Critical reflexivity as a fundamental skill for applying equity frameworks, drawing on Nixon's coin model¶

Theory · All theories
Evidence · 1 claim (1 for) · 1 study (1 design), q2 · 0 of 1 report an effect size · 1 claim rests on one study

Description¶

The article presents critical reflexivity as "a practice designed to locate oneself and others in the systems of power and oppression" that must be understood to devise disruptive actions, calling it a fundamental skill for applying any EDI framework in healthcare. Drawing on Nixon's coin model of privilege and oppression, it identifies two especially important elements: understanding that oppression is unearned structural disadvantage and privilege unearned structural advantage, and understanding that these structural realities are multiple and intersecting. Reflexivity was an expectation of participants in the co-design process.

Design Implications¶

Context¶

Requirements¶

• Investments in education for critical reflexivity must take place alongside efforts to apply the framework

Constraints¶

Target Learners¶

• healthcare improvement practitioners
• healthcare organizations

Target Learning Objectives¶

• recognizing one's own position in systems of privilege and oppression to design actions that disrupt them

Claims¶

• Existing health equity frameworks often lack implementation guidance and treat equity as distributive rather than addressing how inequity is produced [+W]

Related Theories¶

• HEC Health Equity Framework: actions to disrupt intersecting systems of oppression surrounding improved care at the centre

Examples¶

Key Sources¶

• Mehelay S, Comeau B, Chandra S, Fancott C, Gordon D, Loftgard K, Louzado C, Nixon SA, Shahid S, Tilson K, Wilson C, Shaw J. (2026). Shifting power: co-developing a framework for equity in healthcare. BMC Health Services Research. https://doi.org/10.1186/s12913-026-14964-7