Centring racial health equity in systematic reviews
Although we know the importance of racial health equity, evidence synthesis does not routinely require this to be addressed in research. Highlighting racial equity as part of systematic reviews may play a pivotal role in improving health and healthcare. As systematic reviews often influence clinical practice guidelines, clinical payment decisions, quality metrics, future research and policy development, failing to look at racial equity means that we are further marginalising minority populations and creating health disparities.
In the context of a growing interest in racial health disparities and social injustice in the US following the Black Lives Matter movement, a team was formed within the Cochrane US Network to address this issue. After receiving a US$1,006,828 grant from the Robert Wood Johnson Foundation, a strategic partnership between Cochrane US and other priority stakeholders, such as the US Centers for Disease Control and Prevention (CDC) was formed to lead a research project.
What did we aim to achieve?
The project aimed to create a national consensus on the importance of centring racial health equity in evidence syntheses. We started the project by forming a steering committee of diverse stakeholder voices, such as from patients, clinicians, community organisations, researchers, health systems, policymakers and training institutions. Once this was established, we conducted 28 stakeholder interviews to weigh in on considerations to centre racial health equity in systematic reviews, such as:
- definitions and frameworks
- team structure and inclusion of patients
- questions, evidence and methods
- implementation, dissemination and translation
- measuring success.
Based on these interviews, we were able to establish key themes that helped guide a landscape review. Additionally, we conducted a systematic review of the literature to search for any frameworks that already exist on racial health equity in evidence synthesis, and also any methods for engaging community stakeholders in the review process, which will be followed by a prioritisation exercise.
What did we learn?
The preliminary results suggest that there were key nuances in how racial health equity was defined. Our landscape review on terminology and definitions found that, out of the 29 public health organisations, only five had a definition of racial health equity. When we looked at conceptual and theoretical literature on the topic, we found 17 different definitions with overlapping, but inconsistent themes.
Furthermore, out of the 29 evidence synthesis products that exist for racial health equity and engaged stakeholders, none of the models included a framework for stakeholder engagement. When we looked deeper into this, we found that, of the six frameworks that are currently used for racial health equity, only one framework addressed varied constructs, such as stakeholder identification, recruitment, stakeholder dynamics (at any level) and stakeholder engagement/integration in evidence synthesis or research processes.
Our conversations with stakeholders emphasised how they supported racial health equity in systematic reviews, especially when stark racial disparities were documented.
While the stakeholders we interviewed stated that reviews should focus on effectiveness of interventions, they also pointed to the importance of systematically assessing the context and implications of disparities in etiology, access to care and uptake of interventions.
In addition to this, stakeholders suggested broadening evidence to include qualitative data, in order to provide additional context and background relating to health inequities.
Where do we go from here?
This project will contextualise the understanding of current practices, gaps in methodological guidance and future research directions for centring racial health equity in the US context. Our main goal is to ensure that this work will lead to the development of minimum standards for methods for systematic review research around health equity. In addition, we aim to identify methods and processes that establish evidence utility and primary research on interventions to address racial health equity.
Authors
Tiffany Duque, Mariam Salman.
We would like to thank the Robert Wood Johnson Foundation and Dru Riddle, Meera Viswanathan, Vivian Welch, Patricia Heyn, Damian Francis, Nila Sathe, Amy Lansky, Jennifer Lin, Angela Odoms-Young, Iris Mabry-Hernandez, Richard Morley, Peter Tugwell and the Cochrane US Network team for their contribution towards this project.
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