The BIAS FREE Framework: a new analytical tool for global health research.

OBJECTIVE: To test the applicability of the BIAS FREE Framework in African settings. PARTICIPANTS: Researchers from the Tanzanian National Institute for Medical Research, university and community-based researchers from Tanzania, the Gambia and South Africa.
SETTING: National Institute for Medical Research, Dar es Salaam--Tanzania. INTERVENTION: An intensive two-day workshop to examine the applicability of the BIAS FREE Framework within an African setting. This involved clarification of the following concepts: construction of knowledge, objectivity, logic of domination, hierarchy, power, sex and gender, disability, and race/ethnicity. The Framework identifies three types of bias problems that derive from social hierarchies based on gender, race and disability: maintaining hierarchy, failing to examine differences, and using double standards. Participants used the 20 diagnostic questions at the heart of the Framework to analyze various research publications, including some authored by participants. OUTCOMES: Participants uniformly stated that the Framework is useful for uncovering bias in public health research, policy and programs; that it is immediately applicable in their work settings; and that doing so would improve equity in research and, ultimately, in health. One participant re-analyzed published data using the Framework and submitted a supplementary report with some new recommendations. IMPLICATIONS: The applicability of the BIAS FREE Framework has been demonstrated in diverse settings. It is now being offered for broader application as a tool for uncovering and eliminating biases in health research that derive from social hierarchies and for addressing the persistence of global health inequities.