Promoting diversity, equity, and inclusion in psychological clinical science through assessment: A global lens
Authored by: Violeta J. Rodriguez
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA, Department of Psychology, University of Georgia, Georgia, USA, Department of Psychiatry, University of Illinois at Chicago, Illinois, USA
Though the adaptation of psychological interventions for use among specific groups has received attention and is widely recognized as a need in the psychological clinical science literature, the adaptation of quantitative measures for use with specific groups is less frequently discussed. From the perspective of a bilingual, non-native English speaker, reading self-report scales in English and Spanish, I wondered how truly “equivalent” scales were when assessing different groups of people (i.e., Spanish versus English speakers, for example). This was further emphasized by my experience a data manager and analyst for clinical trials in HIV in Argentina, South Africa, and Zambia, when I realized just how important the translation and adaptation of measures was to assessing trial outcomes and adjusting for psychological factors as covariates. In addition, in applied clinical science, quantitative assessments are important for screening patients into interventions, 2) identifying additional needs requiring support during interventions, and 3) monitoring progress once patients are engaged in interventions. In those cases, what happens when we used a cut-off from the majority population among underrepresented segments of the population? Further, when measures are translated (for example, see Rodriguez, Mandell, and Jones, 2022 of a depression measure translated into Zulu from English) or adapted for a specific population (see Rodriguez et al., 2022), are we still assessing the intended construct, or does it change depending on that population’s characteristics? When people from different backgrounds complete the same quantitative scale, do the “scores” that we obtain from these scales have the same meaning, even though people come from different backgrounds (see Rodriguez et al., 2020 for an example)? These are the questions that have informed my program of research, which aims to promote diversity, equity, and inclusion in psychological clinical science through assessment with a global lens.
Within my program of research, which focuses on the psychometrics of parenting and family constructs, the exploration of important psychometric properties for assessing racial and ethnic minorities are important. A widely known psychometric property clinical scientists may explore in this regard is measurement equivalence. Measurement equivalence refers to whether constructs, such as psychological terms, have a similar meaning across the diverse groups assessed in a sample. For example, assessing positive and negative parenting may carry different meanings across racial and ethnic groups, particularly because of systemic, historical, structural, and contemporary challenges that families from underrepresented backgrounds face. An illustrative example is assessing neglect via resources that may not be available to historically marginalized groups. For example, a previous study I led showed that racial and ethnic minorities were less likely to report having someone take them to the doctor, which is in the physical neglect subscale of the Childhood Trauma Questionnaire (Rodriguez et al., 2019). However, such an item may measure healthcare access or both healthcare access and neglect, as opposed to parental neglect purely. In such cases, establishing measurement equivalence is vital for making conclusions about the types of parenting that may be promoted in parenting interventions among families from underrepresented backgrounds. It also highlights the importance of carefully considering how we conceptualize psychological constructs depending on the groups we are assessing.
In assessing these important psychometric properties, I also conducted a systematic review of parenting measures for which measurement invariance analyses have been conducted by race and ethnicity (Rodriguez et al., 2021). Prior to this review, we knew that in general, there is a limited consideration of how measures of parenting function in racially and ethnically diverse groups. So, although we expected that there would be some lack of evidence for measurement invariance/equivalence across diverse groups of parents, we were surprised by the extent of this omission in the literature, which has persisted and remains essentially unchanged after decades since these problems were noted in the literature. We also learned more about specific potential problems with the ways measurement invariance/equivalence by race and ethnicity of parenting measures is assessed. That is, we found not only that measurement invariance/equivalence of parenting measures by race and ethnicity is rarely evaluated but also that when it is evaluated, the methods are inconsistently used across studies (e.g., whether factor-analytic or item-response-theory approaches are used). There is also a striking lack of qualitative research to inform measure development, and we see this as an important strategy to future measure development that is informed by input from diverse groups of parents. This is something that I proposed to change (somewhat) through my dissertation, funded by an R36 Dissertation Grant by the National Institute of Mental Health. My dissertation addresses this unmet need by revising and validating the Multidimensional Assessment of Parenting Scale (MAPS) using a mixed methods approach to yield a psychometrically sound measure of parenting for use in racially and ethnically diverse families.
I ultimately hope that the findings across my program of research will stimulate more research on the psychometrics of psychological measures with samples comprising greater racial and ethnic diversity. This research is needed to improve the validity and utility of psychological measures with groups that have been historically underrepresented in research and will ensure that conclusions based on group comparisons are valid and not based on measurement bias. Although measurement bias is complex, and it cannot always be completely removed, addressing these questions can help us reach a higher standard for diversity, equity, and inclusion in psychological clinical science, ensuring considerations across the multiple steps of research. I also hope that my research encourages more multimethod (e.g., qualitative, mixed methods) approaches are used in either developing or refining measures to incorporate more diverse perspectives and more accurately reflect the evolving demographics of the United States.
Violeta J. Rodriguez was this year’s SSCP Outstanding Student Diversity Research Award Winner. We are grateful for her contributions to the field and for sharing her important work with us here on the blog!
If you are interested in submitting a piece related to DEI and it’s effects in clinical science and practice, please email us at sscpdiversitycommittee@gmail.com with your idea!
References
Rodriguez, V. J., Shaffer, A., Are, F., Madden, A., Jones, D. L., & Kumar, M. (2019). Identification of differential item functioning by race and ethnicity in the Childhood Trauma Questionnaire. Child Abuse & Neglect, 94, 104030.
Rodriguez, V. J., La Barrie, D. L., Zegarac, M. C., & Shaffer, A. (2021). A Systematic Review of Parenting Scales Measurement Invariance/Equivalence of by Race and Ethnicity: Recommendations for Inclusive Parenting Research. Assessment, 10731911211038630.
Rodriguez, V. J., Mandell, L. N., & Jones, D. L. (2022). Factor Structure and Differential Item Functioning of the Edinburgh Postnatal Depression Scale: A Comparison of Zulu and English Versions Among Ante-and Postnatal Women Living with HIV in South Africa. Maternal and Child Health Journal, 1–8.
Rodriguez, V. J., Alcaide, M. L., Salazar, A. S., Montgomerie, E. K., Maddalon, M. J., & Jones, D. L. (2022). Psychometric properties of a vaccine hesitancy scale adapted for COVID-19 vaccination among people with HIV. AIDS and Behavior, 26(1), 96–101.
Rodriguez, V. J., Zegarac, M., La Barrie, D. L., Parrish, M. S., Matseke, G., Peltzer, K., & Jones, D. L. (2020). Validation of the Bayley Infant Neurodevelopmental Screener among HIV-exposed infants in rural South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 85(4), 507–516.
Acknowledgements: VJR’s writing was supported by a Ford Foundation Fellowship, administered by the National Academies of Science, a PEO Scholar Award from the PEO Sisterhood, and a grant from the NIH of the National Institutes of Health under Award Number R36MH127838.
Conflicts of Interest: No conflicts of interest to disclose.
