Introduction:Black participants, especially older adults, remain underrepresented in clinical research due to longstanding barriers, including systemic racism within the health care system and resulting mistrust of medical and research institutions. Methods:Using a community-based participatory research (CBPR) framework, this paper identifies facilitators and barriers for recruiting older Black adults into a community-based exercise study, emphasizing collaboration and co-learning with community members. Results:Strategies include building community partnerships, developing culturally appropriate recruitment materials, eliciting community feedback, and providing meaningful, tangible benefits to participants. Discussion:These facilitators illustrate effective CBPR implementation and provide a practical framework for recruitment in future research.
Introduction: Community is an integral part of the health and well-being of individuals. Community care is particularly important for Black birthing people who are and have historically been harmed by institutional systems of care. The purpose of this study is to understand the role(s) of community care for Black birthing people during pregnancy, birth, and postpartum. Methods: We conducted 12 semistructured interviews ( N = 12) with Black women who have given birth in Washington State. We performed a thematic analysis of the interview data using an iterative coding process. Results: We found community care enables TRIBE (Tangible, Relational/peer, Informational, Birthworker, Emotional) support. In addition, we found that identity plays a key role in how Mothers define community, seek support, and experience joy in motherhood. Health Equity Implications: Community care creates holistic support networks that address essential needs often neglected by traditional health care systems. The TRIBE framework serves as both a way to understand support and a guide for designing better care systems. It challenges traditional research and clinical ideals by recognizing community, not just clinicians, as vital to maternal health outcomes. Future efforts should prioritize funding, formal partnerships, and service integration that uplift community care models, including expanding Medicaid coverage for doulas and investing in community-based maternal health organizations supporting Black birthing people and families.
Background: Sleep-related infant deaths disproportionately affect Black non-Hispanic families in New York City, representing a critical perinatal health equity issue. Traditional safe sleep messaging can fail to reflect the lived realities of structurally marginalized communities, creating disconnects between clinical recommendations and caregiving practices. Objective: To demonstrate how participant-generated photography can reimagine perinatal care by centering Black maternal knowledge in infant safety interventions. Methods: We conducted photo-elicitation interviews with 30 Black non-Hispanic mothers of infants aged <12 months in New York City. Participants documented their infant’s sleep environments through photography ( n = 86 images), which were then used to elicit in-depth interviews exploring decision-making processes and lived experiences. Selected photographs and quotes were incorporated as role-playing scenarios in training sessions with infant home-visiting staff. Results: Nearly all photographs depicted sleep environments with multiple risk factors according to traditional guidelines; however, participants demonstrated sophisticated reasoning rooted in love, survival, and contextual safety. Key themes included: (1) multiple caregivers and sleep locations reflecting housing instability and extended family networks; (2) daytime and unplanned sleep driven by work schedules and practical constraints; and (3) knowledge-practice disconnects, where mothers understood clinical recommendations but adapted them to structural realities. When used in staff training, 97% of 165 home visitors and health care staff found these authentic images to be helpful for identifying real-world risks. Conclusions: Participant-generated visual methods can transform perinatal care by revealing wisdom embedded in marginalized communities’ caregiving practices. Rather than viewing deviations as “non-compliance,” this approach illuminates how structural inequities shape infant care and points toward more equitable, community-informed interventions.
Introduction: Our goal was to co-create a locally tailored social risk screening protocol for use in obstetric care settings in Metro Atlanta. Methods: We conducted a community-based participatory study consisting of key informant interviews and a year-long working group. Interviews were conducted with representatives of community organizations ( n = 7) and people who were currently or recently pregnant ( n = 8). Select interview participants and care providers were then invited to participate in a working group. Over six meetings, the group collaboratively reviewed interview data, current literature, published screening tools, and local resource information for eight domains: education/employment, health literacy, housing, food insecurity, financial strain, childcare, safety, and transportation. A final set of questions and recommended processes for social needs screening during pregnancy and postpartum were iteratively derived via group consensus. Results: Key interview themes included the need for a central and reliable source of information, challenges of enrollment, limited availability of resources for some domains of needs (e.g., housing), and the inability of passive navigation strategies (e.g., written resource lists) to effectively meet needs. The working group created a final screening tool consisting of a combination of an initial question regarding any urgent needs and 36 multiple-choice and open-ended questions. The tool included recommendations for timing of screening during pregnancy and processes for resource provision within each domain. Conclusions: The community-informed social needs screening tool and protocol provides a framework for targeted social support during and after pregnancy that could be integrated in routine obstetric care in Metro Atlanta and other practice settings.
Objective: Processes for implementing racial equity and social justice (RESJ) policies are not well understood, despite their growing adoption across local governments. To address this gap, this qualitative study examines how practitioners navigate the day-to-day work of translating RESJ policy mandates into practice and the institutional, political, and organizational conditions shaping implementation across three jurisdictions in a large U.S. metropolitan area. Methods: We conducted in-depth, semi-structured interviews with 10 practitioners involved in RESJ policy implementation and identified through purposive sampling between June and November 2023. Interviews explored participants’ experiences with policy interpretation, community and stakeholder engagement, organizational capacity, accountability, and perceived policy impact. Data were analyzed using a reflexive thematic analysis. Results: Six themes and 14 subthemes were identified. The themes characterized participants’ experiences with interpreting and operationalizing policy mandates; organizational capacity and resource constraints; data infrastructure and practices; formal and relational accountability and oversight; emotional and ethical challenges; and political durability and risk. The findings illuminated key barriers and facilitators shaping policy adoption, acceptability, feasibility, fidelity, and sustainment, highlighting critical leverage points within RESJ policy implementation processes. Discussion: These insights underscore the need for greater institutional capacity, explicit and transparent accountability mechanisms, and sustained political and material support to strengthen RESJ policy implementation. Amid recent retrenchment of equity-focused policies, these findings provide guidance for policymakers and administrators seeking to design, implement, and sustain equity policies within local government systems.
Addressing health inequities in Kansas on access to care, health outcomes, and the impact of social determinants of health is necessary. The Center for African American Health (CAAH), now The Broderick Crawford Center for Advancing Community Health and Health Outcomes was established to create a community-university partnership to improve health outcomes in two Kansas communities. CAAH was uniquely created to utilize community-based participatory research tools in creating health and behavioral health programs, fostering education, and research implementation that focuses on health equity. This perspective will focus on the implementation of the center in two Kansas communities.
Partners in Contraceptive Choice and Knowledge (PICCK) was a time-limited (2018-2023) initiative to improve access to and quality of contraceptive care at Massachusetts birth hospitals and included continuous involvement of a community advisory board (CAB). In addition to providing strategic guidance, CAB members co-lead didactic activities, helped develop a patient-centered contraceptive decision aid, and created a novel mechanism to provide health literacy and accessibility assessments to clinics. Inclusion of a CAB in PICCK proved feasible and helped ensure equity-focused programming.
Objectives:Type 2 diabetes (T2DM) is a growing public health concern, particularly in the Middle East and North Africa (MENA) region, where prevalence rates continue to rise. Social determinants of health, including material needs security and food security, play a critical role in diabetes management, yet their interrelated effects remain underexplored. This study aims to examine the relationship between material needs security and food security among Lebanese adults with T2DM of low socioeconomic status. Methods:A cross-sectional study was conducted on 299 Lebanese adults with T2DM recruited from three primary health care centers. Participants completed validated questionnaires assessing sociodemographic factors and food security. Material needs security score was computed based on ownership and access for certain house utilities, as well as car ownership. Unadjusted and adjusted logistic regression models were conducted to evaluate associations between material needs security and food security. Results:Higher material needs security was significantly associated with food security in both the unadjusted and adjusted regression models (odds ratio = 1.26, 95% confidence interval: 1.06-1.49, p = 0.007). Food and material needs insecurities were more prevalent among females and individuals with lower income, lower education, and lack of health insurance. Conclusion:This study highlights the strong association between material needs security and food security in Lebanese adults with T2DM, emphasizing the importance of addressing social determinants in diabetes management. Policies targeting financial stability, food security interventions, and access to health care are essential to improving health outcomes in vulnerable populations.
Background: Structural racism is recognized as a fundamental cause of health inequities, but there is limited quantitative evidence on how structural racism influences abortion care. This study evaluates the relationship between racialized economic segregation—a commonly measured manifestation of structural racism—and timing of abortion care. Methods: Data included all abortions among non-Hispanic Black and White patients provided at a high-volume clinic network in Washington state from January 1, 2017, to April 30, 2025 ( n = 12,268). We used American Community Survey data to calculate the index of concentration at the extremes (ICE race-income ) to measure racialized economic segregation at the zip-code level. We reverse-coded and categorized ICE race-income into quartiles of spatial concentrations of racial and economic (dis)advantage, with higher quartiles indicating structural disadvantage and lower quartiles indicating structural advantage. We used generalized estimating equation models with an independence working correlation structure to estimate the association between ICE race-income and gestational duration (days) and time to abortion (days), controlling for sociodemographic and clinical factors. Results: Individuals living in the most structurally disadvantaged neighborhoods generally received care later in gestation and had a longer time to abortion than those in structurally advantaged neighborhoods. Associations were primarily null among first-trimester abortions, and effect sizes were larger in the second trimester and among Black individuals. Conclusion: These findings suggest that racially and economically segregated communities experience greater delays to abortion care, particularly in the second trimester. Efforts aimed at expanding abortion access in protective states must address structural racial and economic barriers.
Background: The United States lags peer nations in infant mortality, with persistent racial and geographic inequities. In Missouri, Black infants experience mortality rates more than double those of White infants. Addressing these disparities requires community-driven interventions beginning before conception and extending beyond routine perinatal care. Objectives: We describe the development and feasibility of Women & Person-Empowered Community Access for Reproductive Equity (WE CARE)-Jackson County (JC), a reproductive justice-informed intervention adapted from the Detroit WE CARE model to address reproductive health and infant mortality disparities. Design/Setting: WE CARE-JC used a two-phase, mixed-methods design. Phase 1 included listening sessions with advocacy groups and reproductive-age women, and a community survey ( N = 537) to identify needs, barriers, and engagement strategies. Phase 2 piloted the intervention in a safety-net hospital’s emergency department. Intervention components included the “One Key Question,” MyPath decision-support tool, community health worker-led counseling, and follow-up care navigation. Results: Listening sessions identified trusted providers as preferred sources of family planning guidance, while stigma, limited provider access, and knowledge gaps were key barriers. Survey data showed social (13% housing, 22% food, and 35% transportation insecurity) and medical (51% comorbid condition) vulnerability. In the pilot, 45 women were enrolled (85% of those approached), of whom 58% scheduled follow-up care and 10 (39%) attended appointments. Feedback from eight attendees showed high acceptability of the MyPath tool, counseling, and navigation support. Implications for Health Equity: WE CARE-JC demonstrated feasibility and acceptability of a reproductive justice-informed, community-engaged model to reduce barriers and improve equitable access to reproductive health care. This model provides a scalable framework for addressing upstream drivers of infant mortality inequities.
Radical imagination is required to cultivate equitable and just systems that offer optimal perinatal care within our communities. The practice of art is a mechanism for exploring and envisioning an equitable and just future—a future where pregnant capable people and their families can flourish. This creative work submission includes a mixed media drawing, entitled Uncaged , that explores the process of nondominant hand drawing as a tool for reducing self-criticism, accessing creativity and emotion, and reestablishing (re)connection to intuition. In the artist statement, the artist discusses the effects of this practice on her work in promoting health equity in perinatal care as a midwifery/women's health nurse practitioner (WHNP) educator and leader.
Introduction: Black disabled women face disproportionality high rates of maternal morbidity and mortality in the United States. This review synthesizes academic and community perspectives to assess how ableism and racism shape obstetric care and maternal health outcomes, identifying gaps for policy and practice reform. Methods: Using an intersectional ecological framework, we conducted a narrative review of peer-reviewed and gray literature on how racism and ableism shape obstetric care for Black disabled women. We searched PubMed, Google Scholar, and targeted sources for studies published in the last 25 years that addressed maternal health outcomes, barriers, or structural racism and ableism. Included sources encompassed qualitative studies, epidemiologic analyses, community reports, and policy analyses that examined barriers across the obstetric care continuum. Results: One hundred and fifteen sources were included in this review. Barriers to obstetric care for Black disabled women include: (1) maternal care deserts and inaccessible facilities; (2) inadequate preconception and prenatal care; (3) provider bias, surveillance, and reproductive coercion; (4) gaps in provider knowledge and training on disability and culturally congruent care; and (5) policy failures, such as weak disability rights enforcement, Medicaid nonexpansion, restrictive reproductive laws, and absent intersectional data. These barriers are rooted in racism and ableism, which intersect to cause care delays and denials, fuel mistrust, and increase risks of severe maternal morbidity and mortality. Discussion: Obstetric inequities for Black disabled women are rooted in the intersecting structures of racism and ableism that shape policy, access to care, and clinical culture. Yet, this intersection remains underexamined in research, leaving critical gaps in knowledge and action. Closing these gaps requires intersectional, community-led research and policy reforms—expanding Medicaid, enforcing accessibility, mandating provider training, collecting intersectional data, and investing in inclusive care grounded in disability and racial justice.
The Heaviest White is a poetic inquiry into the symbolic and moral weight of the white coat within the landscape of the U.S. maternal mortality. Through layered imagery and reflective narrative, the poem examines silence, complicity, and professional responsibility as they operate within medical authority when mothers die preventable deaths. Centered in a first-person clinician perspective, the piece engages in moral reckoning and self-accountability, positioning eyewitnessing and forensic truth as ethical acts within clinical practice. Rather than presuming to hold institutions accountable on its own, the poem invites clinicians, researchers, and readers into justice-oriented reflection—particularly in relation to the disproportionate and enduring loss of Black women. By weaving together clinical insight and creative expression, The Heaviest White challenges its audience to confront the emotional and ethical burden carried by medicine and to imagine a future in which no woman dies unseen, unheard, or unremembered.
Objectives: There is a need for formal guidance around antiracist research practices to dismantle structural racism, which has been embedded into the design and conduct of health sciences research. Our objective is to review and summarize recommendations from published literature published on antiracist research practices applicable to all health sciences research studies. Method: In 2022, we systematically reviewed PubMed, SCOPUS, Excerpta Medica Database, British Nursing Index, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Sociological Abstracts using search terms about antiracist research. We found 5362 papers, screened 3962 titles, assessed 171 abstracts for eligibility, and reviewed 103 using a standardized extraction form. We reviewed 11 papers twice to confirm accuracy. We narratively synthesized recommendations relevant to six stages of the research process via combined deductive and inductive qualitative analysis. Results: A total of 1407 individual recommendations were grouped into themes and subthemes within each research stage. Project development had the most themes (n = 7) and subthemes (n = 24); dissemination of findings had the fewest (2 themes and 5 subthemes). When designing a project, researchers are encouraged to develop diverse, representative, and empowered research teams; design projects important to marginalized groups; and use conceptual frameworks that build on the work of marginalized scholars. Researchers were encouraged to promote inclusive consent processes, accessible recruitment materials, and recruitment and retention strategies that maximized diversity. When analyzing data, recommendations included involving community partners to ensure appropriate conceptualization and measurement of race, justifying the selection of reference groups, and considering intersectional identities. Recommendations for data interpretation include contextualizing findings, considering structural racism, and improving community involvement to enhance the transparency of data analysis. During dissemination, recommendations highlighted increasing accessibility of research findings. Conclusions: We identified a comprehensive list of recommendations describing antiracist research practices. Our synthesis can be used to guide individual research teams, institutional review boards, and grant committees, and to develop educational curricula around antiracist research practices.
Introduction: Coloniality continues to define knowledge, culture, relationships and health outcomes for Indigenous peoples around the world. Health systems are shaped by coloniality, influencing access to health care and the quality of care. Decolonization, although pluralistic in understanding, provides a theoretical foundation for health system transformation. The aim of this scoping review was to explore what is known about decolonization, Indigenous health, and equity in publicly funded health systems, and to identify gaps in existing literature. Methods: This research is grounded in an Indigenous methodology and positioning, providing a critical structural analytical framework. Scoping review methods developed by the Joanna Briggs Institute and PRISMA-ScR were situated within a Kaupapa Māori framework to identify decolonization approaches and characteristics in publicly funded health systems within Aotearoa New Zealand, Australia and Canada. Data sources included four databases and an Aotearoa New Zealand-focused gray literature search. Results: Sixteen texts were included with more than three-quarters published between 2019 and 2021. The majority of approaches were at the level of the system or health professional and exploratory in nature. Implementation and outcome measurement were scarce. Characteristics of decolonization in health systems were categorized as Addressing Coloniality, Transformation, Relationships and Indigeneity. Conclusions: This review provides a novel synthesis of decolonization in the context of publicly funded health systems, identifying an emergent research area, and disconnect between theory and practice. Decolonization provides a rights-based intersectional framework that is distinct from alternative approaches, unique in its ambition to address power imbalance and see structural transformation. Misalignment between ideological positioning of decolonial theory and governments may limit the opportunity for implementation within publicly funded health systems. Research, implementation and evaluation of decolonization approaches is needed to expand knowledge, influence future public policy and see structural transformation of health systems to support Indigenous well-being and health equity.
Weight-inclusive interventions offer a promising alternative to traditional weight-centric approaches that focus primarily on weight loss. Black women, who are disproportionately classified as having obesity based on body mass index (BMI) criteria, often face limited success and added stigma from weight-focused models, which overlook the complex biological, social, and structural factors affecting health, as well as intersecting oppressions like racism, sexism, and weight bias. This article examines how cultural norms, body image, and systemic barriers shape health behaviors among Black women and argues for weight-inclusive care, which prioritizes health-promoting behaviors and overall well-being rather than weight loss and better aligns with their values and lived experiences, including autonomy. Evidence from weight-inclusive interventions demonstrates improvements in psychological well-being, body appreciation, and health behaviors, though research in racially diverse populations remains limited. Culturally responsive, weight-inclusive approaches tailored to Black women are essential for supporting sustainable, meaningful health outcomes while fostering positive body image and self-perception.
Community-based participatory research (CBPR) promises equity but often falls short, reproducing power imbalances and tokenistic engagement. This perspective calls for a transformative CBPR praxis grounded in intersectionality, positionality, and critical consciousness. We critique superficial applications of CBPR and propose actionable commitments: community sovereignty, intersectional accountability, structural reflexivity, critical action priorities, epistemic justice, and institutional reform. By interrogating researcher privilege and systemic inequities, CBPR can move beyond symbolic inclusion toward authentic collaboration that centers community voice and authority. Transformative CBPR is essential for advancing health equity and resisting exploitative research practices.
