Let us Dance Around the World! Toward More Diversity, Equity, and Inclusion in Research

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Mai ChinAPaw Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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Manou Anselma Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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We strongly believe that diversity, equity, and inclusion in research lead to better science, more innovations and more relevant outcomes that better serve society at large. Historically, scientific research is quite WEIRD, meaning that it is dominated by researchers and study samples from Western, Educated, Industrialized, Rich, and Democratic countries. Such WEIRD research leads to results that better serve a small, privileged group of WEIRD people, widening health inequalities. Research among a selective group with similar backgrounds and perspectives results in bias and hinders innovation. As a result, we end up missing out on the valuable holistic viewpoint that more inclusive research would gain. In this invited commentary based on the International Conference on Ambulatory Monitoring of Physical Activity and Movement (ICAMPAM) 2022 keynote presentation by Prof. ChinAPaw, we discuss the importance of diversity, equity, and inclusion in research and introduce our vision for AWESOME science—All-inclusive, Worldwide ranging, Equitable, Sincere, Open-minded, Mindful of our own implicit bias, and Essential—that is more inclusive and relevant for everyone regardless of who they are and where they live. More diversity, equity, and inclusion make our collective dance toward healthy societies more beautiful and impactful!

Imagine a world where every person has optimal chances to live a healthy and happy life, where one feels included and valued. Vernā Myers introduced a well-known quote: “Diversity is being asked to the party, inclusion is being asked to dance” (Myers, 2015) that many others have built on for instance by adding equity and belonging. Diversity can be described as that among everyone invited to the party, there is representation across many dimensions of diversity and lived experience. Inclusion is not only being asked to dance, but it also entails that everyone had the opportunity to be part of the planning committee of the dance, for example, being able to decide on the music. Equity is related to the principles of equality and fairness, for example, everyone is provided with adequate space on the dance floor. Belonging refers to being able to bring your authentic self, feeling that you are respected for that, and feeling related to the other attendees: One can dance like no one is watching or decide to not dance at all. Unfortunately, the scientific dance floor is shockingly exclusive. In this invited commentary based on the International Conference on Ambulatory Monitoring of Physical Activity and Movement (ICAMPAM) 2022 keynote presentation by Prof. ChinAPaw, we present examples of exclusive, WEIRD (Western, Educated, Industrialized, Rich, and Democratic countries; Henrich et al., 2010) science and introduce our vision for AWESOME science—All-inclusive, Worldwide ranging, Equitable, Sincere, Open-minded, Mindful of our own implicit bias, and Essential.

Exclusive “WEIRD” Science

Gender and ethnic disparities become more and more recognized in academia, especially at the higher professional ranks. A recent U.K. study among professors found that among more than 22,000 professors, only 28% identified as female and 0.2% as other than male or female (“Higher Education Staff Data, 2019/20,” 2021). Furthermore, in the medical field, more evidence exists based on male samples than on female samples (Sechzer et al., 1994). Gender bias was also shown in 1,382 articles published in three major sports science journals involving more than 6 million participants (Costello et al., 2014). The average percentage of female participants per article published across the three journals ranged from 35% to 37%, showing that females were significantly underrepresented. Underrepresentation of females among professors as well as study samples may be related, because female researchers are more inclined to study female health problems and to report findings by sex/gender than male researchers (Nielsen et al., 2017; Sugimoto et al., 2019).

There appears to be gender bias in the peer review process as well. Murrar et al. (2021) conducted a randomized controlled trial on bias of reviewers regarding the gender of study samples in the peer-review process of articles. They invited 315 reviewers to join a study, explaining that the journal was piloting a new approach evaluating whether reviewers could make assessments about an article solely based on its abstract. Participants were randomly assigned to one of three conditions reviewing exactly the same abstract except for referring to: (a) a female sample; (b) a male sample; and (c) a sample of “individuals,” which served as a control group. The reviewers were asked to assess the study’s scientific rigor, contribution to medical science, and whether they would recommend publishing the full article. Remarkably, there was no significant difference in perceived research rigor by abstract condition; while contribution to medical science was perceived to be even greater for research conducted in a female sample. Nevertheless, reviewers were almost twice as likely to recommend publication for research conducted in male samples than the same research conducted in female samples. Gender-based publication bias means that less research on women is published, leading to gender disparities in the quality of health care (Hamberg, 2008).

Gender bias has also been shown in the grant review process as illustrated by a study examining the peer-review system of grants submitted to the Swedish Medical Research Council (Wenneras & Wold, 1997). The researchers calculated the impact of each applicant based on the citations of their publications and the impact factors of the journals. For every calculated impact point, male applicants received a higher subjective competence score from the reviewers than female applicants meaning that female applicants had to publish approximately three extra articles in high-impact journals such as Nature or Science (impact factor 25 and 22, respectively), or 20 additional articles in a journal with an impact factor of around three, in order to receive a similar competence score. The combination of fewer publications and less appreciation of funding agencies due to gender bias reduces the likelihood that women will be promoted to senior faculty or professorships.

“Ethnicity” is another characteristic where large disparities exist. We are aware of the ambiguity of the term ethnicity as well as the misuse and poor operationalization of the term. However, a discussion of the debate on terminology is beyond the scope of this commentary. In this commentary, we follow the terminology as used in the cited articles. In the previouslymentioned U.K. study (“Higher Education Staff Data, 2019/20,” 2021) among more than 20,000 professors, only 0.7% identified as “Black,” 6.6% as “Asian,” and 1.3% as “mixed.” As a result of the lack of ethnic diversity among university staff in many countries, some students rarely see themselves represented contributing to the so-called “leaky pipeline” meaning that ethnic underrepresented students are not pursuing a career in academia (Tweed et al., 2022; Zirkel, 2002).

Furthermore, a lack of ethnic diversity is apparent in study samples. In genome-wide association studies in 2016, only 19% of participants were of non-European ancestry, whereas individuals of African and Latin American ancestry, Hispanic people, and “Native” or “Indigenous” people represented less than 4% of all samples analyzed (Popejoy & Fullerton, 2016). Also accelerometer studies lack diversity. Figures 1 and 2 show graphs of the origin of samples included in two systematic reviews on accelerometer-based methods (Evenson et al., 2015; Lettink et al., 2022). Only one study was conducted in Malawi (Pulakka et al., 2013) and one study in South Korea (Jun & Choi, 2020), while the rest of the included studies (n = 22 and n = 62, respectively) were performed in samples from the United States, Europe, and Australia. These two examples reflect the predominant sampling in certain global regions for studies on physical activity measurement.

Figure 1
Figure 1

—Country distribution of samples included in a systematic review of consumer-wearable activity trackers (Evenson et al., 2015). A darker shade indicates that more samples from that particular country were included in the review, with the lightest shade indicating that no samples were included from that particular country.

Citation: Journal for the Measurement of Physical Behaviour 6, 1; 10.1123/jmpb.2022-0043

Figure 2
Figure 2

—Country distribution of samples included in a systematic review of accelerometer-based methods in young children (Lettink et al., 2022). A darker shade indicates that more samples from that particular country were included in the review, with the lightest shade indicating that no samples were included from that particular country.

Citation: Journal for the Measurement of Physical Behaviour 6, 1; 10.1123/jmpb.2022-0043

Lack of diversity is also seen in authorship: numerous studies have outlined the low rates of authorship from low-income and low-and-middle-income countries on scientific publications (Sumathipala et al., 2004). A comprehensive analysis of scientific articles published between January 2014 and June 2016 in the four most prominent general medicine and five most prominent global health journals showed that even in studies conducted in low-income countries, only 30% included a local author (Ghani et al., 2021).

Is this lack of diversity a problem for a research field such as the measurement of physical behavior? Is lack of diverse samples also an issue when using accelerometers? Absolutely! One can imagine that physical behavior is quite different across different parts of the world, and as a result, the relationship with health may vary. For instance, active transport might be healthy in some parts of the world, but very dangerous due to road traffic deaths and injuries in other parts of the world (“Global status report on road safety 2018,” 2018). In addition, the health benefits of active mobility may be reduced in high-traffic areas due to exposure to air pollution (Chandia-Poblete et al., 2022). Also sitting may be quite different around the world. You can imagine that sitting in a lotus or squat position, which is common in Asia, may have very different physical effects compared to sitting reclined, while binge watching Netflix series. Thus, algorithms that are developed based on physical behaviors in one group may be incompatible for analyzing physical behaviors in another.

We have shown that diversity in science is extremely poor, let alone equity and belonging. Publications in high-impact journals and the related decision making is dominated by WEIRD people who are from Western, highly Educated, Industrialized, Rich, and Democratic countries (Henrich et al., 2010; Sumathipala et al., 2004). The acronym WEIRD was introduced by Joseph Henrich who made the observation that in psychology, most research is conducted among psychology students, who are obviously not representative for all citizens across the world. Conducting WEIRD science means that research output and impact lack diversity, serving some groups better than others. Diverse perspectives improve collective understanding and collective problem solving. Research teams with greater diversity in their social identities tend to ask different and broader scientific questions, resulting in alternative, more creative, and better solutions to complex problems (Hong & Page, 2004). That is exactly why we need more diversity in scientific practice in order to create diverse knowledge.

Inclusive “AWESOME” Science

Our vision is that science becomes more AWESOME—All-inclusive, Worldwide ranging, Equitable, Sincere, Open-minded, Mindful of our own implicit bias, and Essential. More inclusive and relevant for everyone regardless of who they are and where they live. AWESOME research contributes to social justice and more equal opportunities for everyone. This requires more diverse, inclusive, and equitable research teams, who use more inclusive research designs and methods, and recruit more diverse samples.

In epidemiology, bias is defined as “an error in the conception and design of a study—or in the collection, analysis, interpretation, reporting, publication, or review or data—leading to results or conclusions that are systematically (as opposed to randomly) different from truth” (Porta, 2014). There are many forms of bias in epidemiological research, but implicit bias is seldom discussed. Implicit bias refers to bias that we all have, but in an unconscious way. We all have an unconscious biased view of the world. We see the world from our own perspective, colored by the context we grew up in. Thus, working in more diverse and inclusive research teams will increase our understanding of the topic under research since new perspectives will be added and different questions will be asked. Moreover, culturally diverse research teams may lead to more culturally sensitive study materials such as measurement instruments and strategies aimed at including people from different cultural backgrounds.

We need more diverse and inclusive study samples to improve the generalizability of our studies and also to enable exploration of subgroup differences: do interventions benefit some people more than others or even harm certain subgroups? And better, more suitable interventions, tools, and instruments lead to improved health equity. Finally, the impact of research will also be distributed more equally.

How can we promote more inclusive research? We happily share some results from three focus group interviews with youth (n = 17, aged 18–19 years) about their experience being a participant in the Amsterdam Born Children and their Development cohort study (Van Eijsden et al., 2011). As we were specifically interested in experiences of racism within research, we invited participants with at least one parent born outside the Netherlands. Regarding feelings of exclusion, participants mentioned that they sometimes perceived a disconnection between researchers and participants: “researchers ask you something and then you do not hear from them for a while.” Motivations for continued study participation were: “It does not take much time but you are helping other people,” “I like seeing my life reflected in a statistic,” but also receiving gift vouchers and reimbursement of travel expenses. Participants mentioned they liked the physical measurements and would appreciate more of these to keep them motivated, especially if they were provided with their personal results afterward. To the question why individuals with a migration background would be less inclined to participate in research, they mentioned language barriers and lack of familiarity with research in some countries or cultures. Furthermore, “research” is a broad term, which may have negative connotations for some people, for example, potentially painful or harmful, making parents hesitant when their children have to wear a measurement device. Moreover, if you recently moved to a new country, you may have other priorities: “you first want stability in your life, both financially as well as mentally,” “you may be afraid to lose your passport.” Familiarity and trustworthiness of the research institution were also mentioned: “you need to trust that they carefully handle your data and privacy.” Participants provided valuable recommendations for more inclusive research, of which many were related to clear communication: about the project’s benefits, how the data are used, providing personalized feedback on the study results (instead of general newsletters), communication in multiple languages (both the invitation as well as study materials) and also use of simple language. Furthermore, they recommended to provide a clear explanation on the whole research process, the study duration, what participants can expect and what is expected from them, and how the different parts of the study are connected (e.g., surveys and physical measurements). Moreover, if you invite a specific subgroup of participants, for example, with a migration background, clearly communicate why. Participants also appreciated direct communication with themselves already from a young age instead of through their parents. Participants felt comfortable with interested researchers who were open for critical feedback or suggestions for improvement. Another advice was to keep up to date with recent developments such as diversity and inclusion: “[name of researcher] added she/her behind her name [in her email signature] implying a safe environment” and “researchers could ask participants how they would like to be approached (he/she/they) in communication.” These recommendations highlight the value of taking your study population seriously, as they are the experts of their lived experience. Therefore, including the participant perspective in designing and conducting your research is extremely important for more inclusive research, but unfortunately not yet common practice.

We hope we clearly presented our vision for AWESOME science. Science that is less WEIRD, more inclusive and relevant for everyone regardless of gender, ethnicity, age, nationality, educational level, and so on. AWESOME research that contributes to social justice and more equal opportunities for people to grow up and live healthier and happier lives. We all live in our own bubble, growing up with certain habits and thinking that what we are used to is normal. But what is normal for you may not be normal for someone else and normal is not the same as optimal. Therefore, we want to conclude with three key messages and refer to the textbox for a number of suggestions for the International Society for the Measurement of Physical Behavior and the Journal for the Measurement of Physical Behavior:

  1. (a)Become aware of your own biases and stereotypes;
  2. (b)Let us jump out of our bubble and become curious to other’s perspective, because we can learn so much from each other;
  3. (c)Let us advocate for more diverse knowledge and make our own research more equitable and inclusive.

In short, let us make research less WEIRD and more AWESOME!

Box 1

Box 1 Ideas for more AWESOME research, specifically in the area of physical activity.

  1. We urgently call for more diversity in boards and committees of both international societies as well as journals prioritizing members from non-WEIRD countries.
  2. For the peer-review process, journal editors could ensure diversity among reviewers as well as expose reviewers to the risk of implicit bias and offer online implicit bias training. Preferably such a training is specifically developed for reviewers in the area of physical activity research.
  3. Journal editors could prioritize articles from countries that are currently underrepresented in the area of physical activity research and check that articles also include authors from the countries where the data have been collected.
  4. Journal editors could initiate special issues that highlight global collaboration both regarding authorship as well as study samples or studies on the validity or feasibility of measurement instruments in non-WEIRD countries.
  5. Ideally regular collaboration with or engagement of people whose experiences are different from our own is embedded in our daily work. Examples are asking feedback on our research from a diverse group of people. To facilitate such feedback, international societies could demand that conference symposia represent speakers with diverse backgrounds.
  6. International societies could offer scholarships that cover membership, publication fees, and travel and accommodation to conferences for researchers from non-WEIRD countries.
  7. Track and celebrate improvement.
  8. Last, but not least: Involve colleagues from non-WEIRD countries in collecting and translating ideas and perspectives in concrete actions for more AWESOME science.

Acknowledgments

This commentary is based on the keynote lecture of ChinAPaw at the ICAMPAM 2022. The contribution of Anselma is funded by the Amsterdam Public Health Research Institute. We would like to acknowledge Dr. Tanja Vrijkotte for connecting us with the participants of the ABCD cohort study and Jasmijn van Heijst for making the figures.

References

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  • Figure 1

    —Country distribution of samples included in a systematic review of consumer-wearable activity trackers (Evenson et al., 2015). A darker shade indicates that more samples from that particular country were included in the review, with the lightest shade indicating that no samples were included from that particular country.

  • Figure 2

    —Country distribution of samples included in a systematic review of accelerometer-based methods in young children (Lettink et al., 2022). A darker shade indicates that more samples from that particular country were included in the review, with the lightest shade indicating that no samples were included from that particular country.

  • Chandia-Poblete, D., Cole-Hunter, T., Haswell, M., & Heesch, K.C. (2022). The influence of air pollution exposure on the short- and long-term health benefits associated with active mobility: A systematic review. Science of the Total Environment, 850, Article 157978. https://doi.org/10.1016/j.scitotenv.2022.157978

    • Search Google Scholar
    • Export Citation
  • Costello, J.T., Bieuzen, F., & Bleakley, C.M. (2014). Where are all the female participants in sports and exercise medicine research? European Journal of Sport Science, 14(8), 847851. https://doi.org/10.1080/17461391.2014.911354

    • Search Google Scholar
    • Export Citation
  • Evenson, K.R., Goto, M.M., & Furberg, R.D. (2015). Systematic review of the validity and reliability of consumer-wearable activity trackers. The International Journal of Behavioral Nutrition and Physical Activity, 12, 159. https://doi.org/10.1186/s12966-015-0314-1

    • Search Google Scholar
    • Export Citation
  • Ghani, M., Hurrell, R., Verceles, A.C., McCurdy, M.T., & Papali, A. (2021). Geographic, subject, and authorship trends among LMIC-based scientific publications in high-impact global health and general medicine journals: A 30-month bibliometric analysis. Journal of Epidemiology and Global Health, 11(1), 9297. https://doi.org/10.2991/jegh.k.200325.001

    • Search Google Scholar
    • Export Citation
  • Global status report on road safety2018. (2018). https://www.who.int/publications/i/item/9789241565684

  • Hamberg, K. (2008). Gender bias in medicine. Women's Health, 4(3), 237243. https://doi.org/10.2217/17455057.4.3.237

  • Henrich, J., Heine, S.J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2–3), 6183. https://doi.org/10.1017/S0140525X0999152X

    • Search Google Scholar
    • Export Citation
  • Higher Education Staff Data,2019/20. (2021). https://www.hesa.ac.uk/news/19-01-2021/sb259-higher-education-staff-statistics

  • Hong, L., & Page, S.E. (2004). Groups of diverse problem solvers can outperform groups of high-ability problem solvers. Proceedings of the National Academy of Sciences of the United States of America, 101(46), 1638516389. https://doi.org/10.1073/pnas.0403723101

    • Search Google Scholar
    • Export Citation
  • Jun, K., & Choi, S. (2020). Unsupervised end-to-end deep model for newborn and infant activity recognition. Sensors, 20(22), Article 6467. https://doi.org/10.3390/s20226467

    • Search Google Scholar
    • Export Citation
  • Lettink, A., Altenburg, T.M., Arts, J., van Hees, V.T., & Chinapaw, M.J.M. (2022). Systematic review of accelerometer-based methods for 24-h physical behavior assessment in young children (0–5 years old). The International Journal of Behavioral Nutrition and Physical Activity, 19(1), 116. https://doi.org/10.1186/s12966-022-01296-y

    • Search Google Scholar
    • Export Citation
  • Murrar, S., Johnson, P.A., Lee, Y.G., & Carnes, M. (2021). Research conducted in women was deemed more impactful but less publishable than the same research conducted in men. Journal of Women's Health, 30(9), 12591267. https://doi.org/10.1089/jwh.2020.8666

    • Search Google Scholar
    • Export Citation
  • Myers, V. (2015). Diversity is being invited to the party; inclusion is being asked to dance. American Bar Association.

  • Nielsen, M.W., Andersen, J.P., Schiebinger, L., & Schneider, J.W. (2017). One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis. Nature Human Behaviour, 1(11), 791796. https://doi.org/10.1038/s41562-017-0235-x

    • Search Google Scholar
    • Export Citation
  • Popejoy, A.B., & Fullerton, S.M. (2016). Genomics is failing on diversity. Nature, 538(7624), 161164. https://doi.org/10.1038/538161a

    • Search Google Scholar
    • Export Citation
  • Porta, M. (2014). A dictionary of epidemiology. Oxford University Press.

  • Pulakka, A., Cheung, Y.B., Ashorn, U., Penpraze, V., Maleta, K., Phuka, J.C., & Ashorn, P. (2013). Feasibility and validity of the ActiGraph GT3X accelerometer in measuring physical activity of Malawian toddlers. Acta Paediatrica, 102(12), 11921198. https://doi.org/10.1111/apa.12412

    • Search Google Scholar
    • Export Citation
  • Sechzer, J.A., Rabinowitz, V.C., Denmark, F.L., McGinn, M.F., Weeks, B.M., & Wilkens, C.L. (1994). Sex and gender bias in animal research and in clinical studies of cancer, cardiovascular disease, and depression. Annals of the New York Academy of Sciences, 736, 2148. https://doi.org/10.1111/j.1749-6632.1994.tb12816.x

    • Search Google Scholar
    • Export Citation
  • Sugimoto, C.R., Ahn, Y.Y., Smith, E., Macaluso, B., & Lariviere, V. (2019). Factors affecting sex-related reporting in medical research: A cross-disciplinary bibliometric analysis. The Lancet, 393(10171), 550559. https://doi.org/10.1016/S0140-6736(18)32995-7

    • Search Google Scholar
    • Export Citation
  • Sumathipala, A., Siribaddana, S., & Patel, V. (2004). Under-representation of developing countries in the research literature: Ethical issues arising from a survey of five leading medical journals. BMC Medical Ethics, 5, E5. https://doi.org/10.1186/1472-6939-5-5

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