Health Equity, Diversity, and Inclusion: Fundamental Considerations for Improving Patient Care

The COVID-19 pandemic has radically altered the health-care landscape, particularly regarding populations most affected by health disparities and inequities. Stretched resources, lockdowns, and overwhelmed facilities forced many to delay or even forgo care for chronic health conditions, while many preventive and diagnostic services were suspended. In this unprecedented context, it often fell to nurses or other healthcare providers to devise new ways of addressing patient care and attending to the needs of the most vulnerable. In doing so, the voices of patients and their capacity to identify and describe their experiences and needs became more pronounced than ever before. Foregrounding these voices, capturing and disseminating the knowledge gained, requires thoughtful and creative attention to both factors previously known to contribute to health inequities, and new contextual factors that can increase risk for health inequities. Diversity of thought, population, and indeed methodology is necessary to develop high-quality interventions for patients and families. Culturally appropriate and effective interventions cannot be developed without a deep understanding of the lived experiences of those affected. Reducing barriers to care and advocating for the needs of underserved groups is a critical function of nursing, in both research and practice. As the Editors of an international journal, we are extremely conscious of the differences across contexts and need to replicate clinical research across populations, with a variety of methodological approaches, to identify and respond to otherwise overlooked issues of diversity, equity, and inclusion. As an example, a recent study identified decreases in age-adjusted cardiovascular mortality among Black and White U.S. adults but noted that the former continue to experience higher overall mortality—suggesting that racial inequities continue to influence cardiovascular health (Kylawazi et al., 2022). Without the direct input of patients affected by such issues, it is impossible to provide holistic care—attending to both individual and synergistic factors— for those most at risk. Though not explicitly stated as such, issues related to health disparities can often be found in the limitations section of research papers. For example, authors may note loss to follow up because of lack of transportation, that some groups were not able to engage with data collection technologies, or that few members of a certain population volunteered to participate. While these statements are important, we suggest they are also missed opportunities to address inequities across economic, racial, gender, and ability domains in research design, methodology, and implementation. This issue of Clinical Nursing Research seeks to explore some of the ways researchers can amplify patient voices and experiences in the receipt of care, through diversity of inquiry, study population, and method. In a concept analysis of HIV-related psychological distress, Ma et al. (2023) particularly consider this experience within the constellation of HIV-related symptoms, concerns, and medication side effects; they account for the ways in which these also interact with HIV-related stigma. The analysis by Ma et al. (2023) powerfully demonstrates how HIV is not a singular illness in a singular population, but an experiential and in fact existential condition, factoring into both health inequities and patient functioning on a daily basis. Similarly, a study of the predictive ability of routine laboratory parameters to discriminate patients with fibromyalgia from healthy subjects reflects the disparate impact of fibromyalgia on women, identifying specific endocrinologic markers that can help to identify those affected diagnostically more rapidly—a process which can take up to 5 years otherwise (Russ et al., 2023). This is an important consideration, given that not only is fibromyalgia notoriously difficult to diagnose, but because it most often affects women it 1143230 CNRXXX10.1177/10547738221143230Clinical Nursing ResearchBurton and Pinto editorial2022