manuscript is to describe the application of an antiracism framework to a graduate APRN program. This article describes the application of this framework, which led to significant administrative, curricular, and course changes to prepare pediatric-focused APRN students to address the health inequities and poor social determinants of health facing children today. By describing our journey to embed an antiracism framework, other nursing schools can make substantive changes necessary to prepare their students to address these health inequities.

An Innovative Educational Intervention for Pediatric Nurse Practitioner Faculty to Meet Social Justice Curriculum Standards.

The association between adverse childhood experiences and negative health outcomes is a public health concern, particularly affecting disadvantaged groups and contributing to health disparities. Pediatric nurse practitioners are well-positioned to address this issue, emphasizing the importance of incorporating social justice concepts into nursing education to develop a pediatric workforce with the necessary skills to curb health disparities. However, evidence-based approaches to incorporating these concepts into pediatric nursing education are limited. To address this gap, we describe an innovative educational intervention that harnesses the power of narratives to empower future pediatric nurse practitioners as champions of social justice and health equity.

Predicting life expectancy in the united states: The importance of healthy living behaviors and residential geography.

According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of

Cardiorespiratory fitness and physical activity in the lens of social justice - Reporting on the disparities that exist.

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differences in susceptibility to poor health outcomes, including non-communicable disease. Race and ethnic differences in CRF may partly be explained by social injustices rooted in persistent structural and systemic racism. These forces contribute to environments that are unsupportive for opportunities to achieve optimal CRF levels. This review aims to examine, through the lens of social justice, the inequities in key social ecological factors, including socioeconomic status, the built environment, and structural racism, that underly the systemic differences in CRF and PA in vulnerable communities. Further, this review highlights current public health initiatives, as well as opportunities in future research, to address inequities and enhance CRF through the promotion of regular PA.

Health, mental health, and hearing indigenous voices.

OBJECTIVE: To identify the issues raised by the unsuccessful Voice referendum and propose removal of barriers to reporting and prevention of family violence in remote communities as the most ambitious measure of success in hearing First Nations voices. CONCLUSIONS: The Voice referendum was partly justified to improve the mental health of First Nations Australians, despite concern the process and its outcome might worsen both. Aboriginal and Torres Strait Islander leaders revealed the tensions that arise between individual and communal interests when marginalised groups fight for self-determination. While a unified First Nation Voice is likely to amplify prominent messengers, we should also be interested in hearing diverse, dissenting voices. As the most marginalised group within a marginalised community, the ability to hear the voices of women and children subject to family violence in rural/remote Australian communities may be the best measure of success in overcoming the barriers that was the motivation for the referendum.

Operationalizing Equity, Inclusion, and Access in Research Practice at a Large Academic Institution.

INTRODUCTION: Healthcare advances are hindered by underrepresentation in prospective research; sociodemographic, data, and measurement infidelity in retrospective research; and a paucity of guidelines surrounding equitable research practices. OBJECTIVE: The Joint Research Practices Working Group was created in 2021 to develop and disseminate guidelines for the conduct of inclusive and equitable research. METHODS: Volunteer faculty and staff from two research centers at the University of Pennsylvania initiated a multi-pronged approach to guideline development, including literature searches, center-level feedback, and mutual learning with local experts. RESULTS: We developed guidelines for (1) participant payment and incentives; (2) language interpretation and translation; (3) plain language in research communications; (4) readability of study materials; and (5) inclusive language for scientific communications. Key recommendations include (1) offer cash payments and multiple payment options to participants when required actions are completed; (2) identify top languages of your target population, map points of contact, and determine available interpretation and translation resources; (3) assess reading levels of materials and simplify language, targeting 6th- to 8th-grade reading levels; (4) improve readability through text formatting and style, symbols, and visuals; and (5) use specific, humanizing terms as adjectives rather than nouns. CONCLUSIONS: Diversity, inclusion, and access are critical values for research conduct that promotes justice and equity. These values can be operationalized through organizational commitment that combines bottom-up and top-down approaches and through partnerships across organizations that promote mutual learning and synergy. While our guidelines represent best practices at one time, we recognize that practices evolve and need to be evaluated continuously for accuracy and relevance. Our intention is to bring awareness to these critical topics and form a foundation for important conversations surrounding equitable and inclusive research practices.

Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review.

AIM: To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity. DESIGN: Integrative review. METHODS: The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases. DATA SOURCES: Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022. RESULTS: Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity. CONCLUSION: Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration. IMPACT STATEMENT: Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy. SUMMARY STATEMENT: What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research. REPORTING METHOD: This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The contribution of the nursing profession to the establishment of social justice: A grounded theory study.

BACKGROUND: Social inequities in the healthcare system threaten global health. Efforts to establish equity in healthcare is a key goal of healthcare systems worldwide. Social justice is a basic value of the nursing profession that always merits attention. OBJECTIVE: This study aimed to identify and explain the processes of the nursing profession's participation in establishing social justice in healthcare system. RESEARCH DESIGN AND METHODS: This qualitative study was conducted using the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through in-depth, semi-structured, individual interviews with 26 participants, 23 of whom were members of the nursing profession. Sampling started purposefully and, then, continued with theoretical sampling. Field notes were also taken for data collection. Data analysis was performed using Corbin and Strauss' 2015 method. ETHICAL CONSIDERATIONS: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran. FINDINGS: The "Professional Dynamics in the Path of Justice" was the study's core category. This theory is the result of nine main categories: "inefficient professional authority," "social justice, a neglected component in education," "clinical concerns, barriers to nurses' presence in society," "individual input reserves to facilitate social justice," "inadequate maturity of the profession in the path of equity in health," "promoting justice in clinical practice," "a tendency to community-oriented profession," "use of personal approaches for justice promotion," and "emerging justice-expanding nursing." These categories cover the underlying factors, strategies, and outcomes of the nursing profession's participation in establishing social justice process in healthcare. CONCLUSION: The theory of professional dynamics in the path of justice can be used as a practical guide to describe the role of nurses in establishing social justice. Further studies with a quantitative approach to applying this theory are recommended.

Exploring the complex cognitive, affective and behavioural processes of individuals with intellectual disabilities in financially abusive situations.

BACKGROUND: Understanding the cognitive processes of individuals with intellectual disabilities in financially abusive situations is critical to develop effective prevention strategies. AIMS: This study investigated how persons with intellectual disabilities define and analyse financially abusive situations, and how they would feel and act in situations that they consider abusive. MATERIALS AND METHODS: Twelve participants with intellectual disabilities participated in a semi-structured interview where they were asked to reflect on three vignettes illustrating financial abuse. We analysed the interviews using thematic analysis. FINDINGS: The findings revealed that individuals with intellectual disabilities considered the type of relationship between the victims and the perpetrators, the behavioural patterns of the perpetrators, and their own experiences when interpreting the situation. Furthermore, they discussed their emotional and behavioural reactions to the vignettes. CONCLUSION: This study has important implications in supporting the autonomy and decision-making rights of persons with intellectual disabilities regarding their finances and developing effective preventions against financial abuse among this population.

Nursing Students' Experience of a Poverty Simulation and Its Impact on Empathy and Social Justice Awareness: A Descriptive Qualitative Study.

Holistic nursing practice requires an understanding of the constraints of poverty as one of the social determinants of health. Future nurses need to be change agents for social justice. A descriptive, qualitative study was conducted to explore students' experience of the Missouri Association for Community Action Poverty Simulation© (CAPS) and its impact on empathy and social justice awareness among a purposive sample of 56 sophomore baccalaureate nursing students at a public university in the Northeastern United States. Inductive thematic analysis was applied to data collected from a postparticipation reflection paper. Five themes emerged: (a) emotions, (b) personal history of poverty, (c) empathy, (d) rising advocacy, and (e) lessons learned. The results support that the CAPS simulation provides an experiential opportunity which impacts empathy and foundational attitudes to be a change agent for social justice. Recommendations include structured education about social determinants of health prior to the CAPS simulation, continued education throughout nursing curricula, and experiential opportunities to apply social justice skills before graduation.