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MSI Fellowship Week: Kate Cartwright on When Best Practices Miss the Mark: Health Equity and Evaluation Design

I am Kate Cartwright, a 2016 AEA Minority Serving Institution Fellow and an Assistant Professor of Health Administration in the School of Public Administration at the University of New Mexico in Albuquerque. I study racial and ethnic health equity in regard to healthcare access, quality, and outcomes.

As an evaluator who values health equity, the imbalance of funding and research which prioritizes the health of underrepresented and underserved populations is of great concern. Researchers and evaluators alike are able to follow best practices in the field. However, too often the “best” practices reify inequities, which includes practices that leave out underrepresented groups.

A provocative essay published in The Atlantic in the summer of 2016 investigates why health studies are frequently so white when our population is so diverse. The article offers several theories, but repeatedly reveals that best practices in research fail to hold researchers accountable for non-inclusive sampling strategies. A recent PLoS Medicine article notes that even though the 1993 National Institutes of Health (NIH) Revitalization Act mandates that federally funded clinical research prioritize the inclusion of women and minorities, the act has not yielded parity in clinical study inclusion (for example, less than 2% of National Cancer Institute funded cancer trials from 1993 to 2013 met the NIH inclusion criteria).

Lesson Learned: Design Inclusive Sampling Strategies

Evaluators must design evaluations which have inclusive sampling strategies if they hope to improve the efficacy, effectiveness, and equity of evaluations.

Hot Tip: Always Include the Community as a Stakeholder

In one workshop on culturally responsive evaluation I attended at Evaluation 2016, some participants lamented that they would like to be more inclusive of community members when evaluating community health programs, but that they had to respond to the priorities of their stakeholders first. Thankfully, we were in a session with a great leader who gently, but firmly, challenged them (and all of us) to remember that community members must be counted as primary stakeholders in all evaluations.

Rad Resources:

The American Evaluation Association is AEA Minority Serving Institution (MSI) Fellowship Experience week. The contributions all this week to aea365 come from AEA’s MSI Fellows. For more information on the MSI fellowship, see this webpage: http://www.eval.org/p/cm/ld/fid=230 Do you have questions, concerns, kudos, or content to extend this aea365 contribution? Please add them in the comments section for this post on the aea365 webpage so that we may enrich our community of practice. Would you like to submit an aea365 Tip? Please send a note of interest to aea365@eval.org. aea365 is sponsored by the American Evaluation Association and provides a Tip-a-Day by and for evaluators.

1 thought on “MSI Fellowship Week: Kate Cartwright on When Best Practices Miss the Mark: Health Equity and Evaluation Design”

  1. Hi Kate,

    I agree that there is as you put it an “imbalance of funding and research which prioritizes the health of underrepresented and underserved populations.” The Atlantic article that you linked to mentioned many reasons for this, including distrust and lack of diversity in the research community reflected in these studies. In particular, one thing that strikes me is how socio-economic status plays into the criteria for who is being studied and how. For participants, time to participate in such studies is a luxury and often comes at the expense of jobs, income and other worthy priorities. I agree with making “the community” a stakeholder, but I think practically, stressing accountability to such a stakeholder is difficult. I would love to see a good example how effective research and evaluation has been able recruit key minorities and retain accountability to them, all the while making such research cost effective, unbiased and reliable. It sounds like you have a worthy topic of study and research. Would love to see more.

    Thanks for your post,

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