Learn by Doing: Out of the Classroom and Into the Field

Shekinah Fashaw, MSPH is interested in home and community based services, health disparities, aging, and quality and access to care. She was a McNair Scholar and also a Brown University Diversity Fellow.

You’re interested in racial and ethnic disparities when it comes to accessing home and community-based services for elderly patients; how did you come to be interested in that?
Part of my interest came from the personal experiences that I had with my grandmother and her experiences with home-care nurses coming into her home. When I was an undergraduate student, I wanted to know what the research process was like, so I went to the single faculty member of color in my department and she suggested that I study older adults. I started looking into it and I really grew to love the population and began to ask more questions about where people of color are aging and why are they aging there. I remember reading an article that talked about how more and more people of color were going into nursing homes, as white people were leaving nursing homes and going into assisted living and home care. I started to question why there is a disparity in access. I also thought about the impact that a neighborhood’s characteristics can have on quality of care. This all led to my interest in where people are aging and what quality of life they are experiencing while aging in that place.

What do you think policymakers can do to reduce these disparities?
I think that Medicare and Medicaid services don’t reimburse nearly as much as they should, so changing reimbursement policies and the level of reimbursement is important. I also think that there are other ways to incentive home care agencies and other health services to serve disadvantaged populations—this usually means giving them the funding they need to improve their resources; like the amount and quality of nurses they hire for instance. I think incentivizing is the number one way to make this happen.

What does your average research day look like? What do you spend your time doing?
A lot of my time is spent reading and trying to understand the literature. There’s very little research on home health, so I depend a lot on nursing home and hospice literature. A large amount of my time is spent just thinking. Thinking about how the research from other care settings applies to my work. I also play a lot with data—Medicare data, OASIS data, nursing home assessment data, and some publicly available data—and think about questions I can ask based on the data.

If there is one thing you would like the general public to understand about your research, what would it be?
That institutional and structural racism is real and it impacts the everyday life of black and brown people. This goes across the life course; from children to older adults who may have spent the entirety of their life in one particular neighborhood. It affects their health outcomes, their access to care, and the quality of care that they receive, and we should do something about it. My work is hinged on the idea that racism still exists and that it manifests itself in ways that maybe one would not expect to see.

You recently presented your research in a TED style talk at Research Matters at Brown. What was that like and how did you find the process of translating your research for a general audience?
I’ve always been a talker so it was fun to find new ways to communicate my ideas. Working with people in the graduate school was really helpful because they pointed out parts of the talk that really resonated with them, so I decided to focus on those areas. It was a great experience figuring out how to translate the regressions I ran into plain English and for people to say, “I totally get what you’re saying.”

What advice would you give to other scientists who want to communicate in the same way?
The advice I would give is figure out your story. I recently gave a talk at the Leadership Alliance National Symposium and the basis of the talk was, the most important part of your research is the “who” behind what you do. It’s who you are, the story that you’re telling—if it’s not who you are, it’s the population you’re studying—the “who” of your population. Once you have a story, then you’re able to translate your research into something that’s memorable for others.

Why did you come to Brown for your Ph.D.? How has your experience been so far?
I came to Brown because when I started studying older adults, I kept citing papers that were by researchers based at Brown. I thought, if I continue to study older adults, Brown is where I need to be. When I came to Brown, I felt a sense of investment. I felt like they saw me as a person and a researcher and wanted to invest in my future. I also felt like they saw parts of me that I couldn’t see. When I feel like maybe I wasn’t built for this, my program director will tell me “I remember you wrote in your personal statement” or “I remember what you said in your interview.” That’s what matters—they took the time to know me and they really believe in my potential. My experience has been wonderful at the School of Public Health, the Graduate School, and the University as a whole. I really feel like a part of something bigger here at Brown.

What is your advice to others considering, research similar to yours?
I would remind them that this is a vulnerable population. The way that we talk about older adults from disadvantaged backgrounds is very important. It always has to be the patient or resident first—it has to be that ‘person first’ language that leads and guides the research that we do and the way that we think about people. They are not just data points in a dataset but people with stories. I am constantly reminded of that when I think about my own grandparents—each of them has a story.

Outside of your research, what do you like to do in Providence and at Brown?
At Brown, I’m a part of the Samuel M. Nabrit Black Graduate Student Association. I love hanging out with other students of color and having that safe space where you can just be with other people who understand what you’re going through. In Providence, I’ve been kayaking on the Providence River, gone to Waterfire a few times, and I enjoy the mall—in fact, I checked out the mall before I applied because I love window shopping. Since moving here from Florida, I have really started to love being outside, because the weather’s a little more bearable here, and so I spend a lot of time at India Point Park.