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Hello and welcome to Questions You Didn't Ask.
I'm Nyesha Frey. CEO of Nyasha Frey Consulting,
LLC, and your host of this show. I'm really glad
you're here because today we're kicking off a
very special series, Doing It For Ourselves,
Black Women, Salons, and the Science of Health
Equity. Let me tell you why this series matters
to me and why I think it matters to you. My career
started in HIV research at the University of
North Carolina at Chapel Hill School of Nursing.
When I saw the chance to join the team at the
Heat Lab at Duke University School of Nursing,
working on the Updose Protective Style Study,
also known as using PrEP, doing it for ourselves,
it felt like a full circle moment. At Naisha
Frey Consulting, we build community -informed
solutions to health equity challenges. The Heat
Lab's mission, addressing health disparities
through equity, engagement, advocacy, and trust,
aligns perfectly. They're doing real -world research
in places where people already look for care,
guidance, and trust. Salons and barbershops,
community hubs, the spaces where Black women
and men, and yes, families too, gather. And yes,
some of you might be thinking, wait, HIV? Isn't
that old news? Or we don't hear about HIV like
we used to, especially after COVID. Unfortunately,
HIV is still a thing. And that's why this matters.
Here's what the data show. Black African American
people make up roughly 12 % of the US population,
yet they accounted for 38 % of new HIV diagnoses
in 2022. The US South bears a huge share of this
burden. In 2022, the South accounted for approximately
52%. of all new HIV diagnoses, even though it's
only about 38 % of the population. Among women,
Black women represent about 13 % of U .S. women,
but account for around 50 % of new HIV diagnoses
among women. Prevention is possible. Daily PrEP,
also known as pre -exposure prophylaxis, can
reduce HIV risk by more than 90 % when taken
as prescribed. Yet in many Southern Black communities,
for each new HIV diagnosis among Black people,
there were only about four Black PrEP users.
Now compare that to about 27 White PrEP users
for each new diagnosis among White people. The
comparison is staggering. Four to 27. between
Black and white PrEP users. When you hear these
numbers, you realize the challenge isn't just
science or medicine. It's access, trust, design,
places, people, leadership. And that brings us
back to community health. The mix of programs,
places, policies, and people that make a difference
in a community's well -being. And... Health justice,
the belief that everyone, no matter their zip
code or skin color or income, deserves fair access
to care, resources, and power to shape systems.
We also have to acknowledge the historical backdrop.
For decades, the U .S. healthcare system was
segregated. Hospitals and clinics were designed
to serve white and Black people separately under
laws like the Hill -Burton Act. Broad enforcement
of desegregation only came later via Medicare
and Title VI. That separate and unequal structure
left deep scars. Higher maternal and infant mortality
in Black communities, more chronic disease burden,
less access to research opportunity and leadership
roles, and even higher risk of medical neglect
or error in some settings. And leadership matters.
Very few nurses have research doctorates. Fewer
than 3 % of all registered nurses hold a PhD
or equivalent research degree. And Black nurse
scientists are vastly underrepresented, in part
because only a small number of HBCUs historically
offered PhD nursing programs. Until we expand
and diversify the pipeline, equity remains incomplete.
Now let me introduce two remarkable women who
are leading the charge. Dr. Shanita Randolph
is associate professor at Duke University School
of Nursing and is the founding director and principal
investigator of the HEAT Lab. She is a nurse
scientist, educator, and advocate dedicated to
advancing health equity and social justice. Her
research focuses on culturally responsive, community
-driven interventions to address racial and ethnic
health disparities, especially in Black families
and communities. She has secured competitive
national funding, is widely published, and is
a fellow of the American Academy of Nursing.
With the HEAT Lab, she leads the work of turning
research into trust, engagement, and lasting
partnership. Might I add that Dr. Randolph recently
received tenure at the Duke University School
of Nursing. Congratulations, Dr. Randolph. Dr.
Reagan Johnson is Associate Clinical Professor
and Project Director of LEAP, known as Leading
to Equitable Access to Health Professionals at
Duke University School of Nursing, and co -investigator
in the UPDO study. With nearly 20 years of experience,
she combines clinician, educator, and scholar
roles. Her work focuses on sexual health promotion
in Black communities and innovatively uses space
like salons and barbershops for outreach. Her
scholarship was featured in the New England Journal
of Medicine, and she is a national leader in
equitable HIV prevention. Both of these women
are among the few doctorally trained nurse scientists
at elite universities. who are leading large
-scale community -based research initiatives.
Duke University School of Nursing itself is globally
recognized for innovation, leadership, and research
excellence, making this team uniquely powerful.
Over the next four episodes, we'll dive into
how stylists become health navigators, how salons
become sites for trust and prevention, how prep
becomes accessible, and how Black women become
leaders in their own health story. We'll ask,
how do you build interventions with the community,
not just for them? How do you link real -world
research with lived experience? How do you shift
power so that change is not done to Black women,
but by Black women? So whether you're listening
in your car, on your walk, or sitting in your
favorite salon chair, get ready. Get ready to
engage. Get ready to be inspired. Get ready to
take action. Because this isn't just about asking
questions. It's about changing the system. Together,
let's begin. Now that we have heard your illustrious
bios and my audience is excited to hear more
about the work that you do, I want to start out
with you, Dr. Randolph. You know, this is a question
that I give most of my guests just so that my
audience gets an idea of like, what motivated
you to join us here today and have this conversation?
Well, first of all, thank you for having me.
I think that it was definitely the goals and
your vision for your podcast definitely aligned
with me around, especially around equity and
engaging people in conversations that are real
conversations. Questions that they may think
about, but really don't have the safe space to
have those conversations. So that was it. And
of course, because it's you, Naisha. Thank you
so much, Shanita. I appreciate that. Dr. Reagan
Johnson, tell us a little bit about why did you
say yes when I called and said, would you please
join us in this conversation? Yeah, so like,
thank you again for inviting me and having me
on. It's a pleasure to be here. And like Shanita
said, because you asked, but also I've had the
pleasure of listening to several of your episodes
and seasons. And I just really like how you frame
health equity in a different way, right? What
we traditionally think about health equity and
how you kind of weave in other topics, I think
is really good. Well, thank you so much for that
compliment. One of the reasons why I asked that
question is one, because it helps people, of
course, understand. Well, why did she invite
these people? And why do they even want to talk
to her about these things? But also to encourage
other people that when you have a vision and
you see people that you admire and you want to
engage them in partnership and collaboration,
sometimes it's just a matter of asking the question,
right? And a lot of times you'll be surprised
at the response that you get, even if it's a
no for right now or a no, but I know somebody.
Please lean into these conversations and opportunities
for collaboration. partnership and collective
action. So I've read your bios and share it with
everyone who you are professionally, right? But
I would love for you, and I'll start again with
you, Dr. Shanita Randolph, if you could just
tell us a little bit more about your origin story
and where you come from and what shaped your
journey into nursing and research. Wonderful.
Well, thank you. So I grew up in rural North
Carolina. I like to joke and say that I was born
in Brooklyn, but I grew up in rural North Carolina
with my grandparents. My grandfather was a farmer
and my grandmother's sisters was a nurse and
she had been a nurse for. maybe 40 years before
she retired into nursing. And so I really credit
her and some of her stories around nursing as
to why that was my career choice. And it was
time for me to go off to college. One of my good
friends that I graduated high school with was
also going into nursing at A &T. And so that
sort of led me into that career field. But once
I got into it, Community health really became
my thing. I knew from my community health nursing
instructor that, oh, community health is where
it's at. And I just loved it so much. But at
the time, you had to go to the hospital. It was
a requirement. You had to work in the hospital
a couple of years. And so I did that. But I always
went back to my love and community health. From
there, I went on to get my master's degree in
public health. So it's just those concepts of
public health and engaging the community and
health promotion that has always been my passion.
So I got my master's degree in public health.
My PhD is actually in public health. And through
being a public health nurse in a clinical setting,
I was in family planning and STDs and HIV and
saw a lot of young people. communities of color
that were coming in for STDs and repeatedly,
like for testing, having to tell people, you
know, your HIV test is positive. So it really
gave me this passion to ask the question of what
is really going on here and how can we find solutions
to address these issues, particularly in our
community, in the Black community. And so I've
been doing this work. I've been a nurse for 26,
27 years. I've been in academia since 2004 and
been in research, particularly at Duke. I've
been at Duke since 2015, but that's sort of my
journey of nursing research and why HIV. Yeah.
Yeah. Well, I mean, it's interesting how so much
of where we grow up and who we grow up with,
you know, makes such a difference in terms of
where we find ourselves in our professional careers.
and how that motivates us into excellence, right?
Because you have not just been your average nurse,
you have not just been your average researcher.
And that I think is, and in my experience working
with you, is what sets you apart because you're
so committed to and reflect back to your connection
to and stay connected to your community and what
their true experiences are. And I just admire
that so much. Dr. Reagan Johnson, I could say
some of the same things about you, but I would
love for my audience to learn more about your
origin story and how you came from where you
started and how you landed in nursing and then
eventually into research. Yeah, so I'm from Memphis,
Tennessee. And when I was young, my great grandfather
had a... He couldn't use his arm. I've told this
story before, but he couldn't use his arm and
found out that it was because he did yard work
or something and a tree fell on his arm and the
hospital would not treat him. And so he never
said, right. So he never had full use of that
arm. And then my mom was like, I was born and
I was born in the late seventies. I ain't gonna
tell you this. And I was born in a clinic because
the hospital turned her away. So I was going
to always do something in health care and health
equity, right? So I thought I was going to be
a doctor, go to college, the Tennessee State
University, and pre -med didn't work out. But
I had a great advisor who shifted me to nursing
and was like, you can do all of the things that
you think you want to do as an MD. You can do
it as a nurse and probably have a bigger impact.
So that's what I did. That's wonderful. I mean,
a lot of people don't consider nursing in the
same light as getting an MD or medicine, right?
But we know better, right? And I'm so glad that
your advisor encouraged you. I mean, your story
is so amazing because a lot of people of our
generation, Reagan, because I was born in that
same part of the 70s, we don't think about our
parents being turned away from health care. And
what that immediately makes me think about is
maternal health equity, having to give birth
at a clinic as opposed to a hospital. And then
also it kind of makes me think about how things
have shifted so much where more women, Black
women in particular, are giving birth at home
with doulas, midwives, nurses, things like that.
So things have changed so much. And it also makes
me think about how impactful and important our
advisors are, our mentors are, our young folks,
making sure that, you know, we don't take no
for an answer, right? And we get to where we're
trying to go. Despite what the circumstances
might be, there's more than one way to get to
your goal. Yes. So, and I know that both of you
mentor young researchers, you mentor graduate
students, things like that. Can you tell our
audience a little bit about what that's like
in this phase of your professional life? You
know, giving back to students that are searching
for ways to make an impact. Yeah, it is by far
such a deep passion for me. So much we have,
along with three other colleagues, we created
a program actually to address it. You know, I'm
a Ph .D. prepared nurse and they're less than
one to two percent. who are Black, who have PhDs
focused around research and nursing. And so we
have co -created Black PhD nurse scientists where
we're trying to bring awareness to the role of
the nurse scientist. We do HBCU tours. When we
look at the historically Black colleges and universities,
there are about three, only three that actually
have PhD programs. And so as we're trying to
address equity, we recognize the significance
of You know, making sure that we are in that
space, too, as leaders to be able to address
equity based on our lived experiences. Right.
And the contribution that we have to that. And
so I am so passionate about mentoring the next
generation. I think so deeply because I know
the people that that were there for me and the
impact we had in my life. And I also know what
it feels like to have no one there. Some of my
experiences that I have experienced, particularly
in higher education, I don't want anyone to have
to go through and have to try to just figure
it out on their own. I want to be able to share
experiences with them, make sure that they have
the tools to be successful. in their career trajectory.
So I am extremely passionate and I'll stop because
I can talk about that. Love, love, love mentoring
the next generation of nurses and nurse scientists.
Well, I want to say thank you for being there
for our next generation of nurses and nurse scientists.
And Dr. Reagan, I know that this is not new for
you either. This is something that you... do
with a full heart. Can you tell our audience
a little bit more about what that's like for
you? Yeah, kind of the same. So my advisor, I
went to an HBCU and I love HBCUs because you
get that foundational. confidence and competence
that you need to go to the next level. So anyway,
my same advisor who kind of pushed me into nursing
also pushed me further in saying like, you can
be a nurse practitioner, you can do this. And
she's like, I know people and I'm going to read
about you one day. And that's what she told me.
And so by the time I got to grad school at a
PWI and the language coming back to me was a
lot different. I had this foundation of who I
was because I believed my advisor, who my advisor
said I was. So my heart really for mentorship
and being able to pour into people in a real
way, you know what I mean? To be really someone's
champion, like Shanita said, somebody's cheerleader
and encourager so that they can go on. So we
have a program to leap is for current RN students
at HBCUs to consider graduate level nursing.
So to think more about being a nurse practitioner
or being a doctor of nursing practice. So these
are the things that we want to encourage through
our mentorship as well. And can I just say that
I think the theme in this is, you know, as Reagan
was saying, she went to an HBCU, I went to an
HBCU. I went to an HBCU. There's an undeniable
role that HBCUs play that contributes largely
to this society. And I think bringing voice to
that and acknowledging that is so important.
And it's a culture. Right. It's something that
if you haven't experienced it, you really can't
really define it. But it's so funny because we
have a postdoc who has recently joined us and
we were meeting and she was talking about the
heat lab. And that's our research lab that Dr.
Reagan Johnson and I have at Duke. And she said
to me, she came from a PWI, graduated with her
Ph .D. And her words were. I have so enjoyed
being with you all at the Heat Lab. It's almost
like I'm getting the HBCU experience that I have.
I love it. I said, now, wait a minute. I had
to sit with that for a minute because I was like,
I think that was a compliment. It is. Yeah, because
it feels like home. It feels like home. Even
though we're getting work done with excellence,
right? High excellence. So she feels like in
the heat lab, she's getting the HBCU experience
that she hadn't felt before at a PWI. So I was
like, okay, I love it. I'm here for it. If you're
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I'm so glad you did, because, you know, one of
the many things that I learned from being at
FAMU is wherever you go, there you are. Right.
And so we bring Shanita, your leadership, Reagan,
your leadership tells us, bring your whole self.
Right. And so that's the thing that we got from
being at an HBCU is that our whole self was valued,
nurtured. educated challenged celebrated right
and reprimanded when needed right okay Because
don't have one of your professors have to pull
you aside. You're going to feel like you're at
home with mama now, okay? You're going to feel
like you're at home with mama now. So, you know,
I think that it's interesting because one of
the things about me, you all know I come from
a psychology and public health background. And
even though we have a lot in common in terms
of our academic and professional research experiences.
I came to understand what public health was later
in my career. I came to understand what a nurse
scientist was later in my career. And I feel
like because this is questions you didn't ask,
I would love for you to share with our audience
what your definition of being a nurse scientist
is. So they are definitely scholars who use the
science literature evidence to ask a question
and to solve that question. That's pretty much
in layman's terms. But it's based on methodology,
it's based on the science of things, the evidence,
building upon evidence that may exist, asking
a question, developing interventions. Like for
us, we are looking at Black women in HIV and
recognizing that there's a gap in the literature,
there's a gap in practice. And so the question
becomes, how do we implement something that is
socially and culturally relevant to be able to
address this problem. And so through research,
you're gathering that data and that information
to be able to develop and create solutions and
particularly adding to the discipline of nursing.
So as nurse scientists, you also collaborate
with other disciplines in doing that. So that's
the short answer. short answer, but having critical
questions and creating solutions, not only for
practice, but also for policy change. Yeah. And
it's interesting too, because Shanita, you come
at being a nurse scientist from the perspective
of a person that, as you mentioned, is trained
as a PhD. And that is different than Reagan,
your training, which is a doctor and nurse practitioner.
Am I saying that right? Doctor of Nursing Practice.
Yes, thank you for correcting me. Tell us a little
bit more about what that is and what it means
in both clinical practice and research. Yeah,
so the DMP was brought about to be the practice
doctorate, right? It's a compliment, the PhD,
the nurse scientist, and hopefully to be able
to translate what's happening in research into
the clinical space, right? That's kind of...
how it started. It's expanded over time to include
quality improvement. So can you identify a practice
problem, a practice gap, something that's happening
in the clinic that needs to be addressed and
improved? For instance, in nursing or in medicine,
people get a really short education, right? And
then they're out in practice. And maybe you don't
get everything. Maybe you don't know about menopause.
Yeah, I know I'm real big on menopause, right?
But you don't get a lot of that in your training.
So a nurse practitioner or a DNP could go in
and educate providers on improving care of people
going through mental health. Got you. Got you.
So, you know, I think that one of the things
that I'm reflecting on, too, in terms of my academic
walk is that, you know, a lot of folks would
say to me. If you want to do research, there's
lots of different avenues that you can take to
do research, right? If you want to be a practitioner
now, that is a lot more specific. But some of
what I'm hearing, especially from you, Dr. Randolph,
is that when you get your PhD, right, and you
have a nursing background, you can combine those
things. to inform the types of questions that
you're going to ask. And that's what I get from
you as well, Reagan. But it seems like the DNP,
the Doctor of Nursing Practice, I think I got
it, is a lot more related to exactly what it
says, how you practice nursing care in a clinical
environment. And so the PhD is a little bit broader.
The DNP is a little bit more specific. But what
makes the heat lab so... interesting is that
you combine the two as co -directors for the
Heat Lab. Can you tell my audience a little bit
more about how that came about? What was the
process and the strategy or even motivation for
why that came about? And I'll start with you,
Reagan, and just give you a chance to share what
your insights are, just to switch it up a little
bit. I can't describe in words how great it's
been to be able to partner and work with Shanita
and learn from her and her work that she's doing
and was already doing by the time I got there.
She was already on this trajectory. And then
I started working at the same place and we both
had an interest in HIV prevention. We both had
an interest in barbershops and beauty salons
as kind of places to deliver. information and
health information and so in that way we were
kind of put together a little bit by someone
at the organization who thought we'd be you know
should have lunch and we did and then i think
our spirits also kind of aligned and we had a
similar heart and so the magic was born i love
it And Shanita, I imagine that your recollection
of how this came together is very similar. Are
there any other things that you'd like to share
with our audience, even about, you know, how
to innovate in this space through partnership,
right? Through cross -discipline collaboration.
Why is that important even? Yeah, the PhD -DNP
partnership and collaboration is probably one
of the most. powerful partnerships that can exist
in nursing. I think we have opportunities to
be a little bit more intentional about that.
As Reagan shared, you know, I think the stars
just aligned. There were multiple, multiple things,
but we have been a dynamic duo. And I say that
unapologetically. You know, when you think about
research in general, it can take up to 17 years.
for research to actually translate, like the
process that we go through in identifying problems,
finding solutions. I got to do a pilot study.
Now I got to do a pilot study on the pilot study.
Then I got to do one more pilot study for the
pilot of the pilot. You know, it's just, it can
take. Forever. And so when you think about the
DNP, there's that piece of translating this back
into the clinical space. You think about the
fact that we do community engagement. The questions
that we ask, I think, are different. Some of
our approaches are different and they balance
each other out to not sort of delay it as much
as it typically is delayed. So this collaboration
has been a very powerful partnership in that.
And Naisha, you asked me something else, honey.
Child, I will throw 10 questions at you at once.
My audience knows that. I got to get better about
that. But I think that you answered the essence
of it, you know, in terms of how you balance
each other out, how having the PhD and the DNP
helps to translate the research faster into practice,
right? Because what we know about any type of
health equity research or efforts at all is that
we need it now, right? We need it. yesterday.
We need it tomorrow. And so just that alone is
a major, major benefit to not just the research
aspect, but to the community. And I think that
that's something that's really important. Yeah.
And I think the other thing is that in everything
that we do, like my focus may be on community
and the women, right? And so we have this nurse
-led model of care that thinks about the community.
the clinical piece as well, right? And so Reagan
has that lens of what is happening right now
in clinical practice that's going to impact this
community, right? What's happening right now
with providers that's also going to impact this
because oftentimes we try to create things in
this silo, right? Not realizing that there's
a lived experience. There are really social determinants
of health that impact. So I can create something.
an intervention in the community, but that woman
still has to go see her doctor, right? How do
all of these things integrate? And I think that's
the piece that I love about a PhD -DNP collab
is that you're able to see it through the lenses
of a real world experiences for the populations
that you're working with. It's just amazing.
Contact us for the blueprint, okay? I'm giving
us all of our things. Nobody's going to give
it to us. I'm going to give it to us. We have
done this. Okay. I love it. Reagan, anything
you want to add to this dynamic duo description,
so to speak? Yeah, no, I think it's perfect.
I do feel like we've been the blueprint. we've
shown a successful template for how it can work
and thinking about research practice and then
also we've tied in education too like how do
we prepare the next generation of nurses and
nurse practitioners to be able to do what we're
doing specifically but also to be able to think
about how you address practice in a way that
you come up with your own questions that solves
tomorrow's problem that was Questions You Didn't
Ask, hosted by me, Nyesha Frey. Thanks for joining
us for Doing It For Ourselves, Black Women, Salons,
and the Science of Health Equity. If this episode
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