Decolonising research methods
Evidence hierarchies in healthcare are based upon the idea that it is possible to frame study designs as more or less objective. Those where the researcher’s influence is said to have been neutralised or removed from the process of selecting and analysing data are at the top of the hierarchy. Replication by another ‘neutered’ researcher reaffirms the privileging of objectivity. Donna Haraway (1988) called this belief in the possibility of objectivity ‘the God trick’. Far from objective, scientists and researchers are situated in and function with all kinds of unconscious bias, drawn from assumptions constructed within the society from which they come. Such unconscious bias then gets replicated as research methods are taught and disciplines or professions socialise researchers into ways of seeing and coming to know the world.
As a socialist, White, middle-class, cis-gendered, woman qualitative researcher, I have had to take seriously the idea that, as a researcher, I am in a position of power when it comes to conducting research. I select and interpret the literature to establish the gap. I frame the research question. I decide the methods and study design. I collect the data and then I analyse it. At every step, I am making choices that will reflect conscious choices and my unconscious bias. In qualitative research, there is an understanding that you cannot remove the researcher or pretend that they’re able to be ‘objective’. They are a tool of the study design; they interpret interpretations. You cannot ignore who you are when you’re collecting qualitative data, how your participants respond to you, and the nature of the data you collect. To do qualitative research well, I must be reflexive with my assumptions, I must be interested in outlier data, I must ask myself how my study design and the data I’ve collected challenges my thinking or theory building. I must make this process transparent, so that readers of my work can see how I arrived at my interpretation of the data and selection of the evidence.
In my view, if we are to embed equity-centred, evidence-informed decision-making in research, then all forms of research and evidence synthesis should learn from the rigours of robust qualitative research. As researchers, we all need to be reflexive and transparent about who is conducting the research, and how we have interrogated ourselves, as researchers, in the act of operationalising a study. We should abandon the idea that a researcher can somehow be neutral or objective in the study design or when synthesising evidence. Readers and users of research should be able to know something about a researcher (or researchers) and what those researchers learnt about themselves from operationalising a study (beyond their name, title and institution).
Caroline Criado Perez’s (2019) research brilliantly demonstrates that objectively inspired research, designed to demonstrate the efficacy of drugs or the safety of cars, is biased, because it does not make transparent that those involved in the research as participants are predominantly men. She shows that drugs that work on men don’t work on women, and that cars are, in fact, designed in ways that are safer for men than women. No consideration is given within the study designs to the need to disaggregate data, nor is there any expectation of the researchers to be reflexive and transparent about how their positionality may be affecting their study designs. Despite the power of her work, Perez is unreflexively positioned as a White woman by her book title: Invisible Women: Exposing data bias in a world designed for men. As Dr Maria Arruda (a Black woman scientist) gently pointed out to me (a White woman), our world is not designed for Black men.
As researchers engaged in life-long learning, taking seriously the rigours of reflexively decolonising our own thinking (thanks to the privilege of being knowledge seekers) would go a long way to improving the equity of healthcare research, and thus health equity. Since March 2023, I have been working with a team led by Professor Catrin Evans to more comprehensively address meaningful integration of equity, diversity and inclusion (EDI) in JBI qualitative systematic reviews. The aim of this work is to develop a framework and initial guidance for attending to EDI within the JBI qualitative review process. The importance of researchers and research teams to actively engage with reflexivity is emerging as key to taking seriously questions of EDI in qualitative evidence synthesis. One way an evidence synthesis might address EDI is to pull together a diverse team of researchers. But as readers of that synthesis, we should want to know how that team used their diversity to examine the evidence. Were there differences of opinion? How were more junior, possibly minoritised, researchers supported to question the framing of evidence, the use of data or forms of synthesis? There is no point having diverse teams if the role minoritised researchers played in exposing hidden assumptions isn’t made transparent to the synthesis process. And if our team is not diverse, but is conducting research about a minoritised population, how has that minoritised population decolonised the research team’s assumptions, questions, study design etc?
While fulsome reflexivity is clearly key to addressing global health equity, it is also essential to ensure that research teams don’t just include, but are led by minoritised researchers, so that their positionality or situatedness can ensure that the right questions are prioritised to support exposure of and make visible hidden power (power that may only be hidden to those with forms of social privilege).
I had the honour of being involved in and learning from this year’s ICARE4Justice summit. The summit aims are to share best practices to promote access and equity for racially and ethnically minoritised communities in higher education. From my work alongside colleagues from this summit, and Rachel Ibikunle, a Black midwife PhD student I am working with, I have learnt several things. When White people study Black people’s experiences or health outcomes, there’s a ubiquitous tendency to explain poorer outcomes as resulting from the ‘broken’ Black/Brown body or ‘unhelpful’ cultural habits/health-seeking behaviours, instead of asking in what ways the services, in which a Black or Brown person is supposed to be being cared for, are institutionally racist. In 2021, NICE issued draft guidelines to induce all ethnically minoritised women at 39 weeks, because evidence showed Black women are four times more likely to die in childbirth or during pregnancy. Such guidelines locate the problem and send the colonising message that it is the Black body that is faulty. NICE had to retract its guidance. If we do not ensure that we have research led by researchers with situated knowledge of being minoritised then the ‘deficit model’ will perpetuate and nothing will change.
To achieve global health equity, we must change who is doing and leading research. In the UK, the pipeline from undergraduate to professor is broken. Black women hold less than 0.01% of professorships in UK higher education. Meanwhile UKRI research funds to investigate the disproportionate number of deaths of Black and ethnically minoritised people during COVID has been awarded to teams led by White people.
The problems are systemic. The notion that, if researchers simply follow a robust study design, then good science will ensue, because the identity or positionality of the researcher is irrelevant, is fundamentally flawed. Research and who does it, is infused with power, inequity and injustice, and so we cannot effectively address health equity. Research must be led by marginalised researchers, and all researchers must work to decolonise their assumptions. Finally, as Dr Addy Adelaine argues, we also need safeguards to ensure Black academics and other marginalised individuals can speak freely without fear of retribution.
Thanks to Dr Pearl Agyakwa.
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
