In an interview during the annual Steering Committee meeting, Drs. Rosa Gonzalez-Guarda and Cherise Harrington, cochairs of the Health Equity Core Working Group, shared insights and next steps for health equity in the NIH Pragmatic Trials Collaboratory.

One question discussed at the meeting was how to embed health equity in pragmatic clinical trials. Gonzalez-Guarda said that a key component of addressing health equity is acknowledging the structural and social drivers of that inequity and developing strategies to target them.

“The next phase is to figure out ways that we can encourage embedded pragmatic clinical trials that address the structural causes of health inequities,” said Gonzalez-Guarda, who noted that the National Institutes of Health is supporting more structural interventions.

One way the NIH Pragmatic Trials Collaboratory can lead is by integrating a pragmatic clinical trial lens into structural intervention work, Gonzalez-Guarda said. This work is central to the Health Equity Core, which was launched last fall and began meeting regularly in early 2023.

Health Equity Core members are reviewing a checklist on how to infuse a health equity lens into the research life cycle. As a next step, Harrington and Gonzalez-Guarda would like to ask Core members to think critically about how the checklist can be adapted for pragmatic clinical trials and develop it as a new tool for the research community.

Harrington said another way the Health Equity Core can make an impact is by gathering examples from the NIH Collaboratory Trials of data on underrepresented populations that are not statistically significant but may be clinically significant so that other projects can learn from them.

Drawing from and adding to the NIH Pragmatic Trials Collaboratory’s lessons learned is also a key strategy for the Health Equity Core’s work. Harrington said it is important to share knowledge outside of the research community.

“We need to remember to ask ourselves, 'What am I leaving with this community after the funding is gone that they can still leverage?,’” said Harrington.

Many of the NIH Collaboratory Trials are already implementing health equity plans and engagement strategies to reach diverse patient populations, providers, and community stakeholders.

Gonzalez-Guarda said that it is important to continue this work and to support the careers of junior researchers working on pragmatic clinical trials so they can use engagement practices and be successful. In addition to preparing investigators to engage with diverse communities, part of the engagement work may also be training for communities to better engage with projects in a more meaningful way, Harrington said.

Developing tools and resources is a top priority as the Health Equity Core moves forward, and Gonzalez-Guarda and Harrington look forward to providing guidance for pragmatic clinical trials and continuing the conversation from the Steering Committee meeting.

Learn more about the Health Equity Core and see the complete materials from the 2023 Steering Committee meeting.