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Welcome back to Questions You Didn't Ask. I'm
Nyisha Frey. Today, I'm joined by Dr. Shanita
Randolph and Dr. Reagan Johnson from Duke University
School of Nursing. Together, we're diving into
how stylists and community spaces are changing
the story of HIV prevention. This is Doing It
For Ourselves. Let's get into it. One thing that
I have appreciated, you know, watching and listening
to you, Reagan, is how you will point out the
reality of what it's like to actually be a practitioner,
right? Whether that has to do with time, whether
it has to do with policy, whether that has to
do with patient engagement, right? In terms of
conversations and communication, like what's
realistically going to happen when this thing
gets implemented, right? And so, and research.
You know, one of the things that I love about
it is that it's so creative. You can be so creative.
Right. And sometimes we have, you know, research
that is so creative and so innovative and so,
you know, unique that it doesn't fit. It doesn't
fit in real life. It's a great idea. And if you
were able to replicate those conditions in every
community, then that would be awesome. But that
might not actually be our live reality. And I
see you pulling that into the conversation oftentimes.
Exactly. Because you have to think about, can
it be realistically done? And then also, can
it be realistically sustained? Because anybody
will take your $25 gift card or your $50 gift
card and do it for the six weeks or the six months
of a program or a project. But can it become
a part of your daily practice? That's the question.
And so you have to design these things that It
translates to the provider. Are they willing
to do it? Is this something that, forget time,
will they even do it, period? And then for the
end user, the patient, does the patient want
it? That part. And how do they want it? And how
does that align with the research that these
great innovations and interventions, is this
something that the patient wants in this way?
Yeah. And I do think that that's an important
point to make in regard to what makes this dynamic
duo so special and what makes this heat lab so
effective. We've talked a lot about research.
We've talked a lot about practice. And Shanita,
you picked up on one of the limitations of research,
which is that it oftentimes takes so long to
translate, right? You said 17 years. I mean,
there's some marriages that don't last that long,
right? So, you know, you want to talk about commitment.
Even with the power of research, the creativity
of research, what are some of the other limitations
of academic approaches to advancing health equity
that you have seen in your work? So many. The
community, particularly, and I'm speaking from
the lens of community engaged research, because
that's what we do in the HEAT Lab, right? We
want to address these issues through equity,
engagement, advocacy, and trust. If there is
a problem, I'll give example on gun violence.
The community, their thought is boots on the
ground. Let's fix this problem. Like let's address
it. They're mobilizing grassroots efforts, making
things happen, right? And being creative, being
innovative in that space right now. It doesn't
align with academia. Right. And so we got to
write papers about it. We got to prove that we
we're worthy of it. We got to go to conferences,
national and international. Again, the pilot
of the pilot. So I think that is a limitation
in some of our structures and our systems, even
from our regulatory, from our institutional review
boards. You know, we have to make sure that things
are done ethically. morally right. And although
that is good, I think what we have done is created
systems, though, that are making it more challenging.
We made our good be evil spoken of, you know,
even when it comes to engaging, you know, the
community. And maybe if we're giving compensations,
like we need their social security number, right?
You're asking immigrants or you're asking communities
of color to give their social security number
for participating in the research project. I'll
pause. There's already a trust issue, right?
I give my social security number to no one. So
one thing we do in the heat lab is there are
opportunities to waive that for certain amounts.
And so we have. found some ways to bypass that.
But it's things like that I think that are in
our systems and in the structure on the academic
side that we have good intentions on regulatory,
but our good intentions have also caused a lot
of barriers and limitations. I think the other
limitation is how we disseminate that information
back to the community. And, you know, community
saying that, you know, I've been a part of this
research, but I never heard what happened. Like,
so how do you close that loop and make sure that
the research that people are participating, that
they know what's next? And we are very intentional
about doing that in the heat lab. But that becomes
a limitation because the next study, the person
doesn't really they don't see what are you doing?
How is this really impacting my day to day? And
I think that there are more strategies that we
need to have to stop some of those limitations.
Funding sources bring limits. You know, like
you can pay for this, but you can't do that.
Yeah, it's even for community engagement. Like
if you get federally funded, you can't use any
of that money on like a venue space. You can't
use it on food. For the community, you need to
feed them. Yeah. So the limitations go on and
on and on and on and on. I've had quite a few,
but we are working around them. But yeah, a lot
can be done. Right. And Reagan, you know, from
your perspective, you know, looking at it as
a doctor of nursing practice, how would you say
these limitations affect practice and health
outcomes? Like with academic research. Yeah,
because like you said, it's a 17 -year gap, right?
At least a 17 -year gap. Well, medicine changes
like almost weekly. So in 17 years, whatever
you came up with then, no matter, no more, because
we're doing something different now, it's outdated.
A lot of it never even gets there. By the time
it gets there, it's outdated, right? And so that
has huge implications for health outcomes because
patients are dealing with outdated ideas. Look
at AI, for instance. We're seeing a huge shift
to AI. And as Shanita said, the community is
already using AI, looking up their own, diagnosing
themselves with AI. And healthcare is behind
the game on it. 50 % of the people are resistant
to using it. The other 50 % don't know how to
use it, even if they wanted to. So this stopgap.
between what we think, even what we think we
need or what could be created and the time it
takes to get there. So I think what we're doing
helps that because we're shortening that time
tremendously. So if we write a paper for an academic
journal, we're also trying to write one for a
practice journal so that practice folks can see
it in real time because their practice people
aren't reading as much research journals. You
know, they're going to read stuff about practice.
If we put out something, we want to put it out
for research, practice and the community. So
this three pronged approach. Right. And so you're
turning yourselves into little octopi, if I'm
saying that correctly. But, you know, the point
is, is that that's one of the reasons why you
have a lab. Right. You have multiple people working
collectively with shared values and unique expertise
to help drive that work forward in an effective
fashion. And so when we think about that, you
know, we kind of talked around health equity.
Like, I think my audience knows what health equity
is because, you know, I talk about it in every
single episode. But if you could share with my
audience a little bit more about, you know, how
does it show up in your day -to -day work? What
is health equity to you and how does it show
up in your work, you know, when you're doing
research or teaching even? So health equity for
me is the basis from which I operate. Right.
So if I'm going to be delivering health care,
then I need to do it in a way that that is true
to myself and my moral compass. So I say I am
a North Star and that's health equity and that's
to treat everybody in the way that they need.
Right. Oftentimes we think equity means equality,
that everybody gets the same treatment and that's
not equitable. And some people move forward into
health justice. Right. Ensuring that everybody
gets the very specific thing that they need in
order to reach the place that they need to be.
And I think that's where we should be moving.
I think that requires a lot of, like Shanita
said, policy and audit. We may not be there yet,
but what we can do individually. is ensure that
we're operating from this idea that we use this
framework, five W's of health equity and research
of these principles that ask these questions
of what does this mean for the community? Who's
involved? Where are you doing this research?
I can't think of the other W's right now, but
there's this foundation that we operate from
to say we can check ourselves, really. To say,
okay, what are we missing? Who's not at the table?
And how do we correct it in real time? And just
to help our audience and fill in the gaps before
I move over to Shanita is, you know, exactly
what you're saying. Just kind of checking ourselves,
right? Checking in with ourselves from our values,
right? And being consistent in terms of looking
at the patient that you serve and thinking about.
If I'm making a decision or I'm having a practice,
I got to think about who is impacted by these
decisions, what values and resources are prioritized,
what are activities, where are activities, and
why are they being conducted? And so those kind
of, I just did a quick search and was able to
fill in that gap of what the five W's of health
equity are. And I just encourage everybody to
look that up and get some more information about.
Who benefits? Who is at the table? Who experiences
the negative impacts of inequities? And what
values or resources or access opportunities are
being prioritized or neglected? When are research
activities held? And does this create barriers
for certain groups? When do the issues being
addressed by the research occur in a person's
life? Where are activities taking place? And
the list goes on. So I'm not going to read them
all. I encourage everyone else to lean in. But
I do want to turn to... to Shanita and ask a
similar question of how does health equity show
up in your day -to -day efforts? And I thank
you, Reagan, for bringing up the five W's. Yeah.
You know, touching back on what Reagan said,
right? Like I have this leadership framework
of leading from the inside out, right? You're
going to lead based on your values. When you
think about health equity, what is it? It's giving
people what they need to live healthy and to
reach their full potential. Health equity isn't
what I do. Health equity is who I am. As a leader,
that's my belief, even in leading students or
being a leader for a research project, is giving
people the full potential. You know, given what
they need to have that full potential to be healthy.
And I think that one thing that we can do in
this space is when we think about health equity
is taking an opportunity to reflect inwardly
and to add five W's, which, you know, we contribute
that to Keisha Bentley Edwards and Nadine Barrett.
They were two creators of the five W's and they
co -authored that manuscript that your audience
may take a look at. But how do we do that? And
what is our why? Right. Because if you can truly
reflect on that in times like these that we are
experiencing and have been experiencing since
January of this year, you're not easily shaken.
You know, and I think that is a call to action
for anyone that's doing health equity work. ask
ourselves this question that you're asking us,
like, how does this show up in our day -to -day
efforts? And it shows up internally in everything
that, that I aim to do. And so therefore it's
easy for it to show up when we're doing a research
project to ask the community, what do you think
about this and how do we need to shift this?
And then actually do what they say, right? And
actually do it. You know, there are pieces. Our
project that has shifted, have changed in the
middle of things because the community, our advisory
council members, women have told us, no, that's
not going to work out here in these streets.
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let's keep the conversation going. Right. So,
you know, I'm going to, you know, we talked about,
you know, academia, the limitations and things
like that. And we also talked about, you know,
translating to community. And one thing that
we know is that, you know, it takes money to
do research and it takes money to create systems
change. Right. So. We know the times that we're
in right now, it's, you know, health equity,
diversity, equity, inclusion have turned into
target words, right? Words that have been targeted
by our current 47th Executive Federal Administration
to dissuade people from going down this path,
right? It's also, though, this conundrum of health
equity is, at least for my audience, is seen
as a moral thing. You know, you guys have talked
about how it's a moral issue, but it's also economic.
And you mentioned Dr. Keisha Bentley Edwards.
She is talking about the connection between health
equity and economic justice on one of my previous
series. And so how do you communicate the value
of equity to funders and institutions? Or does
it shape who you go to for funding and institutions?
Yeah, I think it's both. You know, in moving
forward, I think that's one of the things that
I've been thinking about personally and professionally
with the Heat Lab is bringing on a business collaborator.
I think a lot of what we do in this space. has
lots of limits because of the lenses in which
we have been educated on how to address these
issues, right? And so partnering and collaborating
with business and entrepreneurs, I think, is
key. You know, understanding the communicating,
I think, with funders. Like, for example, you
know, where we are now, and even in this project,
we've had people to ask us, why are you just
focusing on Black women? Not only Black women.
There's an economic piece to that, right? So
if we can fix some of the barriers and the gaps
for what is known and has been known for populations
who have the worst outcomes, what we are doing
is that is a standard that we're fixing. But
we're also, by fixing that, we're fixing it for
everybody. Right? And so we're saving money.
So if you can address the people and populations
within a system that have the worst outcomes,
you are fixing the worst things about that organization
or about that system. And whenever you do that,
you're saving that system money. You're creating
better outcomes for everyone who comes across
that system. So I know for me, I'm wanting to
increase and show the dynamics of what that looks
like from a financial perspective. Yeah. Reagan,
do you have any thoughts on that in terms of
the economic translation of health equity research
and how it plays into funding and things like
that? Yeah, I think for this, you've already
mentioned this current administration and the
cuts that have been made to government funding
for health equity research or the buzzwords of
DEI and all of that. I think what's interesting
is. academia itself prioritized this government
funding, right? You weren't really, you were
a better researcher if you get these high -level
grants from the government, right? But now that
everybody's scrambling to get funding, economic
equity, and we're looking outside of those, and
there's always been foundation grants and that
kind of thing. typically aligned. I think now's
an opportunity for us to look to organizations,
large organizations and places who've not traditionally
been stewards in that way. And how can they take
some of their philanthropy dollars and open up
grant funding? So the NBA, the NBA, how can they
get into funding grants for Really, their base.
These are predominantly black leagues. We have
to prioritize health and maybe they have a specific
way that they want to fund certain health projects.
But can we be looking at all of these other businesses,
like Shanita said, these large organizations
that could be given money and really funding
this work? And I'll just add, you know, the heat
lab, we have industry. private, public, and foundation
funding, and also through philanthropy, through
our work with the PhD nurse scientist program.
But the other piece, too, just sort of to add
to that is this is an opportunity for us also
to redefine in higher education what impact looks
like and how we create that impact, because we
have created a structure that says to us as scientists
in higher institutions, That to be successful,
you have to have federal funding from the NIH.
That's what we've said. Right. Or NSF. Right.
Right. And I think what it does is it puts limitations
on our creativity and our innovation as scientists,
because at some point what you are doing then,
if you're not careful, is you start chasing the
academic promotion tenure. Yes. You're not careful
and forget about why you actually went into this
space in the first place. And so I think it's
an opportunity to challenge higher education
to rethink what impact looks like and how people
are measured by success and promotion. Making
sure that what that criteria is, that it truly
aligns with what your mission is. I definitely
get that. And I think that it's really important
to say that, you know, out loud, especially in
the positions that you both hold as faculty at
a top tier research, you know, institution that,
you know, the way in which academia is structured,
that it can create a system. that it incentivizes
people to chase the money as opposed to chase
the mission. Yes. And so we have an opportunity
to shift that. And we've talked a lot about the
Heat Lab, but now I want to lean into it a little
bit more. Shanita, I want you to tell us, what
does HEAT stand for? And what are some of the
standout projects that you all have innovated
in through the Heat Lab? Yes. And so HEAT is
addressing health disparities through engagement,
equity, advocacy, and trust. You might want to
take this out, but AI has caused me to think
that there are other ways. There are other ways
that we can actually make HEAT sound a little
better. I'm thinking about how we can revise
HEAT. But I like it. I like it the way it is.
So let's say it again for the audience with our
full chest. Addressing health disparities through
engagement, equity, advocacy and trust. And a
lot of our work, again, has been partnering with
the beauty industry, barbershops and beauty salons
as trusted spaces in the community. One of the
things that we have done in our beginning days
was addressing sexual health among adolescent
males. and the engagement of their fathers. Partnered
with two barbershops and two barber owners to
co -create The Talk, which is an intervention
that focuses on parent -adolescent sexual health
communications. We have created podcasts, talk
conversation cards, which we are excited about
those and moving forward with those. People are
actually using them now. So these are conversation
cards that... give the opportunity for parents,
adolescents, or for peers of adolescents to just
have conversations around sexual health. And
then our work also focuses on Black women in
HIV. We have co -created with the community using
PrEP, doing it for ourselves, protective styles,
which is updos, which is a three -part intervention
that focuses on bringing awareness and increasing
the uptake of pre -exposure prophylaxis among
Black women who currently are only like 1 % to
2 % of the population who actually use PrEP.
So that's what we've been doing in that space.
We've done a couple of projects focused around
COVID and preferences, barriers, and facilitators
to testing in the Black community. And if we
were to have another major pandemic, how best
do we partner with the Black community to address
those? those things as well. So there's a number
of different topics and partners that you all
have covered through the Heat Lab. I'll turn
to you, Reagan. How do you decide what problems
to tackle? I mean, when I think about the Black
community or health equity, there's so many things
that could be, you know, benefit from this type
of collaborative research lab. But how do you
all decide what problems to tackle? Yeah, that's
a really, really good question. I think for me
and I'll say Shanita as well, we both had very
personal experiences with people living with
HIV that we either knew or were close to in some
type of way. And that kind of guided or gave
me a direction that I initially wanted to go
in. And then you go out into practice or you
go out into the community and you see that. there's
this gap that people don't necessarily understand
that it's an issue or an issue for their community.
And so I think that's been one of the kind of
lampposts that we've used to choose a topic.
I know that Shanita says this all the time that
HIV is where we are right now, but we have an
opportunity to expand that. And once you find
that your method works. Right. Then you can expand
that to other topics that people need. I'll give
you an example. Some of our earlier work, we
asked women, you know, I think that's another
major way, like thinking about what position
you want to make in the world and then asking
the community that you're interested, what they
want. And some of that came back up. Hey, yeah,
we're interested in HIV prevention and sexual
health promotion, but we'd also like that couched.
you know, within other health topics. So we want
to know more about heart disease and we want
to know more about this. And so we've been able
to kind of fortify the project with this other
information. So we're not just solely giving
what we want them to have, but what they're asking
for too. Yeah. And I left out community and firearm
violence. Definitely not one of our priority
things, but. What our theme is, is addressing
health disparities through engagement, equity,
advocacy, and trust, right? And so we did have
a community partner who was a barber and a barbershop
owner who helped to co -develop the talk. And
so he circled back around as the founder of Establishing
Safe Cultures and reached out to the Heat Lab
to partner with them in their efforts to address
gun violence in the community. And so through
Rita and Alex Hillman Foundation, we were funded
to partner with Establishing Safe Cultures to
address some of these issues. And so we've been
working with Establishing Safe Cultures as a
partner for the last year to address firearm
violence. And what that has looked like is really
positioning ESC and partnering with them in such
a way that they can build their infrastructure.
be in positions to be ready for funding to support
the sustainability and helping to inform their
program in terms of some of the gaps in programming
to prove that programming for the community throughout.
And so, again, I think when you ask the question,
how do we, you know, how do we approach this?
That was a great example. I think that it was
definitely through community partnership and
them reaching out. to us for partnership. That
was Questions You Didn't Ask, hosted by Nyesha
Frey with Dr. Shanita Randolph and Dr. Regan
Johnson. If you enjoyed this conversation, tap
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