Research in Gerontological Nursing
Response to the Annual Review: Synthesizing Best Practices to Promote Health Equity for Older Adults Through Community Engaged Research: Bringing Gerontology Research into its Community Era
Jackson JD.
Introduction
As with any discipline within academic medicine, the goalposts for achieving health equity are constantly evolving. Early calls for community-engaged research (CEnR) hailed the sharing of research findings with the public as an aspirational goal of CEnR; later, community advisory boards (CABs) focused on local, marginalized communities became state-of-the-art. Epps et al. (2023) elegantly demonstrate the continued evolution of best practices in health equity through focus on two key elements of CEnR: (a) relationship-centered approaches to research, rather than traditional transaction-based recruitment methods; and (b) an incorporation of best practices that recognize diversity within diverse communities, moving beyond the categorization of minoritized individuals into monoliths without distinction or variance. These key elements allow for a truly scientific design of community-engaged processes and research adaptations that maximize partnerships between researchers and community members.
Epps et al.'s (2023) focus on nuanced, omnidirectional, sustainable partnerships comes at a critical time in aging research, as researchers embrace methods that require reaching marginalized populations at levels never before considered. The advent of representative sampling in longitudinal cohort studies, lifespan designs, and disease-specific research registries targeting registrants at preclinical stages means that cutting-edge aging researchers must not only succeed at embracing equity, but that this must happen at scale. The astonishing breadth of our work requires full and reciprocal collaboration with, and requires empowerment of, partners not otherwise affiliated with our ivory towers. Epps et al. (2023) powerfully demonstrate that invitation of longstanding expertise outside our campuses is at last a necessity to achieve the now-expected goals of gerontological research that generalizes beyond the unusually privileged.
A frequent critique of CEnR approaches is that they are often underspecified and tend to resist generalization beyond highly tailored settings. Epps et al. (2023) neatly address this concern by providing three thoughtful research exemplars across several communities that are perhaps only unified in their collective absence from traditional aging research settings. Although specific challenges and solutions varied across contexts, the authors repeatedly noted that focusing on resilience tended to be more effective in building trust, engagement, and recruitment, rather than the colonial, deficit, or savior mindsets that dominate community-engagement approaches today (Wallerstein et al., 2019). Moreover, the highlighted exemplars together showcase the need for CEnR success outcomes beyond study accrual and feel-good social optics. Researchers, in partnering closely with local communities, must prioritize a spectrum of needs beyond our own scientific gaze. Indeed, is that not what exemplifies successful communities in the first place?
In taking our seat alongside community partners, we may glimpse another predictor of successful CEnR: the extent to which our academic departments and institutions create infrastructure for an evolving discipline of CEnR, just as departments and institutions provide for every other cutting-edge area of scientific inquiry. Centralizing resources for CEnR lifts burdens from individual participants and individual research teams to support robust system-wide community engagement. When institutions implement formal partnerships with community-based organizations, integrations within electronic medical records, communication campaigns, and dissemination platforms, all of which are highlighted in Epps et al. (2023), CEnR success at macro-, meso-, and micro-scales becomes far more likely, irrespective of which marginalized communities serve as collaborative partners.
The often-unspoken advantage that robust community engagement provides, in addition to equity improvements, is improvements to scientific rigor more broadly. Or rather, it may be said that the only rigorous science is an equity-focused science. Current approaches in gerontological research face challenges to rigor in selection and measurement (Mayeda et al., 2018; Weuve et al., 2015). CEnR brings with it a bevy of considerations and metrics for better selection, measurement, adaptation, and implementation of scientific approaches. It is incumbent on gerontology researchers everywhere to embrace equity as a driver of scientific innovation (Gilmore-Bykovskyi et al., 2022). With clear and compelling examples, such as those outlined in Epps et al. (2023), the goalposts of equity have moved beyond minimal approaches to CEnR, such as token CABs or sharing results with communities years after data have been published. For the sake of rigorous science, for the sake of vigorous communities, we must strive to keep pace.
