Innovation and equity in public health research : testing arts-based methods for trauma-informed, culturally-responsive inquiry.

Abstract

As the field of Public Health has shifted from a biomedical paradigm to a social ecological approach, focusing on health equity and social determinants of health, it has increasingly acknowledged the roles of culture and trauma in health outcomes. The field has responded by modifying some research practices, but continues to prioritize conventional methodologies-with few options designed to foreground trauma-and cultural-responsiveness. Unfortunately, to the extent that conventional approaches require health to be defined, communicated, or valued according to dominant norms, they risk perpetuating inequities. Health equity therefore requires the development of research methodologies that increase inclusivity and access, elicit and apply diverse knowledges, reduce intrusion, and incorporate sociocultural factors. Using design thinking, and drawing upon critical theory, hermeneutics, photovoice, and arts in health research, this study developed and tested three methodological prototypes for researching a potentially traumatizing topic (violence) among a vulnerable population (young women ages 11-21). The first prototype collected vi creative writing from an ongoing youth detention intervention; the second utilized a themed citywide writing contest; and the third obtained the script for a play about sexual and relational violence, written and performed by local survivors without researcher elicitation. Methods: All prototype-generated data (combined n = 126) were iteratively analyzed for documented experiences, needs, assets, and priorities related to violence. Four conventional violence-related surveys, administered among the three sample populations (combined n = 1862), were also analyzed. Extensive comparative evaluations were then conducted of all findings and methods, assessing quality/quantity of information, trauma responsiveness, and cultural responsiveness. Results: Findings from the arts-based methods addressed 64 to 89 percent of the same variables as the surveys, while the surveys addressed only 36 to 49 percent of the artsbased data variables. The three prototypes juxtaposed needs with assets, accommodated expressive choice, and involved minimal researcher intrusion-rendering them trauma and culturally responsive. They also generated impactful insights inaccessible via surveys, such as unconventional definitions of violence. The prototypes aided disclosure (thus improving data), were time-and cost-effective, and offered significant potential for research reciprocity. As such, they offer promising models for continued methodological innovation in advancement of health equity. vii TABLE OF CONTENTS

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice

“…This gives rise to positivist epistemology, which sees "hard, secure objective knowledge" [(17), p. 6] as both attainable and singularly valid (16). This epistemological approach drives empiricism: a focus on observation, assuming that repeated observation generates reliable, objective knowledge 5 . The biomedical model also relies on a Cartesian separation of mind and body, in which the body is a manifestation of objectively-observable causes and 4 Coemans and Hannes (15) stated that "[t]raditional research methods have not always been able to fully engage with particular groups in society.…”

“…that are difficult to verbalize" [p. [35][36]. 5 As House (18) observes, a further assumption is that reliability and objectivity together indicate truth. effects (positivism), while the mind-and "human experience" more generally-is subjective and thus unreliable, and thus minimally relevant to legitimate knowledge production or health advancement (19).…”

“…Advancing health equity relies upon understanding the central role of social determinants of health in influencing individuals' contexts, options, and behaviors-and thus their health outcomes. Numerous studies affirm that health outcomes and disparities result not strictly or even primarily from individual behaviors or genetics, but from policies, structures, and systems that circumscribe individuals' choices, access, and knowledge (1)(2)(3)(4)(5). Recognizing the impacts of these factors, the field of public health has increasingly promoted a social ecological approach to understanding (6) by Tasha Golden (7).…”

Generating youth dialogue through the literary arts: A citywide youth health collaboration in the U.S.

“…Five priority opportunities for increased youth leadership are detailed in Table 4. (Checkoway, 2011;Delgado, 2015;Golden, 2019;Gómez & Castañeda, 2019;MacDonald et al, 2011;Strack et al, 2004) Program logistics…”

A scoping review of recommendations in the English language on conducting research with trauma-exposed populations since publication of the Belmont report; thematic review of existing recommendations on research with trauma-exposed populations

“…Articles on methodology concerned sampling and data collection [153][154][155][156], a need to use consistent measures and not conflate different constructs [123,127,128], a need to see participants as potentially being both survivors and perpetrators of violence [122], and the nocebo effect in trauma research [119]. Researchers offered recommendations on improving internal research validity when potential control group members with trauma do not identify themselves as having trauma [31,121], and many recommended using participatory research methods to conduct better research [132,135,137,138,155]. Gultekin et al (2019) [133] introduced the eco-social trauma intervention model, which may be used across disciplines to develop and pilot trauma-informed interventions, and Tol (2020) [139] described using a social justice framework for research.…”