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We aim to (1) evaluate the methods used in systematic reviews of interventions focused on racialized populations to improve racial health equity and (2) examine the types of interventions evaluated for advancing racial health equity in systematic reviews. We searched MEDLINE, Cochrane, and Campbell databases for reviews evaluating interventions focused on racialized populations to mitigate racial health inequities, published from January 2020 to January 2023. We analyzed 157 reviews on racialized populations. Only 22 (14%) reviews addressed racism's role in driving racial health inequities related to the review question. Eleven percent (7) of reviews considered intersectionality when conceptualizing racial inequities. Two-thirds (105, 67%) provided descriptive summaries of included studies rather than synthesizing them. Among those that quantified effect sizes, 54% (21) used biased synthesis methods like vote counting. The most common method assessed was tailoring interventions to meet the needs of racialized populations. Reviews mainly focused on assessing interventions to reduce racial disparities rather than enhancing structural opportunities for racialized populations. Reviews for racial health equity could be improved by enhancing methodologic quality, defining the role of racism in the question, using reliable analytical methods, and assessing process and implementation outcomes. More focus is needed on assessing structural interventions to improve opportunities for racialized populations and prioritize these issues in political and social agendas.

The websites of prominent public health and health care organizations play pivotal roles in ensuring access to quality health information, including information guiding health equity. Several initiatives have been developed in the United States to promote equitable, fair, and inclusive health information and practices across prominent health websites. Currently, health disparities across racial groups are recognized as a critical public health problem. Simultaneously, the use of the term \"racial health equity/equities\" has been rising in academic literature. However, the definition and findability of \"racial health equity/equities\" information have not yet been evaluated in health websites. Thus, we used a systematic review approach to assess the findability and availability of racial health equity terminology and definitions across prominent health organization websites. The objective of this study was to systematically evaluate the definitions and findability of \"racial health equity/equities and related terms\" on prominent health organizations' websites. We conducted a systematic review of websites from government agencies, professional organizations, and selected health care organizations with relevance to the US health care system. Google and the US Digital Analytics program were used for initial searches. Definitions, terms, and accompanying citations for racial health equity terms, including \"racial health inequity\" or \"racial health disparities,\" were extracted from all websites. A findability tool was developed to evaluate the ease of finding the terms and definitions, with ratings ranging from \"very easy\" to \"very difficult.\" Additionally, we analyzed the themes and sentiments of the retrieved definitions. We analyzed 69 websites from prominent health organizations. Approximately half (n=31) of the websites lacked any definitions for racial health equity and related terms, and of the 38 that included definitions, most did not include citations. The definitions varied across websites, and most were rated as \"very difficult\" to find. This study highlights the absence of a systematic, standardized, and accurate approach to organizing, defining, and presenting racial health equity information on prominent health websites. Specifically, there is a lack of consistent definitions for racial health equity and related terms across prominent health organization websites.

Background In the USA, access to quality healthcare varies greatly across racial and ethnic groups, resulting in significant health disparities. A new term, “racial health equity” (RHE), is increasingly reported in the medical literature, but there is currently no consensus definition of the term. Additionally, related terms such as “health disparities,” “health inequities,” and “equality” have been inconsistently used when defining RHE. Methods The primary purpose of this scoping review is to investigate the current use and underlying concepts used to define racial health equity. The study will address two key questions: (1) “What terminology and definitions have been used to characterize RHE?” and (2) “What knowledge gaps and challenges are present in the current state of RHE research and theory?” The review will collect and analyze data from three sources: (1) websites from key national and international health organizations, (2) theoretical and narrative published articles, and (3) evidence synthesis studies addressing interventions targeting racial health equity and minority stakeholder engagement. Discussion Defining “racial health equity” and related terminology is the first step to advancing racial health equity within the USA. This review aims to offer an improved understanding of RHE constructs and definitions, bringing greater unity to national racial health equity research efforts across disciplines. Systematic review registration This protocol is registered with the Open Science Framework at https://osf.io/7pvzq .

This article continues from a prior commentary on evaluating the risk of bias in randomised controlled trials addressing nutritional interventions. Having provided a synopsis of the risk of bias issues, we now address how to understand trial results, including the interpretation of best estimates of effect and the corresponding precision (eg, 95% CIs), as well as the applicability of the evidence to patients based on their unique circumstances (eg, patients’ values and preferences when trading off potential desirable and undesirable health outcomes and indicators (eg, cholesterol), and the potential burden and cost of an intervention). Authors can express the estimates of effect for health outcomes and indicators in relative terms (relative risks, relative risk reductions, OR or HRs)—measures that are generally consistent across populations—and absolute terms (risk differences)—measures that are more intuitive to clinicians and patients. CIs, the range in which the true effect plausibly lies, capture the precision of estimates. To apply results to patients, clinicians should consider the extent to which the study participants were similar to their patients, the extent to which the interventions evaluated in the study are applicable to their patients and if all patient-important outcomes of potential benefit and harm were reported. Subsequently, clinicians should consider the values and preferences of their patients with respect to the balance of the benefits, harms and burdens (and possibly the costs) when making decisions about dietary interventions.

Cardiovascular disease (CVD) is the leading cause of global disease burden and rising health-care costs. Systematic reviews (SRs) rigorously evaluate evidence on health interventions' effects and guide personal, clinical, and policy decision-making. Health equity is the absence of avoidable and unfair differences in health between groups within a population. Assessing equity in lifestyle interventions for cardiovascular health is important due to persisting health inequities in CVD burden and access to interventions. We aim to explore how health equity considerations are addressed in Cochrane SRs of lifestyle interventions for cardiovascular health. This is a methodological review of Cochrane SRs of lifestyle interventions for cardiovascular health using the PROGRESS-Plus framework. PROGRESS-Plus stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, while “Plus” stands for additional factors associated with discrimination and exclusion such as age, disability, and comorbidity. Using predefined selection criteria, two authors independently screened all Cochrane reviews published in the Cochrane Database of Systematic Reviews (CDSR) between August 2017 and December 2022. PROGRESS-Plus factors in the SRs were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence. We included 36 SRs published by 10 Cochrane groups, addressing 11 health conditions with mostly dietary and exercise interventions. The most common PROGRESS-Plus factors assessed were gender/sex, age, and comorbidity. PROGRESS-Plus factors were most addressed in the inclusion criteria (64%), the discussion (75%), and the included studies (92%) sections of the SRs. Only 33% of SoF tables referenced PROGRESS-Plus. Sixty-nine percent of the included SRs planned for subgroup analyses across one or more PROGRESS-Plus factors, but only 43% of SRs conducted subgroup analyses, suggesting limited reporting of PROGRESS-Plus factors in primary studies. Equity factors are not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. Low reporting of PROGRESS-Plus factors in implications for practice and research sections of Cochrane SRs limit equity-focused guidance for current clinical practice, public health interventions, and future research. [Display omitted] •A review of health equity in lifestyle interventions for cardiovascular health.•The most commonly reported PROGRESS-Plus factors were gender, age, and comorbidities. Socioeconomic status, social capital, and the 'plus' factors, were the least reported.•Studies have not explored the intersectionality of the PROGRESS-Plus factors.•Community-based interventions should integrate the PROGRESS-Plus framework into their design.

To identify evidence syntheses of health interventions addressing racial health equity reporting the use of equity-focused frameworks and logic models.OBJECTIVESTo identify evidence syntheses of health interventions addressing racial health equity reporting the use of equity-focused frameworks and logic models.The search strategy included three sources; a search of three bibliographic databases to identify systematic reviews assessing interventions to improve racial health equity, semistructured interviews with diverse group and a targeted organization website searches (eg, National Institute of Health, United States Preventive Services Task Force) to identify relevant logic models and frameworks. The searches were conducted between January 1, 2020, and January 25, 2023. We used a qualitative approach to identify and describe key characteristics of equity-focused logic models and frameworks used in evidence syntheses.STUDY DESIGN AND SETTINGThe search strategy included three sources; a search of three bibliographic databases to identify systematic reviews assessing interventions to improve racial health equity, semistructured interviews with diverse group and a targeted organization website searches (eg, National Institute of Health, United States Preventive Services Task Force) to identify relevant logic models and frameworks. The searches were conducted between January 1, 2020, and January 25, 2023. We used a qualitative approach to identify and describe key characteristics of equity-focused logic models and frameworks used in evidence syntheses.Of the 153 racial health equity-focused evidence syntheses identified, two explicitly used logic models to describe the intervention mechanism. We identified seven existing health equity frameworks from semistructured interviews and electronic search of key websites that were categorized by stated purpose as providing guidance for 1) research, 2) health policy, 3) digital health-care solutions, and 4) clinical preventive services. Two out of seven frameworks included guidance on integrating frameworks or logic models in evidence synthesis while the majority provided contextual information on how to define or consider race or racism as a structural determinant of health.RESULTSOf the 153 racial health equity-focused evidence syntheses identified, two explicitly used logic models to describe the intervention mechanism. We identified seven existing health equity frameworks from semistructured interviews and electronic search of key websites that were categorized by stated purpose as providing guidance for 1) research, 2) health policy, 3) digital health-care solutions, and 4) clinical preventive services. Two out of seven frameworks included guidance on integrating frameworks or logic models in evidence synthesis while the majority provided contextual information on how to define or consider race or racism as a structural determinant of health.There is limited use of logic models and frameworks in evidence syntheses addressing racial health equity. There is a need for more applied frameworks providing guidance for framing, conducting and interpreting findings of evidence syntheses addressing racial health equity.CONCLUSIONThere is limited use of logic models and frameworks in evidence syntheses addressing racial health equity. There is a need for more applied frameworks providing guidance for framing, conducting and interpreting findings of evidence syntheses addressing racial health equity.The goal of this study was to find reviews of health programs that focus on improving racial health equity, and to see if they used special frameworks or models designed to address equity. To do this, we searched three major research databases, conducted interviews with a diverse group of people, and looked at relevant organization websites (like the National Institute of Health and the World Health Organization) between January 2020 and January 2023. We used a qualitative approach to study the key features of these equity-focused frameworks and models. We found 153 reviews focused on racial health equity, but only two of them used logic models to explain the intervention. From interviews and website searches, we identified seven existing health equity frameworks. These were grouped into four categories: research, health policy, digital health care, and clinical preventive services. Only two of these frameworks provided advice on how to use them in evidence reviews, while most focused on understanding how race and racism impact health as a social factor. In conclusion, there is limited use of frameworks and models in reviews about racial health equity. More practical frameworks are needed to help guide the research and interpretation of these reviews.PLAIN LANGUAGE SUMMARYThe goal of this study was to find reviews of health programs that focus on improving racial health equity, and to see if they used special frameworks or models designed to address equity. To do this, we searched three major research databases, conducted interviews with a diverse group of people, and looked at relevant organization websites (like the National Institute of Health and the World Health Organization) between January 2020 and January 2023. We used a qualitative approach to study the key features of these equity-focused frameworks and models. We found 153 reviews focused on racial health equity, but only two of them used logic models to explain the intervention. From interviews and website searches, we identified seven existing health equity frameworks. These were grouped into four categories: research, health policy, digital health care, and clinical preventive services. Only two of these frameworks provided advice on how to use them in evidence reviews, while most focused on understanding how race and racism impact health as a social factor. In conclusion, there is limited use of frameworks and models in reviews about racial health equity. More practical frameworks are needed to help guide the research and interpretation of these reviews.

To identify evidence syntheses of health interventions addressing racial health equity reporting the use of equity-focused frameworks and logic models. The search strategy included three sources; a search of three bibliographic databases to identify systematic reviews assessing interventions to improve racial health equity, semistructured interviews with diverse group and a targeted organization website searches (eg, National Institute of Health, United States Preventive Services Task Force) to identify relevant logic models and frameworks. The searches were conducted between January 1, 2020, and January 25, 2023. We used a qualitative approach to identify and describe key characteristics of equity-focused logic models and frameworks used in evidence syntheses. Of the 153 racial health equity-focused evidence syntheses identified, two explicitly used logic models to describe the intervention mechanism. We identified seven existing health equity frameworks from semistructured interviews and electronic search of key websites that were categorized by stated purpose as providing guidance for 1) research, 2) health policy, 3) digital health-care solutions, and 4) clinical preventive services. Two out of seven frameworks included guidance on integrating frameworks or logic models in evidence synthesis while the majority provided contextual information on how to define or consider race or racism as a structural determinant of health. There is limited use of logic models and frameworks in evidence syntheses addressing racial health equity. There is a need for more applied frameworks providing guidance for framing, conducting and interpreting findings of evidence syntheses addressing racial health equity. The goal of this study was to find reviews of health programs that focus on improving racial health equity, and to see if they used special frameworks or models designed to address equity. To do this, we searched three major research databases, conducted interviews with a diverse group of people, and looked at relevant organization websites (like the National Institute of Health and the World Health Organization) between January 2020 and January 2023. We used a qualitative approach to study the key features of these equity-focused frameworks and models. We found 153 reviews focused on racial health equity, but only two of them used logic models to explain the intervention. From interviews and website searches, we identified seven existing health equity frameworks. These were grouped into four categories: research, health policy, digital health care, and clinical preventive services. Only two of these frameworks provided advice on how to use them in evidence reviews, while most focused on understanding how race and racism impact health as a social factor. In conclusion, there is limited use of frameworks and models in reviews about racial health equity. More practical frameworks are needed to help guide the research and interpretation of these reviews.

To inform methods for centering racial health equity in syntheses, we explored (1) how syntheses that assess health-related interventions and explicitly address racial health inequities have engaged interest holders and (2) guidance for engaging racially and ethnically diverse interest holders. We systematically identified evidence syntheses (searches limited to January 1, 2020, through January 25, 2023) and guidance documents (no search date limits) for this overview. From syntheses we extracted data on engagement rationale and processes and extracted approaches suggested from guidance documents. We summarized findings qualitatively. Twenty-nine of the 157 (18%) eligible syntheses reported using engagement. Syntheses typically lacked robust detail on why and how to use and structure engagement and outcomes/effects of engagement, though syntheses involving Indigenous populations typically included more detail. When reported, engagement typically occurred in early and later synthesis phases. We did not identify guidance documents that specifically intended to provide guidance for engaging racially/ethnically diverse individuals in syntheses; some related guidance described broader equity considerations or engagement in general. This review highlights gaps in understanding of the use of engagement in racial health equity-focused syntheses and in guidance specifically addressing engaging racially and ethnically diverse populations. Syntheses and guidance materials we identified reported limited data addressing the whys, hows, and whats (ie, rationale for, approaches to, resources needed and effects of) of engagement, and we lack information for understanding whether engagement makes a difference to the conduct and findings of syntheses and when and how engagement of specific populations may contribute to centering racial health equity. A more informed understanding of these issues, facilitated by prospective and retrospective descriptions of engagement of diverse interest holders, may help advance actionable guidance and reviews. We identified evidence syntheses (a kind of research that identifies and summarizes findings of individual studies or publications to address research questions) that looked at studies of interventions to improve differences in effects on health for racial or ethnic populations to see (1) if and how they incorporated perspectives of interest holders, people with an interest in the subject being studied; (2) what guidance for how to engage or involve racially or ethnically diverse interest holders exists. We found that 29 of 157 syntheses addressing interventions to improve differences in effects on health reported involving interest holders but typically did not provide much detail about how to involve people. Syntheses that involved Indigenous people usually had more information, but overall, the syntheses did not have much information about how to involve people and what the impact of involving them may be. We did not find guidance information that specifically set out to provide information about engaging racially/ethnically diverse individuals in syntheses; some related guidance described considerations about involving people in syntheses in general. This review highlights gaps in understanding of how to engage people in racial health equity-focused syntheses and in guidance specifically addressing engaging racially and ethnically diverse populations. Syntheses and guidance materials we identified reported limited information about whys, hows, and whats (ie, reasons to use, how to do, and resources needed and effects of) related to engagement, and we lack information to help understand whether engagement makes a difference in doing syntheses and when and how engagement of specific populations may help to address racial health equity. [Display omitted]

In the context of profound and persistent racial health inequities, we sought to understand how to define racial health equity in the context of systematic reviews and how to staff, conduct, disseminate, sustain, and evaluate systematic reviews that address racial health equity. The study consisted of virtual, semistructured interviews followed by structured coding and qualitative analyses using NVivo. Twenty-nine individuals, primarily United States–based, including patients, community representatives, systematic reviewers, clinicians, guideline developers, primary researchers, and funders, participated in this study. These interest holders brought up systems of power, injustice, social determinants of health, and intersectionality when conceptualizing racial health equity. They also emphasized including community members with lived experience in review teams. They suggested making changes to systematic review scope, methods, and eligible evidence (such as adapting review methods to include racial health equity considerations in prioritizing topics for reviews, formulating key questions and searches, and specifying outcomes) and broadening evidence to include designs that address implementation and access. Interest holders noted that sustained efforts to center racial health equity in systematic reviews require resources, time, training, and demonstrating value to funders. Interest holders identified changes to the funding, staffing, conduct, dissemination, and implementation of systematic reviews to center racial health equity. Action on these steps requires clear standards for success, an evidence base to support transformative changes, and consensus among interest holders on the way forward. [Display omitted]

The current literature lacks an established and adoptable definition of “racial health equity.” This study aimed to catalog and evaluate, via thematic analyses, definitions and terminology related to racial health equity across the specific studies from the Robert Wood Johnson Foundation and Cochrane-US (United States) (RWJF-Cochrane) “Centering Racial Health Equity in Systematic Reviews” project and to propose a working definition based on study findings. We employed an integrative review framework to analyze current definitions of racial health equity terms identified within published studies from the RWJF-Cochrane project. Definitions of racial health equity were identified via dual reviewer screening of all identified studies and interview transcripts, which included recent systematic reviews (published since 2020), theoretical and conceptual health literature, and listening exercises with interest holders involved in systematic reviews addressing health equity. Identified definitions were analyzed via thematic coding using the Braun and Clarke framework. We reviewed 157 systematic reviews, 29 interviews, and 16 articles related to racial health equity for the presence of racial health equity definitions. This review resulted in 32 definitions of racial health equity from theoretical and conceptual health literature (n = 16) and interest holder transcripts (n = 16). No systematic reviews contained definitions of racial health equity. Retrieved definitions emphasize equality in health or health care, including outcomes, processes, or care; themes of discrimination in health-care settings; and acknowledgments of the intersections of social determinants of health with health equity. Definitions varied on the role of improving health-care access in achieving racial health equity. A working definition of racial health equity is proposed using common themes identified across definitions. Our findings highlight that a clear and consistent definition of racial health equity will assist researchers, practitioners, and policymakers with developing metrics and interventions aimed at reducing racial health inequities. Thus, we propose a working definition for racial health equity, which emphasizes 1) fairness and justice in health, 2) equality in health outcomes and access across racialized groups, 3) a recognition that social consequences of one's race and/or ethnicity may influence health or the quality of health care received. We also note areas of variability in understandings that require further discussion. •Zero out of 157 systematic reviews defined racial health equity in our analysis.•We identified 32 definitions from 16 articles and 16 interest holder interviews.•Most interest holder definitions emphasized health equality or outcomes.•Structural racism appeared in 10 of 16 article definitions.•We propose a working definition to guide equity-focused research and policy.