An Inspired Path to Health Equity with Cory Bradley

[00:00:00] Erin Spain, MS: Welcome to Science in Translation, a podcast from NUCATS, Northwestern University Clinical and Translational Sciences Institute. I'm your host, Erin Spain.Today's guest, Dr. Cory Bradley is playing important roles in helping NUCATS achieve its three aims: Include, Innovate and implement. He joins the show to talk about his work to help NUCATS develop communities and a diverse workforce that powers social justice in the translational sciences and his efforts to infuse dissemination and implementation science methods across the translational continuum to create public health interventions that reach and benefit everyone, especially marginalized communities. Dr. Bradley is an assistant professor and team scientist at Northwestern University Feinberg School of Medicine and core faculty in the Center for Dissemination and Implementation Science and the Institute for Public Health and Medicine at Feinberg. Welcome to the show.

[00:01:07] Cory Bradley, PhD: Thank you so much. I'm happy to be here.

[00:01:09] Erin Spain, MS: You're fairly new to Northwestern. You just joined the faculty in 2023, but you come here with a really interesting background. I understand you were a pastor for more than a decade before pivoting to academics. Tell me about that and your career journey so far.

[00:01:25] Cory Bradley, PhD: Thank you for that question. I finished from Morehouse College my undergraduate days,after that time, I was headed toward a post bach actually at, at NIH. And during my undergraduate experience at Morehouse, had an opportunity to participate in what at the time was a research opportunities program for underrepresented minority undergraduate students. And so I really got invested in research as a way of kind of answering problems. And at that time I was really into clinical psychology. Just About time to graduate, I really felt compelled. We in the, in the spirit world, we call it, you know, a calling. to commit my time, my energy, and my resources to building a spiritual community. And just put that post back on hold and move. I actually moved to Dallas and was on my way to DC to Bethesda and came back once an opportunity opened up with the church that I was a part of there to work as a paraprofessional . I kind of worked in grant management during that time as well. And then the church eventually decided to plant a church in Charlotte, North Carolina. And so I went with the church, as their worship pastor. And so my responsibility, as I described it, was to cultivate an atmosphere, spirit among the congregation where we could express artistically the experience of transformation with our faith, and as a community of people, then also brought in community opportunities to the church I participated in things like AIDS walk, AIDS education, HIV AIDS prevention, but there just came a point when something more came up for me.So I returned back to, graduate school to do a master's in social work and a master's in public health while I was still in school doing ministry. I wanted to be a part of the production of the knowledge that would be applied. I had some bones to pick with some of the theories and ideas and some of the approaches that were taken. And I wanted to be able to represent that a different perspective and insight, and also contribute to social justice in the way that knowledge production happened.And I applied to Hopkins, and was admitted to the program. And I retired from ministry as I call it, but I often think the work that I still do, even in science, feels like ministry.

[00:03:38] Erin Spain, MS: Tell me a bit more about your roles here at Northwestern with the center for dissemination implementation science and here at NUCATS and some of the work that you're digging into.

[00:03:48] Cory Bradley, PhD: Part of the attraction to coming to Chicago As I talked with several colleagues, about the opportunity was this openness by the center to really think about how we integrate health equity and social justice in implementation science. And so that's a part of my contribution as a team scientist working with different research teams, scientists, bringing a methodological expertise that introduces or expands, elaborates on a critical stance in health equity. And I integrate a lot of interdisciplinary thinking, to, to break us out of the silos and walls of our discipline so that we can have a more contextualized view of what the implementation process involves. Implementation, I like to say, impacts or it affects subjectivity. I like to call them positionality, right? That we're asking teams and communities to utilize these innovations and the way that they come to utilize those innovations requires behavioral change and it's an introduction of a new novel idea into the culture, right? We think we talk a lot about how science has evolved culture and so with that, I think that it is incumbent upon us as implementation scientists to be attentive to the ways that our social world changes, is impacted by, and how we can use those opportunities to leverage goodness. A couple of the projects that I'm working on. One of them is a study of how we can better implement and scale out what's called the hub. It's a space where folks, living with HIV or folks interested in prevention of HIV can connect with other resources that meet the other needs that are connected to our sexual health needs. Talking with folks about how they understand the hub, is it useful to them, and what could be done for folks who have not been introduced to the hub, how can the hub be developed, so that folks will adopt use of the hub. So that's one of the projects that I'm working on. The other one that I have written about in a diversity supplement is to explore how we can utilize a model of care called low barrier care. And this is the work to research award, R01 award with Dennis Lee and Nanette Ben Boe, and they have this great award, they're working with Chicago Department of Public Health's HIV Safety Net Clinics and addressing this issue of disparities in viral suppression, retention, and engagement in HIV care . Low barrier care is a model that in the vernacular meets patients where they are and provides accessible opportunities for them to receive care and stay connected to care. And so I have added on to their inquiry to explore how and whether low barrier care is an option that improves the outcomes for black sexual minority men. So I am asking them through journey mapping. How do they engage in care, both in the clinic setting, and then also more broadly in the kind of the self care ways that they attempt to take care of themselves. Even if there are ways that we don't think that are necessarily resulting in the best outcomes, still an approach at trying to take care of themselves, I believe. I use journey maps to get a sense of that identity. How low barrier care might be working for folks from the population and identifying those mechanisms. What's making care more accessible, enabling the opportunity to stay retained in care, and to meet viral suppression goals. And then to, now that we, once we've had a base in understanding how low barrier care might work in the experiences of black sexual minority men, how That I'll ask a question of the clinics to say hey, are there ways that we can integrate this Understanding in our strategies for care or the strategies that we use to implement low barrier care in our clinics. A lot of the tribe of NUCATS, is not just to make sure that folks can do the research, but that we don't leave folks behind. In, in this notion of translating means that we are able to take. For example, the language of science, and be able to wrap that, integrate it into the lived experiences of communities, of providers, of folks who would make use of these innovations.

[00:08:38] Erin Spain, MS: There's also part of your role that's really focused on the workforce, the biomedical workforce. Tell me about that.

[00:08:45] Cory Bradley, PhD: The particular work that I am a part of is thinking about how do we extend the workforce? Where do we find the thinkers, the social workers like myself? The folks in, in various disciplines who are not represented as well in the, the bench of research science. How do we create pathways for them to see themselves in this work and accomplish those priorities, those aspirations that are important for them. And a lot of folks of color, particularly, specifically, rather I should say, bring a reflexivity of their experiences to their work and their aspirations. And I think that that kind of training, that kind of pathway for folks, I think opens opportunities for our communities who will ultimately be impacted by the work and the research that happens.

[00:09:40] Erin Spain, MS: Tell me a little bit more about what drives your passion for the social determinants of health research.

[00:09:46] Cory Bradley, PhD: It is deeply rooted in, belief in the capacity of humanity for goodness. And aware of the barriers and the challenges, and the inequity that results in a bit of waste of those kinds of potentials, a waste of those opportunities, because they're not distributed with justice, with justice. And my own experience my mother was the daughter of a sharecropper. She only went to school when it rained in Arkansas. But she rose to incredible accomplishments both in high school and then graduating as the valedictorian summa cum laude from Philander Smith College. And I'm a bit of a legacy social worker because that's also what she, what she studied as well. So just have always had a concern around social problems. We call them determinants, but they become deterrents for folks, in realizing their full capacity and the fullness of, of health. And so I just empathize deeply and also have set myself you know, the use of myself in saying what it would mean to experience liberation from those things, what it would mean to be emancipated from those limitations, what kind of world and what kind of society could we, could we produce?

[00:11:10] Erin Spain, MS: Tell me about some of the work that you're doing for developing curricula for community engaged implementation science.

[00:11:16] Cory Bradley, PhD: I did a great study in the annual review with Shoba Ramadan and colleagues, where we looked at participatory implementation science and how to characterize participatory implementation science. And that curriculum that's developing, really kind of hones in on the power of community in generating what I call and what Jose Medina has called epistemic friction. So that there are realities and experiences that researchers may not necessarily be able to touch, but in partnership with communities, they supply the insight that we need that makes the science more robust. We think about how that kind of knowledge becomes valued, in the scientific process rather than discarded or treat it as less important. So there's, there's a certain power that comes, comes with that. Communities understand their realities well enough to be able to help direct the solutions and oftentimes are needing the resources in the facilitation to be able to get to those solutions. We want to build investigators, who are able to facilitate that process. So the curriculum will definitely provide opportunities for folks to come in contact with the kinds of skills that encourage the expertise of our community partners in addressing the larger social problems that we're encountering.

[00:12:45] Erin Spain, MS: We had Jen Brown and Sherita Morrison on this podcast a few months ago talking about the importance of building trust within communities and how investigators can really play a role in getting out and meeting folks and going to community centers and going to events. Can you talk a little bit about that importance of building trust and what our investigators can do to really get involved in these communities in which they may be studying?

[00:13:10] Cory Bradley, PhD: Trust happens through proximity and closeness and being in the space. It happens when we come not with our handout about what you can give, but we come bringing our bearing gifts, and here it is, and bearing curiosity, and wonder, and an expectation to grow and to develop as a result of that exchange. So those are things that build trustworthiness. This is the work that I've read. It talks about not just expecting that others should trust you, but being found to be trustworthy. That's being accountable. That's saying the things that matter to you matter to me. So that's a part of becoming a trustworthy institution. And I think that this goes hand in hand with the phenomenon of Disinformation and misinformation that maybe perhaps we don't need better information. We need better relationships. Better relationships enable us to be able to hold the bodies of evidence and information in ways that can be applied and utilized to improve life and health.

[00:14:18] Erin Spain, MS: Tell me a little bit more about your role in helping the Institute's development, evaluation, and dissemination of cutting edge professional development activities for the research staff, investigators, and entire workforce here at NUCAS.

[00:14:32] Cory Bradley, PhD: One of the ways that we're realizing that is through a pathways program that will reach out and invite undergraduate students and some post graduate students as well that might be interested in the biomedical sciences and research in that space. The pathway program will bring those younger scholars, and get them versed in the language, the vocabulary, getting comfortable with that, and also inviting them to push back and to resist and develop their own terms upon their own terms. How science can, can happen, how translational sciences, can be realized. We'll interact with folks at minority serving institutions. I'm really excited about potential partnerships with city colleges. We want to look for folks hiding in plain sight in studying things that we don't quite naturally correlate with clinical and translational sciences? For example, there may be folks that are studying African American history. What are the insights that they might be able to bring to the research process? With the experience of social movements or experience a deep kind of analysis of structural kinds of conditions and how they play out, how do those kinds of explanations serve the strategies that we'd like to develop? so that it improves or increases the adoption and uptake of interventions as well as how they are sustained in communities. So we're looking for that kind of talent to bring into this space, connect with teams within research that are doing research here at Northwestern and just really set them ablaze and help them create a pathway for that kind of success.

[00:16:22] Erin Spain, MS: mean, it's a critical part of the mission of NUCATS to diversify the clinical and translational science workforce. One way is to try to find these young students who might be able to contribute. Can you just talk about in your own words, how important this is, this bringing more folks into the space with different lived experiences, different backgrounds, to really achieve the goals that are out there?

[00:16:46] Cory Bradley, PhD: There is an idea feminist scholarship that's described as situated knowledges. And the idea behind situated knowledges is that it advances this idea that there is not any knowledge that is neutral. that every concept, even facts are conceptually mediated. There's a concept behind the color red concept behind color. So then, it requires an interrogation of those ideas. That is where the science is. When we engage in inquiry and ask questions, how this came to be, how do we know this to be, that is where science happens for us. So as I mentioned earlier, the invitation for folks with lived experiences that can help us with those situated knowledges, with their expertise, to bring those into the laboratory, so to speak, into the laboratory of science making, strengthens the science. We talk a lot about adaptation and implementation science and how do we adapt interventions or adapt strategies to implement based on the context. And so we need minds, who are clear about the diverse context in which healing and in which interventions take place. That also means that we have to change the space and rearrange the space that we do our work in because it is traditionally been reserved for a particular type, right? For white men, white straight men, on top of that. So there are a lot of folks who have been left out over time. This is where we get the idea of underrepresented scholars. And making space for that scholarship, you know, there's been a discourse that, that. has suggested, you know, what if the cure for a certain kind of cancer had always existed, but structurally, those opportunities were inhibited because of the ideologies or because of discrimination or various ways that folks could not get into the opportunities that would help them thrive. Realize the potential for those kinds of solutions and cures. I think that this effort is suggesting that those answers exist in spaces that we may not be looking and NUCATS in the search for those persons. And then also willing to make space, as they were in our camp and, and in our institution for those kinds of scholars to emerge.

[00:19:23] Erin Spain, MS: At the beginning of the show, I mentioned that NUCATS is positioned around three aims, include, innovate, and implement. What do those aims mean to you?

[00:19:32] Cory Bradley, PhD: First of all, we have to appreciate that they are verbs of action. This is important for health equity, that it requires action. We are not able to implement unless we are inclusive. The problem with implementation in several settings, for example with regard to PrEP, which is the pre-exposure prophylaxis that prevents HIV transmission. And black cis, straight women, heterosexual women were omitted. They were omitted and in ways erased. from this particular innovative technology by not being included in the research and questions being asked about their experiences. And so we see that there is low uptake of that particular innovation prep among black women. And so we have to include populations in both the study And then also leading those studies because their leadership inspires a different level of engagement and involvement from communities who have felt excluded. And so I think, you know, in that example, you can see a bit of include and innovate, right? That innovation is incredibly powerful and what it might mean for implementation, how all of those different factors work together with that particular innovation.

[00:20:57] Erin Spain, MS: a great example. Well, I want to thank you so much today, Dr. Bradley, for coming on the show and sharing your expertise. And it's great to get to know you and to have the NUCATS community get to know you too. So thanks again.

[00:21:08] Cory Bradley, PhD: Thank you.

[00:21:09] Erin Spain, MS: Subscribe to Science in Translation wherever you listen to your podcasts. To find out more about NUCATS, check out our website, NUCATS.Northwestern.edu.