While a chiropractic student, I traveled with a group of medical providers to a community in Ghana to provide supplies, assist with health screens in remote villages, and work in a local hospital within a variety of departments. During my time there, I interviewed different community members employed by the hospital or by non-governmental organizations working with the hospital about their perceived health burdens and openness to chiropractic. Unexpectedly, interviewees expressed that while they practiced a Western medicine model, there was some uncertainty on how much that body of knowledge applied to them since they felt so underrepresented in the studies that contributed to that knowledge. The patients and study participants described were rarely people that came from similar geography, cultures, and lifestyles or had physical characteristics they identified with.
Naming the Problem
Closer to home, this issue resurfaced in discussions about the abilities of chiropractors to provide culturally competent care for populations that are underserved and have very different experiences than chiropractors were thought to have had. The other parties were not saying that chiropractors could not or should not practice in these settings, but rather they were not able to find published materials that demonstrated this was happening. The available material did not sufficiently support the expansion of these services within an already resource-strained public health system.
Therefore, while we focus on diversity within our profession, it appears we would be well served to also focus on the diversity of the patients and communities we serve and this focus needs to be evidenced in publications and inclusion in research.
This is not a problem unique to chiropractic and many different groups of health professionals are trying to find ways to include research participants that better reflect the population. Previous efforts to increase diversity in NIH-funded studies have brought to light valuable information about disease processes and experiences that would have otherwise been overlooked.1 This led to the authors concluding that increased diversity in clinical and biomedical research is necessary for sound science that yields the best long-term benefit.1
Exploring Solutions
Recruiting populations that have been traditionally underrepresented in research can have added challenges. However, the strategies to mitigate these challenges are often inextricably linked with greater acceptance of the findings by various communities as well as strengthening of the science.2 Community engagement in medical research builds respect in the community-research partnership, allowing the increased relevance and acceptance of the research.2 These community relationships can be further developed to better inform service.2
This likely mirrors what happens as practitioners become embedded in their local communities, but increasing community engagement in research and academic partnerships would provide an avenue to demonstrate this commitment on a larger scale. Through subsequent publications, we would better establish a body of evidence revealing our commitment to patient and community health to those outside of the chiropractic profession such as the greater scientific and health care communities, but most importantly, our patients.
Dr. Madigan is a member of the ACA Commission on Diversity and also serves on the ACA Editorial Review Advisory Board, Clinical Guideline Review Task Force, and the Student ACA Committee. Her current faculty appointment at National University of Health Sciences, her alma mater, allows her to serve as the NUHS-IL SACA advisor. She is also completing her PhD in Public Health at University of Illinois at Chicago.
References
- Oh SS, Galanter J, Thakur N, Pino-Yanes M, Barcelo NE, White MJ, de Bruin DM, Greenblatt RM, Bibbins-Domingo K, Wu AHB, Borrell LN, Gunter C, Powe NR, Burchard EG. Diversity in Clinical and Biomedical Research: A Promise Yet to Be Fulfilled. PLoS Med, 2015; 12(12): e1001918.
- Holzer JK, Ellis L, Merritt MW. Why we need community engagement in medical research. J Investig Med, 2014; 62(6): 851–855.
