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By 玛吉·拉米雷斯, 博士学位, MS, a CATALYsT scholar at 2022世界杯下注网站健康世界杯下注网站所 (KPWHRI) and assistant professor of 卫生服务 at the University of Washington School of Public Health
Medical researchers nationwide are stepping up their efforts to address the growing inequities in health and health care. 这种变化要求我们重新思考我们的工作方式. 消除我们医疗体系中的系统性种族主义, 世界杯下注网站必须更加多样化.
上个月，在“成人思想的变化”(行为世界杯下注网站)世界杯下注网站研讨会, I was invited to speak on the types of discrimination that compromise many studies and the measures we can take to end such practices. My research focuses on the role that information technology can play to close racial and ethnic gaps in health. 最近，作为一个 催化剂的学者 at KPWHRI, I have been investigating how technology can improve support for Latino caregivers of Latino people with Alzheimer’s disease and related dementias.
Latinos are at least 50% more likely than non-Latino whites to develop dementia. 然而，尽管拉美裔占美国人口的17%.S. population, they represent 1 percent of participants in National Institute of Health (NIH) trials. How can we do better at engaging Latinos and, more generally, people of color in research? 根据我自己的世界杯下注网站经验，我建议采取3种行动.
First, stop excluding people from participating in research if they aren't fluent English speakers. 8%的美国人英语水平有限, 其中拉丁美洲人占绝大多数. 世界杯下注网站 grants need to set aside funds for creating study materials in multiple languages. A great example is the NIH-funded stroke prevention study that I worked on in graduate school: It had materials in English, 西班牙语, 普通话, 广东话, 和韩国. 纳入是这些世界杯下注网站者的首要任务.
第二项行动是建立更加多样化的世界杯下注网站团队. 例如，拉丁裔仅占3%.5%的主要世界杯下注网站人员由NIH资助. 世界杯下注网站人员 of color are more likely to focus their research on people of color. 反过来，他们可能会更好地获得这些社区的信任. There's evidence that people of color are more likely to participate in research if they're recruited by staff they can identify with. In my CATALyST research on Latino caregivers, we have a tiny team: me and a staff member. 我是双语者, 二元文化的拉丁, 第一代美国人, and my staff member is a recent Mexican immigrant who worked as a physician serving marginalized communities in Mexico. 我们理解文化习语, 的隐喻, 的语录, 幽默, 这些习俗是我们语言的一部分, 我们的文化. We believe that this helps participants to feel comfortable and 分享 their perspectives more freely.
第三, 当世界杯下注网站人员, we need to thoroughly consider the impact on equity of each and every inclusion and exclusion criterion in our studies. 语言是一个显而易见的因素，但其他因素是微妙的. When we don't examine these criteria we risk sustaining racial and ethnic inequities in research participation.
Here’s an interesting case: My dementia study is part of a larger NIH grant at KPWHRI. 首席世界杯下注网站员为KPWHRI高级世界杯下注网站员 罗伯特Penfold她也是我在CATALyST项目中的导师. 而我的世界杯下注网站重点是拉丁裔, the larger study is working with a general population drawn from 凯撒永久医疗机构华盛顿 to study an intervention to help family caregivers attend to relatives with dementia. 在招募参与者的过程中, I changed a couple of criteria for participating—I removed the language requirement while adding the ethnicity requirement—but otherwise the criteria were the same in the 2 studies. This included a requirement that the participants with dementia had been prescribed an antipsychotic medication for behavioral symptoms of dementia. The prescription serves as a proxy to identify family caregivers who are dealing with challenging behaviors. A goal of the study is to reduce the use of antipsychotics for this indication.
I then encountered a problem that many researchers experience in seeking Latino, 黑色的, or Indigenous participants: After months of trying to recruit Latinos for my study, 我几乎没有成功. I reviewed the criteria and identified the antipsychotic criterion as a potential problem: It appears that Latino KPWA members are much less likely than non-Latino members to be prescribed an antipsychotic. 虽然需要进一步的世界杯下注网站来验证这一假设, 罗布和我都认为这个标准对我的世界杯下注网站并不重要. I have eliminated it for my study in an attempt to identify a larger sample of Latino participants. More careful scrutiny of criteria in advance of recruitment could prevent such unintended consequences.
还有其他步骤. 过采样, in which researchers select participants of color so that they comprise a larger 分享 of study enrollment, 能立竿见影吗. 从长远来看, 虽然, the foundation that underlies all of these efforts is developing a relationship of trust between researchers and communities of color. 这是我的亲身经历. 我刚从洛杉矶搬到西雅图的时候, I approached community leaders who have extensive experience working with Latino populations in this area. 尽管我自己是拉丁裔，和他们见面的时候会说西班牙语, they still are hesitant to help me to recruit Latino participants for my study. They encourage me to hang out with their community informally and show my face so they can get to know me. Once that relationship is built, and there's trust, then we can talk about research collaborations.
While such changes will take serious effort, they need not take decades and should be adopted now. 世界杯下注网站的好处, 拉丁裔社区和所有有色人种, 最终对我们整个社会来说都太重要了，不能再等了.
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