Igniting Change: towards inclusive research design

Heart and circulatory diseases are often diseases of inequality, and many groups are currently under-served by cardiovascular research. Amending our research funding application forms to help encourage inclusive research design is one step that BHF is making towards tackling these inequalities. 

In May 2022 we launched our Equality, Diversity and Inclusion (EDI) strategy, with the aim of igniting change for our colleagues and volunteers, the research community and for the millions of people living with heart and circulatory diseases. A key ambition included in the strategy is to see that, by 2025, our research community is actively considering strategies to improve the representativeness of their research where appropriate.

Research is an essential part of advancing care for people living with heart and circulatory diseases. We simply wouldn’t have all the treatments, diagnostic tests, preventative medications and countless other aspects of current, lifesaving cardiovascular care without it. But many people are currently under-served by cardiovascular research. For example, despite cardiovascular diseases being a leading cause of death among women, female participants have been consistently under-represented in cardiovascular clinical trials, and many areas of pre-clinical research tend to focus on male animals or cells - at the risk of not detecting sex-specific differences or mechanisms, which could impact effective, equitable transition from the bench to the clinic. People from an ethnic minority background are also often underrepresented; for example, a review of clinical trials examining cardiovascular complications in diabetes found that the majority involved no or very few people with a South Asian background, despite type 2 diabetes being at least twice as prevalent among South Asian people (compared to White European people) in the UK.  

As the biggest independent funder of cardiovascular research in the UK - investing around £100 million in research into conditions affecting the heart and blood vessels each year - BHF has a responsibility to help ensure that the research we fund is representative of, and could lead to future advances for, the people who need it. To this end, since July 2021, we have required BHF Clinical Study Grant applicants to explain how they aim to recruit a diverse group of participants that represent the relevant patient population, and how their recruitment and retention methods will engage with groups who are currently under-served by research. But we know that we need to go further.

Next steps

By June 2023, a new section in application forms will be rolled out across most BHF funding schemes on our Grants Management System, asking for information on:
• Whether and how factors such as age, sex, gender or ethnicity have been considered as part of the design of the research project.
• Male/female representation in the proposed study.

View an example of the new section, with a list of funding schemes it will apply to

This new section will be mandatory if the proposed study involves human participants, animals, or samples/data relating to humans or animals, and information provided may form part of the assessment of research design and methods by our committee members and independent expert reviewers.

We recognise that there is no perfect way of taking diversity into account when designing a research project, and that this will be easier to do for some types of research compared to others. But we believe this is an important step towards the goals outlined in our EDI strategy (which is also in line with changes being implemented by other research funders). This new process is intended as a prompt to encourage applicants to consider diversity as part of their research design, and to allow us to begin collecting data on current practice in this area. 

We plan a review of the data collected in Summer 2024, to inform any future potential changes to our application guidance - for example, towards the use of both sexes being the default in laboratory experimental design. We will also be continuing to review other funders’ approaches and considering joint sector working, for example through collaboration with the Association of Medical Research Charities (AMRC).

Get in touch

If you have any questions or would like to put forward ideas for how else we could improve in this area, or EDI in research in general, get in touch at [email protected]