DUSON’s Systemic Racism Research Aims to Improve Students’ Mental Health
When high school students are exposed to systemic racism, it can have a crushing effect on their mental health. That’s why it’s so critical for the next generation of nurses to be able to evaluate multilevel interventions to help students who are suffering. That’s the focus of a new research paper authored by eight Duke University School of Nursing professors.
The paper, entitled “A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools,” was published in the Prevention Science journal in January.
“This was a truly collaborative project,” said co-author Marta Mulawa, PhD, MHS, an assistant professor of Nursing and Global Health at DUSON. “This paper was really unique in that it focused on study design and analytic methods but required us to identify a multilevel intervention that could be proposed to address structural racism and reduce health disparities.”
The National Institutes of Health’s Office of Disease Prevention put out a call for papers on design and analytic methods to evaluate multilevel interventions to reduce health disparities. In response, DUSON Vice Dean for Research Sharron Docherty convened a group of faculty at the school to discuss potential ideas.
Along with Docherty and Mulawa, the team included:
- Wei Pan, associate professor and senior author
- Chip Bailey, associate professor
- Rosa Gonzalez-Guarda, associate professor
- Isaac Lipkus, professor
- Schenita Randolph, associate professor
- Qing Yang, associate research professor
Using a hypothetical, theory-based intervention, the team examined how to rigorously evaluate a multilevel intervention promoting mental health equity in three U.S. school systems using an anti-racist approach at the macro- (school system), meso- (school), and micro- (family and student) levels to improve students’ mental health.
“This was a truly collaborative project. This paper was really unique in that it focused on study design and analytic methods but required us to identify a multilevel intervention that could be proposed to address structural racism and reduce health disparities.”
Co-Author Marta Mulawa
PhD, MHS
Researchers have typically had limited methodological guidance on how to design studies that test multilevel interventions in ways that balance rigor, practicality, and acceptability, especially within communities most affected by systemic racism. The team at DUSON wanted to improve that.
“Multilevel interventions are needed to overcome some of our biggest societal challenges, like systemic racism within schools, but they are tricky to evaluate,” Mulawa said. “By their very nature, multilevel interventions include components operating at different levels, like within schools and families, and these components often interact with each other.” Mulawa noted that standard study designs tend to test multilevel interventions as a package and do not allow researchers to understand synergies between these components.
The DUSON faculty used a health equity lens to propose a study design and corresponding analytic methods that enable a more nuanced understanding of the potential synergy occurring between intervention components of a multilevel intervention promoting mental health in school system using an anti-racist approach.
“This was a great example of why interdisciplinary teams are so critical to reducing health disparities,” Mulawa said. “We drew on our various strengths to develop a theory-informed intervention that could be feasibly implemented within school systems and a corresponding study design that balanced rigor with anticipated constraints of this type of work.”
Systemic racism is a social determinant of health that is prevalent in the U.S. and is an area that DUSON leaders have committed to researching. It’s part of a larger effort at the school to focus on the core values of health equity, social justice, diversity and inclusiveness.
“Our goal was to provide guidance for how the next generation of nurses can evaluate multilevel interventions,” Mulawa said. “We want them to be able to design studies so they can answer critical questions about how best to implement multilevel intervention to reduce health.”
A new research paper authored by eight DUSON professors focuses on evaluating multilevel interventions to reduce mental health inequities due to systemic racism.