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How to … bring a JEDI (justice, equity, diversity and inclusion) lens to your research

2023; Wiley; Volume: 21; Issue: 1 Linguagem: Inglês

10.1111/tct.13660

1743-498X

Neera R. Jain, Laura Nimmon, Laura Yvonne Bulk,

Qualitative Research Methods and Ethics

Scholars are increasingly called to incorporate a justice, equity, diversity and inclusion (JEDI) lens into health professions education (HPE) research.1-5 These and other terms are described in Table 1 and bolded throughout the paper. The complexity of this work can feel overwhelming, leading researchers at any career stage to avoid it altogether saying, 'what I do is not JEDI research'. The pressure to incorporate JEDI 'correctly' may also dissuade researchers who prefer to 'stay in their lane' of expertise. While these tendencies may be understandable, they present a problem: HPE scholarship may fail to recognise vast ways of being, knowing and doing. Every area of research is steeped in a sociohistorical context and shaped by power dynamics (e.g. racism, ableism, colonialism and hetero/cis/sexism), meaning JEDI concerns are always at play. Research not engaging with these complexities risks ignoring scholars' influence on processes and outcomes, thus omitting diverse perspectives and experiences.6 Consequently, constructions based on the norm prevail and researchers may, unintentionally, reconstruct knowledge from an exclusionary position. How can you do research in ways that unearth diverse perspectives and grapple with power dynamics to advance JEDI in HPE, even when this is not the central aim of your research? In this paper, we invite you on a journey to activate a JEDI lens in qualitative research practice, no matter your topic. Campbell FK. Contours of ableism: the production of disability and abledness. Basingstoke, Hampshire: Palgrave Macmillan; 2009 TL Lewis' working definition of ableism https://www.talilalewis.com/blog/working-definition-of-ableism-january-2022-update Jain NR. The capability imperative: theorizing ableism in medical education. Soc Sci Med. 2022;315:115549 Braun V, Clarke V. Thematic analysis: a practical guide. London (GB): Sage; 2022 Varpio L, MacLeod A. Philosophy of science series: harnessing the multidisciplinary edge effect by exploring paradigms, ontologies, epistemologies, axiologies, and methodologies. Acad Med. 2020;95(5):686–9 Hibbs C. Cissexism. In Teo, T, editor. Encyclopedia of critical psychology. New York (NY): Springer; 2014. https://doi.org/10.1007/978-1-4614-5583-7_679 Lennon E, Mistler BJ. Cisgenderism. TSQ. 2014;1:1–2 Bergman E, de Feijter J, Frambach J, Godefrooij M, Slootweg I, Stalmeijer R, van der Zwet J. AM last page: a guide to research paradigms relevant to medical education. Acad Med. 2012;87(4):545 Varpio L, MacLeod A. Philosophy of science series: harnessing the multidisciplinary edge effect by exploring paradigms, ontologies, epistemologies, axiologies, and methodologies. Acad Med. 2020;95(5):686–9 Zerilli L. Politics. In: Disch L, Hawkesworth M, editors. The Oxford handbook of feminist theory [Internet]. Oxford: Oxford Academic; 2015. pp. 632–650. https://doi.org/10.1093/oxfordhb/9780199328581.013.33 Bell K. Open education sociology dictionary [Internet]. Wollongong: University of Wollongong; 2017. Politics; 2017. Available at: https://sociologydictionary.org/politics/ Foucault M. The subject and power. In: Dreyfus HL, Rabinow P, editors. Michel Foucault. Beyond structuralism and hermeneutics. Brighton: Harvester; 1982. pp. 208–28 Nimmon L, Stenfors-Hayes T. The "Handling" of power in the physician-patient encounter: perceptions from experienced physicians. BMC Med Educ. 2016;16:1–9 Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stan L Rev. 1991;43(6):1241–300 Jacobson D, Mustafa N. Social identity map: a reflexivity tool for practicing explicit positionality in critical qualitative research. Int J Qual Methods. https://doi.org/10.1177/1609406919870075 We suggest beginning by awakening your critical consciousness. Friere7 argues this work requires critical reflection on our experiences of power, privilege and equity that reorients our action towards social justice. Harding8 called this work developing a traitorous identity, requiring you to start from others' perspectives to gain insight on your own privileges and ways of understanding the world and then use that insight to do research anew. To begin this work, we encourage you to seek stories told from perspectives different from yours that can counter dominant social narratives. Engage with these stories to critically reflect on your own life experience relative to others, consider how power and privilege shape these experiences,9 and imagine how things might be otherwise (Table 2). In this process, shame may arise in recognition of the harm and inadequacy of our past actions. Be gentle with yourself. This work requires leaning into discomfort to unlearn historically and deeply rooted ways of thinking, being and doing. Building new ways of working happens one courageous step, stumble or roll at a time. By activating your critical consciousness, you will tune into power and privilege more readily. Then, you must commit to action.10 You can employ a JEDI lens at all stages of the research. In the following sections, we focus on three sequential stages of the research process (conceptualisation, design and analysis) and outline JEDI-oriented strategies you can activate for each. We encourage you to use the questions in Table 3 to prompt your reflection throughout the research process. Early work conceptualising the phenomenon you wish to study requires in-depth exploration of existing knowledge on the topic to position the project as novel and relevant to HPE. At this early stage, you can deliberately use a JEDI lens by considering how diverse groups of people might experience the phenomenon differently and how different research approaches might capture these experiences.5, 11, 12 Treat divergent experiences as essential to understanding the phenomena of study, not as outliers. We propose several mechanisms to achieve this. When conducting a literature review, consider how previous research and writing on the topic has attended to researcher and participant positionality and power dynamics. Question whose perspectives have produced the research and who has been erased from existing work. Has existing work engaged with power dynamics in the learning context? You can look beyond HPE literature to consider how researchers in other fields (e.g. education, law, sociology, anthropology, history, gender studies, cultural studies) have revealed the influence of power and diverse perspectives.13 Your library staff may be helpful in navigating these new disciplines. Non-academic sources, such as social media, podcasts and activist blogs, can also illuminate different ways individuals have experienced the phenomenon. Finally, consult colleagues, broadly, to develop your research focus and approach. Consider the positionalities of those you consult with to ensure you have sought perspectives of people with varied lived experiences and expertise. Speaking to scholars and practitioners can invite different ways of examining the phenomenon and alternate frameworks you can apply initially or during analysis. For example, LYB benefitted from including a non-blind research-based theatre expert in her process, whose questions prompted her to consider how to make 'insider' ways of knowing more apparent.14 This type of broad consultation is also an opportunity to develop relationships with potential research partners, who can advise on or directly participate in the project. The paradigm, or underlying philosophical framework, with which you approach the work will fundamentally shape the research design—from team composition, to recruitment, data collection, analysis and knowledge sharing.15 No single paradigm is the 'right' one for researchers seeking to incorporate JEDI values. We encourage you to ask reflective questions (Table 3) about your design and how paradigms may influence this. A JEDI lens is directly aligned with an anti-oppressive paradigm, which 'contend[s] that the roots of the problems people face lie not in personal failings but in oppressive social structures and relations'.16 (p573) Other paradigms may be in tension with adopting a JEDI lens. Paradigms (dis)allow particular approaches to research design. For example, a paradigm might give permission to construct peoples' experiences as marginal and therefore extraneous to the research. Adopting a JEDI lens requires you to consider how to create more space for those experiences. You can create space in your research by involving people from the community of interest in the research design.4 Bear in mind that you must also consider how their paradigm(s) may be in tension with some of your priorities as a researcher and even those of your institution. For example, if you are investigating professional identity development and want to engage Indigenous student perspectives, you will need to devote time to nurturing genuine relationships with communities, which may necessarily slow your previously defined project timelines. Whatever the paradigm(s), you must realise that these influence every aspect of research design. Recruitment determines whose perspectives are included. You can consider attending to difference (e.g. in bodymind experiences, social locations, epistemology) in the ways you recruit. Rather than avoiding divergence in the sample (e.g. including only students who are studying full time, people who do not have any 'additional' diagnosis beyond the one of interest, 'healthy' individuals or clinicians who practice without accommodations), you can enhance your work by recruiting for maximum variation.17 Because this approach seeks to gather a diversity of stories and experiences, it necessitates recruitment materials available in accessible formats that are shared broadly. Elicitation techniques will also shift the perspectives included. For example, booking all interviews after classes conclude for the day might exclude people with caregiving responsibilities. For this reason, in their research, NRJ and LYB offer flexibility in interview or focus group times, durations and format (e.g. virtual, face to face) and discuss access needs in advance while responding dynamically to participant needs in the moment. The positionality of those collecting data will also influence the data. For example, disabled people may share more openly with a researcher who also identifies as disabled, particularly creating a sense of safety for those with invisible disabilities. Moreover, using multiple, flexible elicitation strategies (e.g. synchronous, asynchronous, written and verbal interviews available) may invite multiple ways of expressing knowledge.18 How you engage with data is not a neutral process. Who makes the analytical decisions is political. In other words, power plays out in how you look at the data and whose perspectives you prioritise. For example, even if you are leading a research team as a principal investigator, you should critically and carefully balance your perspective with those of your team. You can activate further strategies to challenge your interpretations of the data and take JEDI into account. At the initial stages of analysis, engage in informal consultation about themes you are noticing in the data, talking with someone about their experiences, bringing someone with lived experience/expertise onto the team. Consider giving equal weight to the theory you use and the diverse perspectives you draw on to sensitise, or focus, your analysis. These strategies may invite dissent and infuse the analysis with different conceptualisations that stretch how you and your research team perceive the data.19 You may notice different perspectives and patterns when someone from an equity-denied group examines the data, or when you take a nuanced approach to considering social identity in the data. For example, in LN and NRJ's research into student mistreatment by patients, the team wrestled with interpretations of data that represented racism and sexism.20 NRJ and another co-author, who identify as visible minorities, brought rich insights to this data interpretation from their own lived experiences and social positions. Wyatt et al. suggest analysing different participant social identities separately and then together to get a fuller picture of complexities, structural inequalities and biases that shape participants' experiences.19 We encourage candid conversations on the research team about how to thoughtfully negotiate and balance research team members' interests and the convictions of participants. Multifaceted JEDI analysis should invite diverging perspectives, not confirmation of researchers' interpretations of the data.1 Finally, pause during analysis and ask critical questions related to power inequities. Explore any tensions between data from those at the margins of power and those closer to the centre.21 Consider whose perspective is centred in analysis; how might it be different if the findings were repositioned from a different perspective?22 Ask the simple yet profound question 'why' during analysis to lift your gaze from individuals to structures: why is this happening the way it is happening?23 This question peels back influences of power at the structural level, while still tuning into individual/social-level perspectives. For example, in NRJ's research,24, 25 asking herself 'why' during data analysis helped her move beyond identifying individual participant behaviour patterns to identifying larger ideas about disability and medicine that shaped those behaviours. You might also incorporate critical theories that reveal layered structures of power.26, 27 This may seem daunting if you settled on a theoretical framework during study design and planned to use it deductively. However, it is acceptable to integrate additional theories while interpreting the data.28 Integrating another theory during analysis invites multiple interpretive lenses to illuminate dimensions of the data that capture diverse positionalities and ideas. This paper joins an ongoing conversation to offer strategies that are by no means exhaustive, but rather places to start. We aim to spark your critical reflection through possible actions and questions (Tables 2 and 3). Our reference list honours the work of others engaged in this conversation who have informed our thinking. You can find discussions in the cited work that take our ideas to further depths. Moving forward, we encourage you to explicitly describe and justify how you engaged in JEDI practices in each stage of your research. The experiences of learners marginalised by our current HPE practices suggest all research in the field must attend to JEDI matters urgently.29-32 Our privileged position as researchers demands we engage using new and potentially uncomfortable approaches to advance inclusivity and activate the power of human difference, rather than erase it.33, 34 We call in researchers to adopt a JEDI lens, courageously, to collectively dismantle oppression and transform the field of HPE. Neera R. Jain: Conceptualization; writing—original draft; writing—review and editing. Laura Nimmon: Conceptualization; writing—original draft; writing—review and editing. Laura Y. Bulk: Conceptualization; writing—original draft; writing—review and editing. With sincere gratitude, we acknowledge that we are settlers on Indigenous lands. Neera recognises Māori as tangata whenua of Aotearoa, with acknowledgement to Ngāti Whātua Ōrākei as local iwi. Laura and Laura reside on the unceded, ancestral, and continually occupied territories of the xwməθkwəy̓əm (Musqueam), Skwxwú7mesh Úxwumixw (Squamish), Tsleil-Waututh (Slay-wa-tuth), and WSÁNEĆ (Saanich) Peoples. As settlers and tangata Tiriti, we recognize our responsibility to address colonial injustices in and beyond health professions education. We are grateful to the scholars, activists, learners, and other individuals who have shaped our critical thinking and learning related to research methods. In particular, we thank Dr. Abby Konopasky, and Dr. Katie Schultz, and Professor Lara Varpio for their guidance as editors of the Tryptich series. Open access publishing facilitated by The University of Auckland, as part of the Wiley - The University of Auckland agreement via the Council of Australian University Librarians. The authors have no conflict of interest to disclose. The authors have no ethical statement to declare. Data sharing is not applicable to this article as no new data were created or analyzed in this study.