Over the past year, since the murder of George Floyd precipitated a groundswell of national reflection and transformative efforts to achieve diversity, equity, and inclusivity (DEI) in all spheres of our lives, I have grappled with how to foster DEI at our journal. Here I share our efforts and some accomplishments.

When I began as Editor-in-Chief in 2018, my goal, as stated in my first editorial (Lake, 2018), was to advance nursing science by elevating RINAH internationally. My reasoning was that “regard for nursing research by nurses and other disciplines is essential for nursing research to improve care and health.” I also anticipated that a strong reputation would, through enhanced readership, “speed the translation of research evidence into practice and policy.” I articulated several other priorities in my first board meeting in June 2018: fair consideration of manuscripts, satisfying service for associate editors, reviewers, and the editorial board, and novel content. Nowhere in my vista was the centrality of DEI to achieving either our journal's mission, that is, “to build knowledge that informs the practice of nursing and other health disciplines,” or my goals.

DEI in scholarly publishing is a goal with singular merit on ethical grounds. What has been dawning on me over time, however, is that DEI is also an essential driver to achieving my original goals and priorities. This is true because DEI broadens the content submitted, which simultaneously augments novelty. DEI increases the likelihood that manuscripts will be considered fairly. DEI makes service to the journal more satisfying by emphasizing that we value DEI. All who serve the journal can feel welcomed, valued, and treated fairly.

My efforts toward DEI at RINAH are multifaceted. Here, I describe four efforts: (1) diversifying the RINAH board and editorial staff, (2) learning about becoming antiracist as a person and about DEI journal practices, (3) planning a special issue on health inequity and social determinants of health (SDOH), and (4) planning a guest editorial series on health equity.

I began to diversify the board and editorial staff upon my arrival. First, I recruited my Penn Nursing faculty colleague, Professor Jianghong Liu, PhD, RN, FAAN, to become an associate editor. At RINAH, the associate editor assesses a manuscript and its peer reviews and prepares guidance to the authors as well as a recommendation to the Executive Editor to accept, invite a minor or major revision, or reject the manuscript. Professor Liu is Chinese and maintains an active program of research on child and adolescent behavior in China as well as in the United States. I intended to diversify our editorial staff and to improve our knowledge and interpretation of the cultural and scientific aspects of the many papers we receive from China, which comprise one-fifth of submissions. I also desired to demonstrate our openness to the large body of Chinese nursing research and scientists.

In 2020, I diversified the editorial board by recruiting Drs. Ronald L. Hickman Jr., PhD, RN, ACNP-BC, FAAN, who is African American, and Nilda (Nena) Peragallo Montano, DRPH, RN, FAAN who is Hispanic from Chile. Dr. Hickman is a Professor who studies health decision-making while serving as Associate Dean for Research at Case Western Reserve University's Frances Payne Bolton School of Nursing. Dr. Peragallo, who is Dean and Professor at the University of North Carolina at Chapel Hill School of Nursing, research health disparities and culturally competent interventions with minority populations. The editorial board members are expected to solicit manuscripts, conduct peer reviews, and assist the editor in decisions such as the topics for special issues. I expected that by their service, Drs. Hickman and Peragallo would signal our commitment to nursing research about minority individuals and by minority researchers. Recently, I crudely evaluated whether the journal content has reflected these board changes by noting papers from Latin or South American institution-based authors or with the word Hispanic, Latino/a/x, Black, or African American in the title. I did not attempt to determine the racial identity of the lead authors. I found that we had published one paper from South American authors (Brazil) before the addition of Dr. Peragallo as a board member, and four (two from Brazil, two from Colombia) after. We also increased the number of empirical research publications focused on Latino populations, according to the article titles, from one before to two after Dr. Peragallo joined the board. We had published three research protocols on patients of the Black race before Dr. Hickman joined the board, and one protocol, a feasibility study, and two empirical papers afterward. I also scanned for the word native or indigenous but found no papers with these words in the titles. Although we cannot attribute these increases to the diversification of our board, I believe that the presence of Drs. Hickman and Peragallo is having a positive influence.

In 2021, I diversified our editorial staff by inviting Dr. Yolanda Powell-Young, PhD, RN, CPN, PCNS-BC, FAAN, who is of African American and Native American heritage, to become an associate editor. Dr. Powell-Young studies biobehavioral factors impacting the health of African American adolescent females and other vulnerable population subgroups. She serves as a Senior Scientist and Advisor at Young Group, LLC, an institute on advancing global science, research, and policy capacity based in Norfolk, VA. Notably, Dr. Powell-Young had been awarded the best RINAH reviewer of 2016, demonstrating her commitment and ability.

My learning about how to be an antiracist includes reading the book, Caste: The origins of our discontents (Wilkerson, 2020). This book opened my eyes to how a caste system based on skin color developed and is perpetuated in the United States. In addition to the profound suffering and injustice endured by African Americans over the past four centuries, this caste system diminishes our society and each individual regardless of our place in the system.

As an editor, I am a member of the International Academy of Nursing Editors. In our 2021 virtual meeting, I attended the outstanding session “Connecting with Readers through Diversity, Inclusivity, and Equity” presented by Assistant Professor Tamika Hudson, DNP, APRN, FNP-C, Associate Professor Courtney Pitts, DNP, MPH, FNP-BC, FAANP, and Professor Rolanda Johnson, PhD, MSN, RN, of Vanderbilt University's School of Nursing. Their excellent presentation may be available from the presenters. They also shared a toolkit developed by the Coalition for Diversity & Inclusion in Scholarly Communications (undated). Another session, “Transforming Scholarly publishing Through an Equity and Anti-Racism Framework,” was presented by Ms. Kerry Webb from the University of Texas Press. Ms. Webb described why and how to change workplace culture at interpersonal, organizational, and cross-organizational levels. What I learned from these sessions that seems promising for our journal to increase in DEI includes self-evaluations for the presence of unconscious bias and cultural humility as well as initiatives such as statements on the journal website addressing DEI and issuing a call for reviewers that cites a commitment to diversity and inclusion.

One of our journal priorities is to advance nursing science by showcasing the latest evidence on urgent topics in special issues. Our editorial board chooses the topics. In my tenure, we presented a special issue on Research Methods in December 2019 (Lake, 2019) and one on Telehealth and mHealth in February 2020 (O'Connor & Bowles, 2021). This second special issue was particularly timely as the COVID-19 pandemic vaulted the use of both telehealth and mHealth.

In December 2020, acknowledging the interrelated crises of 2020, our board selected the special issue topic of health inequity and SDOH, including the impact of COVID-19 on health inequities. In the call for papers, we referenced the World Health Organization's description (2018) of health inequities as “differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.” We specified that population groups of interest include racial and ethnic minorities, LGBTQ individuals, migrants, and military personnel or veterans. The call noted further that the distribution of health resources may be influenced by SDOH. We offered the Healthy People 2030 description of SDOH: “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (U.S. Department of Health and Human Services - Office of Disease Prevention and Health Promotion, undated).

I invite guest editors for our special issues to heighten the visibility of the call for papers, the credibility of the issue and attract papers. For our special issue on health inequity and SDOH, I invited Drs. Bridgette Brawner, PhD, MDiv, APRN, Professor at Villanova University M. Louise Fitzpatrick, College of Nursing, J. Margo Brooks Carthon, PhD, RN, FAAN, Associate Professor, and Adriana Perez, PhD, CRNP, ANP-BC, FAAN, FGSA, Assistant Professor, at the University of Pennsylvania School of Nursing. Dr. Brawner research interventions to address the sexual health needs of adolescents. Dr. Brooks Carthon research the quality of nursing care and racial inequities in outcomes. Dr. Perez research interventions to promote physical activity in older Latinos with mild cognitive impairment. Through these guest editorial appointments, we simultaneously enhance the diversity of our editorial staff.

The guest editors instructed me on the differences between health disparities and health inequities, as well as between social factors or social needs as compared to SDOH. That is, disparities are differences in outcomes, but inequity includes a focus on the unjust systems that cause disparities. We expect the papers that focus on inequity will discuss policy implications. To discern social factors and needs from SDOH, the guest editors recommend two articles that attempt to clarify the meanings (Alderwick & Gottlieb, 2019; Castrucci & Auerbach, 2019). Broadly speaking social needs and factors are individual-level and social determinants are community-level. How these needs, factors, and determinants are incorporated into research questions and the development of interventions warrants thorough scrutiny. We are sharing the guest editors' insights and these resources with the authors of special issue manuscripts to present a cohesive issue in which the content reflects the above definitions and expectations and is thereby more impactful.

Earlier this year, I attended the Eastern Nursing Research Society presentation by Dr. Allison Squires, PhD, RN, FAAN, on the appropriate use of language associated with race/ethnicity, SDOH, immigrants, and substance use. Dr. Squires, an Associate Professor at New York University Rory Meyers College of Nursing, has associate editor roles at multiple health research journals. She is an expert in global health, migration and immigrant health, and health services and workforce research. I invited Dr. Squires to coordinate a series of guest editorials to complement our early 2022 special issue. The series will begin with a December 2021 editorial by Dr. Squires on learning the language of equity. Thereafter, each 2022 RINAH issue will feature a guest editorial on respectful language in scientific writing on immigrants, LGBTQ individuals, race/ethnicity, native Americans, incarcerated people, and veterans, in an order to be determined.

We at RINAH are attempting, with humility, to foster DEI in our journal practices through diversification of our editorial board and staff, and education about antiracist and DEI initiatives. We hope to meet the needs of our RINAH readers and authors by dedicating seven sequential editorials to guidance on appropriate and respectful scientific writing about populations suffering health inequities. By selecting health inequity and SDOH as research topics deserving of a special issue, we will provide empirical evidence that will inform interventions and policy actions to reduce health inequities. Through these initiatives, we will build knowledge by historically underrepresented researchers and for historically underserved peoples to thereby improve health.