As a health equity researcher, Maya Ragavan, an MD, MPH, MS assistant professor of pediatrics at Pitt’s School of Medicine, has seen firsthand the challenges experienced by patients whose language identity doesn’t match the predominant language where they live.

Studies have consistently shown that, in the United States, language barriers adversely affect non-English speaking communities’ access to high-quality health care, their relationships with their physicians and their personal safety. Children of non-English-speaking parents statistically experience higher medical errors.

Ragavan wondered about the extent to which there are language inequities in pediatric research. And so, she partnered with Jaime E. Sidani, a PhD, MPH assistant professor of behavioral and community health sciences, to conduct a review of more than 5,000 studies published in three pediatrics journals from 2012 to 2021.

In an October 2023 paper in JAMA Pediatrics, Ragavan and Sidani reported that only 9% of the studies they reviewed included non-English-speaking participants. “Excluding individuals who do not primarily speak English but are interested in participating in the research process reduces [the] generalizability of results and does little to improve the trustworthiness of research,” says Sidani. Annie Chen, a med student and the first author on the study, notes, “Diversity in research not only makes science better, but it also helps to dismantle structural barriers.”

They also found that of the studies that included non-English-speaking participants, only a small fraction provided specific details about how the research team communicated oral and written information (22% and 29%, respectively).

Failing to include bilingual staff members in research hinders the participation of non-English speaking participants, but the problem goes deeper. Inconsistent translation and interpretation of research materials such as consent forms can lead to confusion about certain concepts and omitted details. To achieve language equity, says Ragavan, who is associate vice chair for diversity, equity and inclusion research in the Department of Pediatrics, all research participants must receive materials in their primary language from start to finish.

Though the findings paint a bleak picture, Ragavan, who is also part of Pitt’s Clinical and Translational Science Institute (CTSI), says the research community met them with interest, support and excitement to work on solutions.

In 2023, CTSI, the Department of Pediatrics Office of Diversity, Equity and Inclusion, and the Mid-Atlantic Regional Public Health Training Center cosponsored the Linguistic Justice in Research Conference, attended by 250 scientists nationwide. “I’m grateful to CTSI and Pitt researchers who are passionate about inclusivity in general,” Ragavan says.

Ragavan also commends the work of her colleagues and codirectors of the CTSI Community PARTners Core: Elizabeth Miller, an MD, PhD who is the Edmund R. McCluskey Professor of Pediatric Medical Education, and Mylynda Massart, an MD, PhD associate professor of family medicine. They’re working to build relationships with community partners who “understand the language identities of the immigrant and refugee communities that they’re serving,” says Ragavan. “They also understand how to include people equitably­—how to recruit people in a way that’s not coercive.”

One such partner is Global Wordsmiths, a Pittsburgh-based social enterprise that provides language assistance services to UPMC.

“People who do not communicate in English are irrefutably excluded from science, including medicine, if they are unable to participate in the process,” says Mary Jayne McCullough, chief executive officer of Global Wordsmiths. “Dr. Ragavan’s work is vital to advancing language accessibility awareness in research so that this inequity can be transformed into a culture of participation, representation and improved outcomes for everyone.”

In the course of her own research, Ragavan has provided materials to participants in 13 different languages.

Looking to introduce future researchers to inclusive strategies early on, Ragavan leads seminars on language equity and teaches a course on community-partnered research and knowledge translation with Miller. “I want to get to people while they’re trainees,” she says. “So, then we build this whole new generation of people who are excited about [language equity] and know how to do it well.”

Read more from the Winter 2024 issue.