Conducting Electroencephalography With Black Individuals: Barriers,Recommendations,and Impact on Generalizability

Abstract

Electroencephalography (EEG) is a critical tool for neuroscience research on brain functioning, as well as clinical applications in neurological and psychiatric illnesses. Anti-Black racism is a substantial societal problem that affects the validity of EEG assessments, thereby undermining efforts in research and in medical practice. There are several barriers present in the process of recording EEG with Black individuals. This includes the physical qualities of Black hair; as well as the cultural and historical significance of Black hair, the features of Black hairstyles, and the discomfort that many Black individuals feel if their hair is touched. The potential impact of these barriers on the application of EEG is considerable, including concerns of individual discomfort, lack of generalizability, and misdiagnosis. Recommendations are proposed here to combat these barriers, including individual researchers who utilize EEG methods, funding agencies that support EEG research, and journal editors who publish EEG findings.

Keywords

EEG anti-Black racism policy hair African American

EEG is a critical tool for neuroscience research and medical practice. For Black individuals, EEG assessment can be a challenging process due to both technological and cultural concerns. Researchers, funding agencies, and journal editors can all contribute to solving this problem.

Key Points

The success of neuroscience research hinges on diverse samples for the sake of generalizability.

The underreporting of race and underrepresentation of Black people in research are intertwined with structural racism, and as a result need to be addressed at both individual and structural levels.

There are both technological and sociocultural barriers to conducting EEG with Black individuals, and both need to be addressed to truly combat the core problem.

Solutions for technological barriers include developing new EEG systems that can better navigate denser hair textures.

Solutions for sociocultural barriers include hiring diverse team members and communicating openly with Black individuals receiving an EEG in advance.

Broader recommendations for the field include strategic funding to support research regarding these issues, standardizing the reporting of participant characteristics, and encouraging EEG research in Black institutions where it currently is not taking place.

Introduction

The Value of EEG

Electroencephalography (EEG) is a method of neurophysiological assessment that is commonly used in research and in medical practice to understand typical and atypical brain functioning. Compared with other measures of brain functioning, EEG has several unique strengths (Luck et al., 2011). Because EEG measures voltage at the scalp, it provides a real-time measure of brain activity, thereby complementing other neurophysiological measures with lower temporal resolution. EEG is noninvasive, is highly tolerable, and has virtually no rule-outs, making it well-suited for clinical applications and lifespan developmental research. EEG also is cost-effective compared to other neurophysiological assessment methods, which is relevant for clinical scalability, as well as expanding neuroscience research opportunities in lower-resourced settings. Within medical practice, EEG commonly is used to diagnose sleep disorders (Petit et al., 2004) and neurological disorders, particularly seizure disorders (Faiman et al., 2021). Within neuroscience research, EEG commonly is used to study neural correlates of psychological processes, including clinical applications among individuals with psychological disorders (Hajcak et al., 2019). Thus, EEG is a powerful tool for basic neuroscience research on brain functioning, as well as clinical application in neurological and psychiatric illnesses.

Technological and Sociocultural Barriers

The great varieties of available EEG systems differ regarding the type of electrode used, the number of electrodes included in the recording montage (e.g., sparse montages with only a handful of electrodes vs. dense montages with dozens or hundreds of electrodes), and the method of contact with the scalp (e.g., dry electrode vs. gel-based or saline-based systems; Di Flumeri et al., 2019). Critically, one aspect that all EEG assessments have in common is physical contact with the individual's hair. Thus, the practical usage of EEG is affected by physical factors such as the texture and style of hair, as well as sociocultural factors relevant to having one's hair touched by another (Choy et al., 2021). The combination of these factors is distinctively relevant for Black individuals, as detailed in the sections below. Understanding these factors is essential for addressing barriers to participation in EEG research by Black individuals, improving the generalizability of EEG research findings, and ultimately addressing health disparities within neurological and psychiatric illnesses that rely upon the routine clinical usage of EEG.

Due to the direct interaction of EEG electrodes with the scalp, contact with the hair serves as an inherent part of the process; the application of EEG methods among Black individuals ought to be considered within the particular historical and cultural context of Black hair. In this case, the meanings of Black hair may contribute to the considerable disparity with regard to racial representation in EEG research (Gatzke-Kopp, 2015). Some of the barriers that challenge EEG research with Black people are linked to anti-Black racism (i.e., racism that is experienced by Black people/people of African descent; Rodríguez et al., 2021). Anti-Black racism is rooted in the history of enslavement and characterized by the distinctive stereotypes that target Black people specifically, including notions that Black people are less than human and have a higher than human pain tolerance (Dryden & Nnorom, 2021).

Black people often experience racism in reference to their hair because of physical differences between Black and non-Black hair. The historical role of Black hair in Euro American contexts involves substantial trauma, including the erasures of local and tribal knowledge systems, as well as forced cultural loss, thereby going far beyond appearance alone (Rajan-Rankin, 2021). Second only to skin color, Black people's hair historically has been devalued by mainstream Euro American society and to those who reference it as the most visible stigma of Blackness (Mercer, 1994).

The impact of anti-Black racism based on hair is substantial partly because of the importance of hair within the Black community: hair has been crucial to the development of Black identity (Lashley, 2020; Lukate, 2021; Ndichu & Upadhyaya, 2018; Onnie-Rogers et al., 2022). In addition, hair plays an even larger role in Black women's identity. Black women often use hair as an act of resistance and a portrayal of God, as opposed to hair simply serving as an aesthetic choice (Langat, 2022).

In summary, for Black people regardless of gender, hair serves both as a crucial component of identity while also a consistent site of discrimination. Because of this and other factors to be discussed, Black people have demonstrated immense aversion to their hair being touched, especially by non-Black people (Collier, 2021). This aversion has the potential to be problematic within medical practice as well as research. It has the potential to alter dramatically a Black person's experience with receiving EEG assessments because they may not be comfortable with someone touching their hair to place the cap, electrodes, and gel.

Research and Clinical Implications

Why Does Generalizability Matter?

Generalizability is the concept of extending research findings to a broader population from which samples are derived. Lack of representation matters because if a particular part of the population is inadequately represented in research samples, then conclusions may not generalize to those members of the population. More specifically, underrepresentation of Black people in basic and applied EEG research limits the generalizability of those findings. This could lead to outright false conclusions for a Black individual based on EEG. As a result, the potential impact of Black people being unable to successfully receive EEG is substantial, including risk of misdiagnosis, systematic exclusion from neuroscience research, and negative experiences.

In medical practice, EEG plays a crucial role in determining Black people's diagnoses, including epilepsy (Drenthen et al., 2021) and sleep disorders (Stores, 2007). To the extent that EEG assessments in Black individuals are invalid or that research findings in EEG studies do not generalize to Black individuals, there are inherent risks that Black people may be less likely to receive proper diagnoses for such illnesses and get appropriate treatments, which would significantly impact health and quality of life. Lack of a diagnosis when the illness is present or a false diagnosis when no illness is present could have a profound impact on the jobs one is able to get, the dynamics of one's interpersonal relationships, and matters of independence (Benbadis, 2007). For example, if a Black individual were to receive an incorrect diagnosis of epilepsy resulting from an EEG, they may unnecessarily lose their freedom to drive.

Studies also have evaluated the utility of EEG in reference to mild traumatic brain injuries, finding evidence to support this usage (Tenney et al., 2021). As it becomes more of a common practice to utilize EEG in this fashion, the relatively lower validity and inaccessibility of EEG recordings for Black people may further exacerbate gaps in treatment and health outcomes.

Similarly, a lack of representation within neuroscience could span widely differing concerns, and therefore potentially impact many people through systemic erasure (Abiodun, 2019). As one example, EEG commonly captures event-related potentials (ERPs) as markers of psychological processes. ERPs are used to assess a wide range of cognitive and affective processes, such as the affective modulation of cognitive flexibility and working memory (Ahumada-Mendez et al., 2022). Clinical applications extend this research to use ERPs as markers of psychological symptoms, risk factors, or prognostic indicators in psychiatric illnesses. For example, this approach has been influential in understanding the pathophysiology of ADHD (Adamou et al., 2020), schizophrenia-spectrum disorders (Murashko & Shmukler, 2019), and bipolar-spectrum disorders (Nguyen et al., 2022). The lack of representation of Black people prevents truly generalized findings (Penner et al., 2022). Therefore, the literature is not as comprehensive as it presented by mainstream scholars and any findings that inform treatment or policy will not be inclusive, thereby contributing to suboptimal health outcomes and health disparities among Black people.

Concerns for Recruitment and Participation

Black and Latinx self-identifying people together make up about 30% of the United States population but account for only 6% of all participants in federally funded clinical trials (Miller et al., 2019). This study noted that racial and ethnic minorities are not necessarily hard to reach, but they are hardly reached, speaking to the point that many researchers rely heavily on Western, educated, industrialized, rich, and democratic (WEIRD; Henrich, 2010) samples and fail to recruit minority participants.

Further, when Black people do decide to participate in EEG assessments, there remains the potential harm done to Black people when receiving an EEG. Because standard EEG equipment is not made to be used on Black hair, the researcher or clinical personnel might spend longer interacting with the Black person's hair, pushing harder on the scalp as they apply gel, or adding more gel than they normally would. This could leave the Black person feeling distressed or in pain during the experience, which also may discourage them from having an EEG done in the future (Louis et al., 2022).

Technological Barriers to EEG

Specific barriers to optimal EEG with Black participants use fall into several domains that can be addressed by researchers and practitioners.

Physical Properties of Black Hair

Many barriers to conducting EEG with Black hair stem from technology, data, and materials. In discussing these specific barriers, note first the differences in the physical properties of Black hair compared to the hair of non-Black people. Black people have great variety in the kinds of hair that they have, but the current discussion references hair of prototypical Black people with ancestors predominantly in West Africa, fitting the United States images (given that the United States produces much of the leading-edge research, and also is home to some of the most pointed contrasts based on “race”). Within this context, Black hair is different from non-Black hair primarily due to density, texture, and follicle shape. Specifically, Black hair comes from smaller, flatter, and more elliptical follicles and shafts, which causes it to grow in a way that is dense and curly (Loussouarn et al., 2007). Additionally, Black hair appears to have the lowest radial swelling rate and lowest swelling percentage in water, meaning that Black hair is less likely to absorb liquid (Franbourg et al., 2003). Because of the differences in the way that Black hair responds to water, the saline solution used in EEG may not act with proper conductance in the way that it would for those with other hair types (Choy et al., 2021).

Black Hairstyles

Differences from the hairstyles preferred by mainstream populations are another source of challenge (and possible unfair treatment) from mainstream EEG operators. Black hairstyles often are the subject of ridicule and therefore a cause for discrimination as well (Donahoo & Smith, 2019); with Black people wearing hairstyles that are often viewed as counter to mainstream or White hair norms (Joseph-Salisbury & Connelly, 2018). These hairstyles include twists, braids, weaves, and dreadlocks (locs) (Jones, 2020), and they are typically more textured in comparison to hairstyles of their White counterparts (Harris, 2023). EEG electrodes are not conducive to the characteristics of natural Black hair or many typical Black hairstyles. This is in part due to the needed precision of electrode placement in collecting EEG data; it can be harder to place the electrodes properly when they are not made to accommodate Black hair. Because of this, some laboratories will ask participants what hairstyles they have prior to them coming into the laboratory, and if participants asked say that they have certain Black hairstyles such as braids and twists, they will be asked to remove or change the hairstyle; if they are unable to do so, they may then be excluded from participation (Choy et al., 2021). Through one ongoing project, researchers are developing a new type of electrode system that works with Black hair, allowing for more intentionality with positioning on the scalp using clip attachments (Etienne et al., 2020); this system is still being developed and not yet broadly used in the field. Currently, those conducting EEG, due to the systems used, might be unable to collect data when working with a Black person; they might also find poorer quality recordings (e.g., noisy or failing to meet the impedance threshold) or unable to be used once collected, which has the potential to skew research data and interfere with proper diagnoses.

Social and Cultural Barriers to EEG

Distrust of Research and the Medical System

Social and cultural barriers for EEG when working with Black participants comprise many considerations. First, when recruiting Black participants, several relevant concerns prevent Black people from participating in research at the same rates as their White counterparts, including elements of study design, logistical problems, low levels of health literacy, and sociocultural factors (Huang & Coker, 2010; Mouton et al., 1997). Black people often have a mistrust of research institutions due to a history of neglect, mistreatment, and abuse, including cases such as the Tuskegee syphilis study among many others (Scharff et al., 2010). These difficulties further contribute to concerns of lack of representation of Black individuals in EEG research studies, as well as neuroscience and medical research more broadly.

Discomfort With Being Touched

Many Black people—and especially Black women—have significant discomfort surrounding their hair being touched. As a Black person, one's hair being touched by another person has historical and structural features that are still apparent in the present (e.g., unwanted or unreciprocated touching indicate power). Both substantial gravity and nuance come with a Black person, especially a Black woman, consenting to their hair being touched (Carrington, 2017). Specifically, some of what must be considered in discussions of touching Black hair with consent relate to the experiences many Black people have experienced with their hair being touched without consent. Carrington addresses the racial history and current negative consequences of Black people's hair being touched without their consent with references to historical anti-Black racism such as the story of Sarah Baartman, a Black woman who was used as an exhibit for White onlookers’ entertainment. Other researchers have found evidence to support this connection as well and have explained how touching has historically been used to ascertain the worth of Black bodies (Morrison, 2018). When discussing Black hair specifically, Morrison writes that touching of Black women's hair demonstrates scripts of perceived exoticism and pedagogical obligation; she continues to say that touching of Black hair by non-Black people is often rooted in entitlement. Because of this complex history of hair touching, Black patients or participants may feel extreme discomfort with their hair being touched or they may avoid it altogether.

Discomfort With Gel

Black people who are going to have an EEG may not be comfortable with gel being in their hair. Within many EEG systems, gel acts as a bridge to establish an electrical connection between the scalp and the electrodes. The addition of gel at all can serve as a barrier for Black people, but especially Black women, due to the often tedious, time-consuming, and strenuous nature of Black hair care and hairstyle maintenance (Hall et al., 2013). Black hair care and hairstyling practices can also be very expensive leading to Black people being less willing to alter them or ruin them to receive an EEG. In addition, Black hair requires less frequent washing (Hall et al., 2013), so Black participants or patients may avoid receiving an EEG to minimize time and financial investments. In cases where it is harder to make the connection using gel, the person conducting the EEG may add additional gel that could result in the gel spreading and bridging electrodes therefore reducing spatial resolution (Etienne et al., 2020). Large amounts of gel can also make it particularly challenging for participants to remove it afterward (Louis et al., 2022), especially when working with Black hair and Black hairstyles.

Policy Considerations

Recommendations for EEG Researchers

Researchers can play a significant role in helping to combat the illustrated barriers. Creating a diverse team of students, staff, and faculty in a laboratory environment can help to promote diversity in ideas, as well as helping participants of varying backgrounds feel comfortable within the space (Vargas et al., 2023). For Black participants specifically, Black researchers may be able to provide a unique contribution when conducting EEG to make it a positive experience for the participant while also collecting useful data. It also likely would aid in the comfort of participants during the EEG assessment because studies consistently have shown that Black individuals respond differently when the researcher working with them is of the same race (Baratz, 1967; Marx & Goff, 2005; Strickland, 1972; Thorson et al., 2019). Similarly, it can be extremely valuable to have hair care products within the laboratory that are conducive to Black hair. This has the potential to both signify to participants that is an inclusive place and makes the cleanup process less burdensome for participants after the EEG has been completed. In addition to having variety in hair care products, it can be beneficial to have variety in EEG cap sizes and shapes to accommodate Black hairstyles, which may be larger than non-Black hairstyles due to hair thickness, curliness, and the nature of various Black hairstyles themselves. When working on research regardless of the topic, it is valuable to utilize collaboration as a tool to further ensure that a laboratory's studies are inclusive to Black participants. It is valuable to not only collaborate with those who can provide diverse opinions, but also to consult with diversity, equity, and inclusion researchers when able to do so. Consulting with researchers who do focus on diversity work can allow for the integration of contemporary methods of which researchers may not have otherwise been aware.

To address concerns of underrepresentation, researchers can design targeted outreach methods for recruiting Black participants. These can include targeted flyers, advertising within Black communities, building trust with Black community members through connecting with community leaders, and collecting relevant data to know how the Black participants learned about the study (Hatchett et al., 2000; Huan & Coker, 2010; Williams et al., 2013). Targeted outreach can improve the participant experience by communicating that they are wanted and valued in the laboratory space. More broadly, increased representation of Black individuals in EEG research would directly benefit the generalizability of findings and, therefore, support basic and applied neuroscience research efforts within the field at large.

To improve the interpretability of data collected with Black participants, researchers should record all basic demographic information (e.g., race, ethnicity, nationality, age, sex, gender, sexual orientation, ability/disability status, education, and socioeconomic status) regardless of the research project's topic. This serves multiple purposes: collecting demographic information allows for a more comprehensive analysis and understanding of findings. Knowing the percentage of the sample that was Black for example allows others to know if the representativeness of Black people within the sample is comparable to that of Black people in the population, which could speak to the representativeness of the findings and if that is not the case it highlights a potential gap in the literature. In addition, collecting demographic variables allows researchers to evaluate the impact of demographics on any findings of the study (Call et al., 2022). These might include moderation or mediation analyses testing whether findings are consistent or distinct across participant subgroups. Collecting demographic information also allows future researchers to potentially analyze the data or integrate findings intentionally across studies (Gatzke-Kopp et al., 2015). This also allows diversity, equity, and inclusion researchers to monitor representation within the field.

Once a Black participant is scheduled to participate in an EEG study, it may be helpful to communicate to them exactly what the protocol entails and what they can expect. This will allow them to have time to adjust anything with their hair if they choose to do so, and it will allow them to make an informed decision before consenting to participate in the study so that everyone's time is used efficiently. During data collection, it may be beneficial to allot more time for study protocols when conducting EEG on Black participants, to get high-quality data while also maintaining a pleasant experience for the participant.

Following the completion of the EEG protocol with a Black participant, it can be helpful to collect both quantitative and qualitative data regarding the participant experience using self-report measures. Such feedback can inform future practice within the laboratory, as well as methodological guidelines for the field. These measures can include questions about what the participant noticed about the physical space of the laboratory, how they would rate their overall experience, if there was anything they would change about their experience, if they have had an EEG before, and if they would do it again. Having both quantitative and qualitative data will allow researchers the flexibility to consider the specific feedback of the participant while also being able to compare input across participants.

Lastly, for individual researchers to begin to combat the inaccessibility of EEG to Black people, researchers should fund and support technological advances regarding EEG systems (Etienne et al., 2020). Systems that are being developed to accommodate Black hair will have value for Black individuals and individual studies, but these systems also will advance the field at large and provide a more direct path to generalizable findings within the literature.

Recommendations for Funding Agencies

In addition to the impact that can be made by individual researchers, funding bodies can greatly improve the accessibility of EEG for Black people. Most notably, funding agencies should implement strategic funding to support the development of new EEG technology that is more accessible. As mentioned, an example of new technology that is more accessible is the novel electrode system that is being developed by Etienne and colleagues (2020). In this system, field standard 10–20 electrodes are held in place with specialized electrode-bearing hair clips designed to separate the hair and promote consistent connectivity throughout the EEG protocol. These electrodes and other potential new systems would allow those conducting EEG to get higher quality data and to maintain participant comfort, regardless of hair texture or density.

In addition, funding agencies could encourage researchers to use EEG systems that are optimized for the population being studied, as opposed to the common practice of using the same system for every participant receiving an EEG. This would assist in the ease with which researchers are able to get quality data, while also helping to keep the participant comfortable.

Similarly, strategic funding should encourage EEG research within institutions that have adequate access to diverse research participants but inadequate access to such research equipment, such as within historically Black colleges and universities (HBCUs). This matters for several reasons. Firstly, allocating funding to institutions that do not currently conduct EEG research would aid in recruitment of individuals who often are not reached, because recruiting within one's own community helps to combat the mistrust that many Black people feel toward researchers. Black researchers are more likely to know how to navigate working with Black hair. Also, having EEG laboratories in institutions such as HBCUs would improve representation of Black EEG researchers. Lastly, encouraging the establishment of EEG laboratories at HBCUs would also provide research opportunities for undergraduate students, which may help diversify the pipeline of biomedical researchers.

Recommendations for Journal Editors

Journal editors also can aid in making EEG more accessible for Black people by improving publication practices. Specifically, journal editors have the authority to mandate subject characteristic reporting, ranging from basic demographic characteristics (e.g., race) to more nuanced characteristics (e.g., participant hair type) (APA, 2022). It also may be helpful to incorporate relevant information for any participant data that is excluded, the reasons for exclusion, and any substantial barriers that impacted participation. At minimum, it would be beneficial to mandate that published studies include race and ethnicity in their sample characteristics, regardless of whether such variables are formally part of the research questions (McGorray et al., 2023); this information will always be helpful for future research, including reviews and meta-analyses.

A longer-term goal would be to document more details about the EEG process for individual participants. This includes factors such as hairstyles and any modification to the EEG setup and recording process that were made for individual participants. This could help inform differences in data quality that might affect findings. Depending on the journal and the nature of the research, the representation of samples could also be formally included as a review criterion, analogous to the evaluation process of federal research grants. The rationale for participant inclusion and recruitment plans—for Black individuals as well as other minoritized groups—could be documented in supplemental materials and evaluated by reviewers. This is relevant when considering the generalizability of findings, as detailed above.

Conclusion

EEG is among the only noninvasive methods to record human brain activity in real-time, and it plays a critical role in advancing neuroscientific understanding of brain functioning, as well as in medical applications. These efforts are undermined by the systematic exclusion of Black people from EEG research, as well as the use of equipment and methods that are at odds with the profound role that Black hair plays in Black identity. Solutions are readily possible at multiple structural levels. EEG researchers can take concrete action to increase representation of Black research participants, create welcoming laboratory environments, and diversify their research teams. Funding agencies can support the development of new EEG technology that will be optimized for Black people, as well as promoting the expansion of EEG facilities among institutions that primarily serve Black individuals. Journal editors can take action to raise the standards of reporting participant characteristics in EEG research and include participant representation as a review criterion. Together, such efforts will yield immediate and long-term benefits for the broader neuroscience field, as well as improving health outcomes among Black individuals.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Lisa Brown

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Conducting Electroencephalography With Black Individuals: Barriers,Recommendations,and Impact on Generalizability

Abstract

Keywords

Tweet

Key Points

Introduction

The Value of EEG

Technological and Sociocultural Barriers

Research and Clinical Implications

Why Does Generalizability Matter?

Concerns for Recruitment and Participation

Technological Barriers to EEG

Physical Properties of Black Hair

Black Hairstyles

Social and Cultural Barriers to EEG

Distrust of Research and the Medical System

Discomfort With Being Touched

Discomfort With Gel

Policy Considerations

Recommendations for EEG Researchers

Recommendations for Funding Agencies

Recommendations for Journal Editors

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

References