Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems

Abstract

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.

Addressing anti-Black racism within public health in North America: a scoping review

“…Put otherwise, redistributive or ‘liberatory’ interventions may be (un)intentionally delimited to the priorities of dominant interest groups and public health ‘professionals’ [ 119 ]. In praxes rooted in CRT, the perspectives of socially marginalized groups should constitute the main axis by which all discourse and decisions take place – the principle of “centering the margins” [ 120 ].…”

“…Recognition of ABR as a public health crisis alone cannot challenge harmful racial hierarchies, and the interventions showcased in this review are but a starting point for the gaps identified in culturally safe outcome evaluation and community leadership. Participatory engagement of stakeholders, through multiple intervention arms and sectors, who are mutually informed and committed to an ethic of transformation (and simultaneously, refusal to engage in or with, exclusionary systems), are important practices to bridge gaps [ 120 ]. Public health institutions should further mobilize action on enduring infrastructure and legislative change that would foster permanent distributive and procedural justice across contexts.…”

Examining ACCURE’s Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care

“…This prior formative work following the Undoing Racism principle of analyzing power led GHDC to focus on transparency as a key principle in its approach to racial equity interventions. With these foundations, ACCURE operationalized transparency and the Undoing Racism concept of maintaining accountability through intervention components at the community, organizational, and interpersonal levels, described in detail elsewhere (Baker et al, 2021, Cykert et al, 2020. For the present analysis, we focused on ACCURE's nurse navigation which was conceptualized as an accountability intervention compo-nent.…”