A scoping umbrella review to identify anti-racist interventions to reduce ethnic disparities in health and care

Abstract

Structured AbstractObjectivesTo identify anti-racist interventions which aim to reduce ethnic disparities in health and care.Eligibility criteria for selecting studiesOnly studies reporting systematic reviews of anti-racist interventions were included. Studies were excluded if no interventions were reported, no comparators reported, or the paper was primarily descriptive.The following databases were searched: Embase, Medline, Social Policy and Practice, Social care online and Web of Science. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool.Due to the nature of the selected reviews, the lack of meta-analyses and heterogeneity of included studies, a narrative synthesis using an inductive thematic analysis approach was conducted to integrate and categorise the evidence on anti-racist interventions for health and care.ResultsA total of 18 systematic reviews are included in the final review. 15 are from the healthcare sector and three are from education and criminal justice. 17 reviews are focused on interventions and one focused on implementation. All 18 reviews described interventions which targeted individuals and their communities, and 11 reviews described interventions targeting both individuals and communities, and healthcare organisations. On an individual level, the most promising interventions reviewed include group-based health education led by professional staff and providing culturally tailored or adapted interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority groups may provide an effective approach to reducing ethnic health disparities. Targeted interventions to improve clinician patient interactions and quality of care for conditions with disproportionately worse outcomes in ethnic minority groups show promise.DiscussionMany of the included studies were low or critically low quality due to methodological or reporting limitations. The heterogeneity of intervention approaches, study designs, and limited reporting of cultural adaptation, implementation and lack of comparison with White ethnic groups limited our understanding of the impact on ethnic health inequalities.In summary, for programme delivery, different types of pathway integration and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on patient education and individual behaviour change rather than organisational change, and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multi-level approach.