Diversity science researcher achieving goal of making difference in people’s lives

Gladys Asiedu, Ph.D., always knew she wanted to make a difference in people's lives. A steady focus on that altruistic goal would ultimately lead her to Mayo Clinic.

As a child in Ghana in West Africa, she didn't know what that would mean, or how she would get there. She received her undergraduate degree in English and religious studies from the University of Cape Coast in Ghana. In 2004, she and her family landed in Manhattan, Kansas, where she pursued graduate education at Kansas State University, receiving a master's in family studies and human services, a Ph.D. in family studies, and a graduate certificate in women's studies.

Her research career in Kansas began with a question: What happens when you or someone you love is diagnosed with HIV or AIDS? What are the mental and social impacts on patients and their families? And how do those impacts affect treatment?

A passion for equity in the pursuit of health and wellness

Dr. Asiedu's experience in international and community health programs before coming to the U.S. gave her firsthand knowledge of the devastating effects of such a diagnosis on underprivileged and underserved populations. In both her master's thesis and Ph.D. dissertation, Dr. Asiedu argued that HIV/AIDS-related stigma and discrimination are not something that affects just one person or one family. It is a systemic issue that affects the health and well-being of a whole community, as well as healthcare providers and care systems.

Dr. Asiedu observed that this stigma was fueled by misinformation and a limited understanding of science, and she proposed that education was the first step to averting fears related to the disease.

"An aspect of our human survival mechanism is to fear the unknown and to stigmatize it," says Dr. Asiedu.

Her dissertation expanded on this finding and illustrated that community-based, participatory research — a newly emerging concept at the time — was an effective way to identify potential interventions.

A continuing focus on community

In 2010, Dr. Asiedu moved to Rochester, hoping to help build a world where people would have equitable experiences and opportunities to live their healthiest and happiest lives.

Mayo didn't initially seem like a promising place to pursue her passion, with sparse ongoing social science research at the time.

"But there is always a first time, and in the first year, I worked with Dr. Sandhya Pruthi in Women's Health, who was crafting cancer screening interventions tailored to the culture and beliefs of low-income women in the Southeastern communities to increase rates of breast cancer screening," Dr. Asiedu says.

"Then I did a postdoc in health services research with Dr. Carmen Radecki Breitkopf, looking at disparities in common cancer screenings, preventive and therapeutic care," she says.

That's when she began to think Mayo might hold opportunities for the kind of work she wanted to pursue.

Diversity science

Today, Dr. Asiedu is a leading researcher in the new Diversity Science Program of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Program Director Renaldo Blocker, Ph.D., Dr. Asiedu and other colleagues defined diversity science at Mayo. They started by thinking about the biases and inequities in the U.S.

"We were initially moved by our own experiences and the experiences of our colleagues, and were passionate about effecting change in our workplace and community," says Dr. Asiedu. "We became passionate about addressing this for our own institution and wanted to do good in the workforce space.  But after the murder of George Floyd, it grew beyond the initial vision."

Mayo Clinic pledged $100 million to eliminate racism, advance equity and inclusion within Mayo Clinic, and improve health equity for people everywhere.

"This pledge from Mayo signifies the investment that the organization has in advancing equity, and that meant so much for what we wanted to do," says Dr. Asiedu. "So it was incumbent on us to define our tasks within the commitment that Mayo made and to reimagine how we approach diversity at Mayo."

That meant revisiting how to design diversity, equity and inclusion efforts, and health equity studies in a more scientific and rigorous manner, and ensuring that diversity, equity and inclusion research and discoveries by Mayo happen in a systematic, scientifically sound manner.

"We created the Diversity Science Program to be a hub for scientists and practitioners who wanted to work in this space but needed the guidance, consults and strategies that could potentially accelerate progress toward inclusivity through research," Dr. Asiedu says.

The team knew their work had to be more than just internal to Mayo. They needed to address the needs of the workforce, patients and community. They had to investigate and build interventions for sustainable transformation inside Mayo and across the global community.

"The fact that this program came into existence signifies our recognition of inequities and inequalities in our world, oppressions and disparities that come from systems of power," Dr. Asiedu says. "Systemic structures and cultural norms that have allowed dominant groups to undermine the value and dignity of members of minority groups.

"Launching the Diversity Science Program showed a renewed commitment by Mayo to conduct the rigorous research that underlies transformation and to share the knowledge gained through investigation and implementation of interventions," says Dr. Asiedu. "It's about time we change the science of characterizing inequities and disparities and move toward impactful science that implements interventions and programs resulting in equity and meaningful outcomes for all groups of people."

For Dr. Asiedu, the birth of the Diversity Science Program also expanded her ability to pursue health equity from myriad perspectives.

Dr. Asiedu invests her research expertise in investigations across all the program focus areas because she feels strongly about holistically examining health and healthcare delivery within larger contexts and identifying ways to improve outcomes and satisfaction among those who experience the most significant disparities.

She derives much satisfaction from her work, which feeds her passion. Her personal life provides more evidence of her commitment to improving the lives of others.

Between the demands of being an "Uber driver" for her school-aged kids, she volunteers for community-building activities in her church. Dr. Asiedu is surrounded by her community of friends and family who inspire and expand on her ideas to make a difference for people in the U.S., her home country, and perhaps the world.

Seeking a new perspective on clinical trial participation among underrepresented minority patients

Together with Katharine Price, M.D., Rahma Warsame, M.D., and others, Dr. Asiedu explored the experiences, motivations, and decision-making of underrepresented minority patients successfully treated in a cancer clinical trial. After reviewing existing literature, they deliberately chose a mixed-methods approach, considering the question from an entirely new angle.

This positive approach acknowledges the existing strengths and everyday experiences of these patients.

"We wanted to gain some idea of barriers and facilitators to clinical trial enrollment through an appreciative inquiry," Dr. Asiedu says.

That meant approaching patients already in a clinical trial and asking, "What are your motivations for participating in this clinical trial?"

The team used surveys and the photo-elicitation interview technique — a visual research method — to explore and understand the motivations and facilitators of trial participation.

"PEI (photo-elicitation interview) is a powerful method for illuminating human experience and surfacing information, which may otherwise remain invisible using conventional approaches," says Dr. Asiedu. "This approach has the potential to alter clinical trial recruitment efforts that include patient-generated visuals of clinical trial experiences that could enhance culturally tailored educational programming."

The authors found that altruism appears to be a significant motivator to enroll in a cancer clinical trial. This message could be incorporated into recruitment strategies to improve the recruitment of diverse patients.

To gain a more comprehensive picture, the study included perspectives from physicians, study coordinators, clinical trial investigators, recruitment personnel and other staff involved in clinical trials to provide important insight into the complex issue of inclusive accrual.

Ultimately, Dr. Asiedu and the team's most critical observation was that clinical trial participation requires a relational approach. It is more than a simple two-party contractual agreement.

"It's not just you, the patient, making the decision. It is a decision for you and your family and friends and together with doctors," she says.

The team expects their study results to be published soon.

Effectively engaging the community to reach vulnerable populations during a public health crisis

Early in the COVID pandemic, Dr. Asiedu worked with two research teams to develop and evaluate a community-engaged bidirectional crisis and emergency-risk communications framework to assist in reaching immigrant communities as well as African Americans in Southeast Minnesota. The researchers knew they needed to work with the communities to identify the paths likely to lead to receptiveness. They needed to refine the messaging in ways that were both palatable and encouraged action while reducing fear and uncertainty.

The two research teams, Rochester Healthy Community Partnership led by Irene Sia, M.D., and Mark Wieland, M.D., and FAITH! led by LaPrincess Brewer, M.D., developed a bidirectional communication approach using the Crisis and Emergency Risk Communication model from the Centers for Disease Control and Prevention to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant, refugee and African American groups in Southeast Minnesota. This communication framework was culturally tailored and adapted to the needs of the immigrant and African American population in Southeast Minnesota.

This communication intervention reached over 40,000 community members in seven different language groups across Olmsted County. Framework implementation also led to systems and policy changes to meet the needs of immigrant, refugee and African American populations.

"The project helped reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies," says Dr. Asiedu. "The framework has been adapted for use in other communities to encourage participation in healthful health communication to diverse populations."

Getting big-city care to the bedsides of the tiniest rural patients

Dr. Asiedu worked with Jennifer Fang, M.D., and her team to determine the best way to incorporate remote neonatology consultative support in hospitals without local access to this specialty.

It seemed simple: Add video telemedicine for newborn resuscitation care, thereby lessening rural health disparities and improving the odds of safer deliveries and healthier babies.

The team quickly realized this, too, was about relationships. Local doctors needed to be brought into conversations where they would learn the value of technology in helping them provide the best possible care for their patients. They needed to understand how the process would work, how the neonatologist would integrate with their local team, and how this intervention would improve outcomes. The research turned toward developing an effective outreach and education program that felt empowering for the rural care providers.

Today, Mayo's Teleneonatology Program is available across Mayo Clinic Health System and also supports non-Mayo medical facilities.

Improving care for men with prostate cancer who are also immigrants from sub-Saharan Africa

Most recently, Dr. Asiedu has been working with colleagues at Mayo Clinic Comprehensive Cancer Center to customize another framework — one for understanding the social determinants of migrant health. They hope their work leads to improved care and survivorship experiences for Black men with prostate cancer.

The current investigation is a pilot study among sub-Saharan African immigrants, identifying factors contributing to health-seeking behavior. Their findings advance knowledge in the iCCaRE Consortium, a shortened name for the Inclusive Cancer Care Research Equity for Black Men Consortium.

The team expects to expand the pilot to phase 2 in early 2024, involving other African and Caribbean immigrant communities and expanding collaborations to the University of Texas MD Anderson Cancer Center.

Read more about this collaboration in Cancer Epidemiology, Biomarkers & Prevention.

Originally published in Mayo Clinic News Network