Applying an Equity Lens to Evidence-Based Preventive Interventions: A Systematic Review of Subgroup Findings from Experimental Evaluations

Abstract

Objective. As racial and ethnic minoritized groups carry the unique burden of structural and systemic racism, they are especially susceptible to adverse outcomes that are in large part due to their social determinants of health. Evidence-based preventive interventions (EBPIs) focused on equity are interventions that are grounded in science derived from high-quality experimental studies shown to: (1) effectively intervene before problems occur or escalate, and (2) reduce disparities. This review explored the prevalence of equity-promoting EBPIs. Methods. We synthesized findings from 292 experimental evaluations of EBPIs published between 2010-2023 (240 conducted in the U.S.) and performed a descriptive analysis to assess: (1) the prevalence of culturally-tailored EBPIs (i.e., interventions designed with consideration of the strengths and experiences of the target population to enhance effectiveness); (2) how frequent tests for subgroup effects were in EBPI evaluations; and (3) whether subgroup findings from EBPIs indicate differential benefits for minoritized groups. Results. We found few culturally-tailored interventions (31%), with 4% evaluating EBPIs developed for African American or Black populations and 1% for Hispanic or Latino youth. In addition, 25% and 15% tested for subgroup effects by race and ethnicity, respectively, with slightly higher frequencies when counting reports that used mixed and non-specified categories such as “non-White” or “minority.” There were also some encouraging findings: (1) EBPIs more often benefited racial and ethnic minoritized groups, and (2) an upward trend was detected in reporting subgroup tests across time. Still, few studies preregistered subgroup tests, causing concerns over cherry-picking results. Conclusions. Currently, limited evidence shows the potential of EBPIs to reduce behavioral health disparities. Investments are needed in community-driven etiological and intervention research addressing behavioral health equity and trials of EBPIs that investigate mitigating disparities.