DiPetrillo et al. Systematic Reviews (2024) 13:266 https://doi.org/10.1186/s13643-024-02679-x
RESEARCH
Systematic Reviews
Open Access
Brooke DiPetrillo1* , Paris B. Adkins-Jackson2, Ruqaiijah Yearby3, Crystal Dixon4,5, Terri D. Pigott6, Ryan J. Petteway7, Ana LaBoy1, Aliza Petiwala1 and Margaret Leonard1
Abstract
Background As a driver of racial and health inequities, racism is deeply ingrained in the interconnected systems that affect health and well-being. Currently, no common frame is employed across researchers, interventionists, and funders to design, implement, and evaluate comprehensive interventions to address racism. Consequently, there is a need to examine the characteristics of interventions implemented in the United States that address rac- ism across social and structural determinants of health and socio-ecological levels. Additionally, we utilized a Health Equity Action Research (HEART) framework to assess how interventions integrate equity principles.
Methods This scoping review examined the characteristics of multi-level interventions that addressed racism
and appraised the interventions using a Health Equity Action Research frame. A comprehensive search strategy was conducted across nine electronic databases between 24 October 2022 through 15 November 2022. Records were included if they were available in English, discussed or evaluated a multi-level intervention or program con- ducted in the United States, and discussed or evaluated the intervention or program regarding the health and well- being of racialized and ethnically minoritized groups.
Results A total of 13,391 records were identified, of which 91 met the eligibility criteria and were included
in the analysis. Most records reported the racialized group impacted by an intervention, of which the majority were racialized as African American or Black (n = 42) and Hispanic or Latino/a/x (n = 18). Eighty-one (89%) of interven- tions reported health outcomes and concentrated on the individual level. Most funders reported across the records, and 86 (51%) were a federal agency or department. A further 43 (25%) were private foundations, 12 (7%) were nonprofit organizations, 10 (6%) were private universities, and 4 (2%) were public universities. Regarding alignment with the HEART framework, 14% of interventions reported a mixed-methods approach, 45% reported community engagement, and less than 1% reported researcher self-reflection.
Conclusions Most interventions prioritized people who are racialized as Black and report health outcomes. Since intervention designs, objectives, and methodological approaches vary, no standard frame defines racism and health equity. Applying the HEART framework offers a standard approach for interventionists and researchers to examine power, integrate community voice, and self-reflect to advance health equity.
Keywords Racism, Intervention, Health equity, Social and structural determinants of health
*Correspondence:
Brooke DiPetrillo
bdipetrillo@gsu.edu
Full list of author information is available at the end of the article
© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
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Background
Current literature has shown that racism is a driver of racial health inequities [1, 2]. Over 100 years ago, DuBois (1901) denounced race as a biological trait, demonstrat- ing how socially constructed racial hierarchies system- atically disadvantaged people racialized as Black while advantaging people racialized as White. While there are numerous definitions of racism, we define racism as “an organized structure in which the dominant racial group, based on an ideology of inferiority, categorizes, and ranks people into social groups called ‘races’ and uses its power to devalue, disempower, and differentially allocate valued societal resources and opportunities to groups defined as inferior [3].”
Racism is deeply ingrained within and across intercon- nected systems that impact health and well-being. These social and structural determinants of health include employment, housing, education, health care, crimi- nal justice, and voting [2]. Individuals who are racially or ethnically minoritized experience discrimination and stigma when seeking and receiving treatment for depres- sion and mental health [4], reproductive and perinatal care [5], and chronic disease care [6, 7], among others. Financial institutions and the housing system excluded racialized and minoritized people from accessing qual- ity, affordable housing, which is attributed to historical and contemporary racial segregation [8, 9]. In the 1930s, redlining housing practices shaped neighborhood devel- opment, home values, and access to home loans, impact- ing where people live and the neighborhood’s economic value today [10]. Additionally, racialized and ethnically minoritized people are systematically excluded from vot- ing, which sustains and perpetuates the systemic inequi- ties described above [11, 12].
Despite extensive evidence illustrating how racism is inextricably intertwined with culture, systems, and institutional practices, there is limited information on the impact of interventions adopted to address racism. Contemporary interventions are primed and funded to address a single outcome within a specific group dur- ing a particular period, even though research shows that racism is fostered through mutually reinforcing systems [2]. Thus, researchers and critical race theorists advo- cate for multi-level, multi-sectoral, and multigenera- tional approaches to address racism across reciprocal and dependent systems [13]. To date, much of the literature focuses on identifying and describing racial and ethnic health inequities, with a limited scholarly focus on the role interventions play in addressing racism and advanc- ing equity. This study aims to examine the characteristics of multi-level interventions that address racism. Since intervention designs, objectives, and methodological approaches vary, no standard frame defines racism and
health equity. Therefore, we applied the Health Equity Action Research Trajectory (henceforth, HEART) frame- work to explore how equity principles informed interven- tion design and research related to health inequity [13].
Methods
This systematic scoping review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) extension for Scoping Reviews (PRISMA- ScR) [14] (Supplementary file 1). Details on methods can be found within the pre-registered protocol at OSF Reg- istries https://doi.org/10.17605/OSF.IO/E2FSG [15].
This systematic scoping review sought to answer the following research questions:
1. What are the characteristics of interventions that address racism in the United States?
2. What do these studies tell us about interventions addressing racism across social and structural deter- minants of health and various socio-ecological levels?
3. What are the gaps in how interventions are imple- mented?
4. To what extent do interventions incorporate the following core equity principles: mixed-methods research, elevating community voice and perspective, and practicing self-reflexivity?
Scoping review team
The study team included six reviewers, a method expert, and four subject matter experts. Six reviewers screened and coded relevant literature. The method and sub- ject matter experts supported the development of the study protocol and procedures and ensured the cred- ibility, validity, and integrity of the research process. The reviewers included author positionality statements (Sup- plementary file 2) to disclose characteristics influencing how they might interpret data and findings. All review- ers identify as cisgender women: one is a first-generation Indian American, one is Kenyan, one is Puerto Rican, and three are racialized as White. Four reviewers are trained in social work, two in public health, and four in mixed- methods or qualitative research.
Search strategy
The literature search was conducted between October 24, 2022, and November 15, 2022. Multidisciplinary aca- demic databases were searched for peer-reviewed and unpublished dissertations and theses, including PubMed, CINAHL Plus, APA PsycINFO, Business Source Com- plete, Sociological Collection, Race Relations Abstracts, and Web of Science. Searches for dissertations and the- ses were conducted through ProQuest Dissertations &
DiPetrillo et al. Systematic Reviews (2024) 13:266
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Theses A&I. Additional records were obtained through citation mining of relevant studies during screening and among the references of the articles that met the study inclusion criteria.
Search terms and selection process
The research team consulted with two librarians, one specializing in public health research and the other in sociology, to ensure an intersectoral approach. Terms related to poverty, socioeconomic status, marginaliza- tion, privilege, and social disadvantage were too broad and more likely to be associated with research that did not include an intervention and, thus, were omitted. The following search terms were used: (“Health Equity” OR “Health Inequity” OR “Social Determinants of Health” OR “Determinants of Health” OR “SDOH” OR “Healthcare Disparities” OR “Health Status Disparities” OR “Minority Health” OR “systemic racism” OR “minority healthcare” OR “minority health system” OR “institutional racism” OR “structural racism”) AND TX (methodologies OR policy OR “public policy” OR methods OR interventions OR programs) (Supplementary file 3).
Article eligibility criteria included the following: (1) conducted in the United States; (2) included racial- ized and ethnically minoritized groups; (3) included a multi-level intervention (e.g., program, policy, practice) that focused on at least two socio-ecological levels (e.g., individual, family, community); and (4) were available in English. We excluded study protocols or literature that described a theoretical model or framework but did not include an intervention.
Citations were managed in EndNote 20. Rayyan was used for abstract and full-text screening [16]. Six inde- pendent reviewers screened abstracts (n=11,005) in Rayyan. Two reviewers double screened 15% of titles and abstracts (n=1650) for reliability using a title and abstract screening. After screening, three independent reviewers examined full-text articles (n = 514) for eligibil- ity using a full-text review tool. Two reviewers examined 20% of full-text articles (n=103) for reliability. All disa- greements between reviewers were resolved through dis- cussion until a consensus was reached.
Data extraction
Ninety-one records met the study eligibility and were coded in Qualtrics [17] and analyzed in Excel [18]. All reviewers participated in developing the codebook and defining the variables, including record, sample, and intervention characteristics (Supplementary file 4). For this study, social determinants of health refer to the essential conditions for all people to live, develop, grow, and thrive (e.g., education, employment, housing, food, safety). Structural determinants of health include social
and cultural norms, laws, policies, regulations, prac- tices, and the institutions that govern and impact how resources are distributed and how people access and engage with the social determinants of health [19]. We used the Vital Conditions for Health and Well-Being Framework [20] to define social and structural determi- nants of health, including (1) housing; (2) social belong- ing and civic muscle; (3) lifelong learning; (4) natural environment; (5) employment and wealth; (6) basic needs (e.g., food, public safety, and health); and (7) transpor- tation. To address our research objectives, we added a category, politico-legal, to capture the structural deter- minants of health defined as the political process, laws, regulations, policies, guidance, advisory opinions, cases, budgetary decisions, practices, and process of or fail- ure to enforce the law [21]. The intervention levels align with the socio-ecological model and include the follow- ing: (a) individual (e.g., intrapersonal); (b) interpersonal (e.g., relationships, interactions between individuals or groups of people); (c) community (e.g., settings where social interaction occur including neighborhoods, schools, church, work, places or recreation); (d) institu- tional (e.g., organizational level, education, healthcare, financial, banking); (e) structural and environmental (e.g., politico-legal processes that govern the built and natural environment); (f) structural and law/policy (e.g., political process, statue, budgetary decision, regulation, enforce- ment, compliance; and (g) structural and economic (e.g., policies and laws that impact economic stability, financial security) [22]. Intercoder reliability was conducted con- tinuously throughout the development of the codebook and the coding process. Discrepancies were resolved by consulting the codebook and through discussion.
Drawing on the foundational elements of HEART [13], which underscores the integration of core equity prin- ciples to drive long-term equity advancing research, we evaluated how interventions were conceptualized, implemented, or evaluated using the equity principles illustrated in the framework. Those equity principles included community engagement, a mixed-methods approach, and researcher self-reflexivity. Mixed-meth- ods approaches are included as an equity principle as an analytical approach to obtain, analyze, and synthesize information holistically to elevate multiple perspectives and encourage a critical reflection of various data points. Coders extracted statements from the records where authors reported any level of community engagement. Data extraction variables can be found on the project’s Open Science Framework page https://osf.io/7e9dj.
Qualitative content analysis
A qualitative content analytic approach identified themes regarding community engagement [23]. Community
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engagement includes any level of engagement with com- munity members and people with lived experiences from input to ownership [24]. Three reviewers examined state- ments extracted during data abstraction and identified relevant words or phrases to describe community inter- actions. Topics and phrases were grouped and defined based on their similarity.
Evidence and gap map
To ensure that the information from this study was acces- sible to the public, practitioners, and researchers, we created an interactive evidence and gap with our results available at https://ghpc.gsu.edu/project/evidence-and- gap-map/. Records were imported into EPPI-Reviewer [25] and were coded for outcomes and characteristics of interventions, including (1) geographic location; (2) socio-ecological levels; (3) race, ethnicity, and national origin of the intervention sample (e.g., National Insti- tute of Health categories); (4) federally protected groups (e.g., children, people with a disability); (5) overall find- ings (e.g., outcomes improved, no change); and (6) study design (e.g., qualitative, impact evaluation, review, obser- vational, pilot).
Results
Study selection
Database searches yielded 13,391 records, of which 2386 were duplicates. We double screened 11,005 records. Abstract screening generated 514 records that advanced to the second round of screening, 55 of which met eli- gibility criteria. Citation mining produced 36 additional records. The final set of included records was 91 (Fig. 1) [26].
To address our first research question about the char- acteristics of interventions that address racism, we described the records, implementation sites, the groups experiencing the intervention, the frameworks employed, funding sources, and the study design.
Study characteristics
Most records (n=48, 47%) were published on or after 2018, of which 88% (n=80) were peer-reviewed, 8% (n=7) were dissertations, and 4% (n=4) were reports. Most interventions within the records included in this study were implemented nationally (n=22, 24%). Three (3%) interventions were implemented in Native Ameri- can Reservations shown in Table 1.
Fig. 1 Preferred reporting for systematic reviews flowchart
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 5 of 23
Table 1 Intervention characteristics, determinants of health, levels, and equity principles across studies (n = 91)
Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ sample
Intervention name
Place Method Housing Belonging and civic
Education
Natural environment
Work and wealth
Food
Public Health safety
Schorling, 1997
PR
B/AA
Alliance of Black Churches Health Project
VA I X
X
Bloom, 2000
R
Low income
Florida’s Family Transition Program
FL P
X
X
Yanek, 2001
PR PR
B/AA B/AA
Project Joy
MD I X NC I X
X X
Margolis, 2001
Linkages for Pre- vention
Bloom, 2002
R PR PR PR
Low income B/AA
B/AA
Low income
Jobs First
NR
Project Sugar 1
CT I
MD I
MD I
NAT RE X X
X
X
Hill, 2003
X
Gary, 2003
X XX X
Anderson, 2003
Mixed-income housing, tenant- based rental assistance
X
Resnicow, 2004
PR B/AA
Body and Soul
CA, GA, NC, I SC, DE, VA
X X
Marcus, 2004 DeBate, 2004 Brown, 2006
PR B/AA PR B/AA PR B/AA
Project Bridge
TX I X NC Q
MI I X
X X X
Stahler, 2007 Fuller, 2007
PR B/AA PR B/AA,
Bridges
NR I NY I
X X
Goldfinger, 2008
PR B/AA PR B/AA,
Project HEAL
X IX X
Foster, 2008
H/L
School Nutrition Policy Initiative
NY P PA
H/L
Expanded Syringe Access Demonstration Program
Charlotte REACH
Faith-Based Net- work Detroit
muscle
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 6 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention Place Method sample name
Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food
Public Health safety
Schensul, 2009
PR PR
B/AA, H/L Vaccinate CT I for influenza
prevention
X X
Berg, 2009
B/AA, H/L Youth Action CT I Research for Pre-
vention
X
Strull, 2010 Lasser, 2011
PR PR PR
Low income Earned Income NAT I Tax Credit
X X X
Pizacani, 2012
Low income Smoke-free OR I policy, Oregon
Tobacco Quit Line
Beck, 2012 Tauras, 2013
PR PR PR
Low income Medical-legal OH DS partnership
X X X
Grubbs, 2013
B/AA Delaware Colo- DE I rectal Cancer
Screening Program
Klein, 2013
PR
Low income B/AA, H/L
Cincinnati Child OH Health-Law Partnership
DSX X X I
DS
I
X
Sekhobo, 2014
PR
NYC Article 47 NY Childcare Regu- lations
X
Patton, 2014
PR
B/AA
State Offices NAT of Minority
Health
X
Hussein, 2014
D PR
Older adults, PWD, ESRD
Medicare Part D NAT
X X
Chung, 2014
B/AA, H/L
Community CA Partners in Care
I
B/AA, IM Patient naviga- MA I tors
X
B/AA, H/L Tobacco control NAT DS policies
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 7 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention Place Method sample name
Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food
Public Health safety
Beck, 2014
PR
Low income Keeping Infants OH I Nourished
X
X X
Patler, 2015 Kuo, 2015
R PR
H/L Deferred Action NAT I for Childhood
Arrivals
X X
X X
Hoynes, 2015
PR
Low income Earned Income NAT I Tax Credit,
X
Douthit, 2015
PR
RU ACA NAT RE
X
Cobb, 2015 Adams, 2015
PR PR
B/AA WIC MD I
X
X X
Riley, 2016
PR PR PR PR PR
BIPOC Expanded medi- MI I cal home
X X X
Brotman, 2016
B/AA, H/L ParentCorps NY I
X
Neelon, 2016
Low income ABC Childcare SC I Program
X
Anyon, 2016 Patzer, 2017
BIPOC Restorative CO DS interventions
X
Guarneros, 2017
D
Young Deferred Action CA Q adults un- for Childhood
documented Arrivals
X
X
and Developing
BIPOC Pathways CA DS for Students
into Healthcare Professions
OBRA 1993 EITC Reform
Older adults, Medicare Part D NAT I PWD, ESRD
B/AA Reducing GA I Disparities In
Access to kidNey Transplantation Community Study
X
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 8 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention sample name
Place Method
Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food
Public Health safety
Grumbach, 2017
PR
B/AA, H/L, A San Francisco Health Improve-
CA I
X
Minkler, 2018
PR
Low income, Healthy Food UR Retailer Incen-
CA I
XXX X
Lachance, 2018
PR
B/AA National Kidney Foundation
MI I
X
X
Lee, 2018
D PR
B/AA, H/L ACA Medicaid expansion
NAT I OR I
X X
McConnell, 2018
B/AA, AI/AN Coordinated Care Organiza-
tions and Medic- aid Program
Findling, 2018
D PR
Low income Supplemental Nutrition Assis- tance Program
NAT I VA I
X X X
Collins,2018
BIPOC Care and Pre- vention
in the United States Demon- stration Project
Chi, 2018
PR
AN Dental Health Aide Therapists
AK DS
X
Bagchi,2018 Angier, 2018
PR D
Older adults NR
NJ P
X X
Allen, 2018
PR
AN Qungasvik ( Toolbox)
AK I
X
X
Low income ACA Medicaid expansion
CA, HI, MD, I MI, NM, OH,
RI, WA, WI
ment Partner- ship
tive Program Ordinance
of Michigan Intervention Programs
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 9 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention sample name
Place Method
Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food
Public Health safety
Titus, 2019
PR
People who Smoke-free laws smoke,
exposed
to smoke
NAT DS
X
Mauller, 2019
PR
B/AA
Policies
that focus
on food access, physical activity, and tobacco use
D.C. IXX
Larzelere, 2019
PR
AI
Arrowhead Busi- ness Group
Fort Apache IXXX Indian Reser-
vation
X
King, 2019
PR
B/AA
Attack infant mortality
FL I
X
Han, 2019
PR PR
B/AA
Plan 4 Success
MD P NAT I
X X
Himmel- stein, 2019
Low income, Medicaid eligible
ACA Medicaid expansion
Guh, 2019 Fuller, 2019
PR PR
BIPOC B/AA, H/L
NR
WA IX
MD IXXX
X X
Babagoli, 2019
PR
BIPOC
Citi Bike NYC bike share program
NY DS
X
Stacy, 2020 Sisson, 2020
PR PR
B/AA AI
Transform Baltimore
MD IX
Reininger, 2020
PR D
H/L
Low income
Salud y Vida 2.0 NR
TX I X NAT IX X
Lacko, 2020
Moving
to opportunity
USDA Child and Adult Care Food Program, Food Resource Equity and Sus- tainability
for Health
Osage IX X Nation
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 10 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention sample name
Place Method
Housing
Belonging Education Natural Work and and civic environment wealth muscle
Food
Public Health safety
Kruse, 2020
PR
BIPOC Realizing Educational Attainment and Careers
NR I
XXX
Guth, 2020
R PR
Low income ACA Medicaid expansion
NAT RE MO I
X X
Barnidge, 2015
B/AA Men
on the Move
X
Goodkind, 2020
PR PR
IM Refugee Well- Being Project
NR I NC, PA I
X
X X
Cykert, 2020
B/AA Accountability for Cancer Care through Undo-
ing Racism and Equity
Titus, 2021
PR
People who Smoke-free laws smoke,
exposed
to smoke
NAT DS
X
Sous, 2021
PR PR
IM I-Care
NY I CA I
X X
Sanchez- Vaznaugh, 2021
B/AA, A, H/L State nutrition policies, National
Healthy Hunger Free Kids Act
Lohr, 2021
PR
H/L Linking Indi- vidual Needs
AZ DS
X
X
Goodman, 2021
PR
A,B/AA, H/L
San Francisco Paid Parental Leave Ordinance
CA IX
in Healthcare
Growing Com- munities
to Community and Clinical Services
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 11 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention sample name
Place Method
Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food
Public Health safety
Collie-Akers, 2021
PR
Pregnant Institute
women, for Equity in Birth postpartum Outcomes women,
infants
CA, MD, OH, I FL, TN, WA
X
Casillas, 2021
PR PR
H/L Fotonovela inter- vention
CA P
X X
Taniguchi, 2022
AI Food Resource Equity and Sus-
tainability for Health
Osage I Nation
X
Rodriguez, 2022
PR PR
Low income, Oregon Repro- IM ductive Health
OR I NAT I
X X
Pearlman, 2022
B/AA
Minimum wage, earned income tax credit, AFDC/ TANF, housing assistance, Med- icaid/CHIP
XX
XX
Nguyen, 2022
PR PR PR PR D PR
A
AI
B/AA B/AA B/AA, H/L IM
ACA
CA I MT I MI P NAT RE NAT I CA I
X X X X X X
Larsson, 2022
Caring for Our Own Program
XX
X
Janevic, 2022
Positive STEPS
Snowden, 2022
ACA Medicaid expansion
Lieff, 2022
ACA Medicaid expansion
Porteny, 2022
ACA, CA state, and county policies
Corbie, 2022 Casey, 2022
PR PR
BIPOC B/AA, H/L
Clinical Scholars National Leader- ship Institute
NAT NAT
IX DS
X
Equity Act
Community Reinvestment Act
X
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 12 of 23
Table 1 (continued) Intervention characteristics
Social and structural determinants of health
First author, year
Type
Population/ Intervention sample name
Place Method Housing
Belonging and civic muscle
Education
Natural environment
Work and wealth
Food Public Health safety
Assoumou, 2022
PR
B/AA, H/L Boston Medical College COVID
Response Program
MA I
X
Francis, 2023
PR
AI/AN Indian Child Welfare Act
NAT RE
X X
Intervention characteristics
Social and structural Socio-ecological levels determinants of health
Equity principles Multi-sector
First author, year
Transportation
Politico-legal Individual
Inter-personal Community Institutional
Structural env.
Structural law/ policy
Structural economic
Community Mixed engagement methods
Self-reflection
Schorling, 1997
X X X
X
X
Bloom, 2000 Yanek, 2001 Margolis, 2001 Bloom, 2002 Hill, 2003
Gary, 2003 Anderson, 2003 Resnicow, 2004 Marcus, 2004 DeBate, 2004 Brown, 2006 Stahler, 2007 Fuller, 2007 Goldfinger, 2008 Foster, 2008 Schensul, 2009 Berg, 2009 Strull, 2010 Lasser, 2011 Pizacani, 2012 Beck, 2012 Tauras, 2013
X X X X X X
X X X X X X
X X
X X
X X X X
X
X X X X X
X X X X X
X X X X X
X
X X X
X X
X X
X X X X X X X X X X X X X X X X X X X
X X X
X X X X X X
X X X
X
X
X
X
X
X
X X
X X
X X X
X
X
X
X
X
X X X X
X X X X X
X X
X
X
X
X X
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 13 of 23
Table 1 (continued)
Intervention characteristics
Social and structural determinants of health
First author, year
Transportation
Structural env.
Structural law/ policy
Structural economic
Multi-sector Community Mixed Self-reflection engagement methods
Grubbs, 2013 Klein, 2013 Sekhobo, 2014 Patton, 2014 Hussein, 2014 Chung, 2014 Beck, 2014
X X X X X X
X
X X X X X
Patler, 2015
X X
X X X
X
X X X
Kuo, 2015
X X X X
Hoynes, 2015
X X
X X X X X X X X
Douthit, 2015
X X X
X X X X
Cobb, 2015
Adams, 2015
Riley, 2016
X X X X X X X X X X X X X X X X
X
Brotman, 2016
X
X
X
X X X
Neelon, 2016
X X
Anyon, 2016
Patzer, 2017
Guarneros, 2017
X X
X X X X X X X
X X
X X
Grumbach,2017
X X
X X X X X
Minkler, 2018
X
Lachance, 2018
X X X
Lee, 2018
X XXXXX
X X XXX
McConnell, 2018
Findling, 2018 Collins,2018
Chi, 2018 Bagchi,2018
Angier, 2018
Allen, 2018
Titus, 2019
Mauller, 2019 X
X X
X X X
X X
Socio-ecological levels
Politico-legal Individual Inter-personal Community Institutional
Equity principles
X X X
X X X X X
X X X
X X X
X X X X
X X X X
X
X X
X X
X X X X X X
X X X
X
X
X X X
X X X X X
X
X X X
X X
X X
X
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 14 of 23
Table 1 (continued)
Intervention characteristics
Social and structural determinants of health
First author, year
Structural env.
Structural law/ policy
Structural Multi-sector Community
Larzelere, 2019 King, 2019 Han, 2019
X X X X X X X X
X X X X
Himmelstein, 2019
X X
X
X
Guh, 2019
X X X X X X
X
X
X
X
X X
Fuller, 2019
X
Babagoli, 2019
X X X
X X X X X
Stacy, 2020
X
Sisson, 2020
X X
Reininger, 2020
X X X X X
X
Lacko, 2020
X X
X
X
X
X X X X
Kruse, 2020
X X X X X
Guth, 2020
Barnidge, 2015
X X
X X X
X X X
Goodkind, 2020
Cykert, 2020
X X
Titus, 2021
X X X X X X X X
X
X
Sous, 2021
Socio-ecological levels
Transportation Politico-legal Individual Inter-personal Community Institutional
Equity principles
Sanchez-X
XXX
X X
Vaznaugh, 2021
Lohr, 2021 X X X
Goodman, 2021 X X X
X
X
X X
Collie-Akers, X X X X X 2021
Casillas, 2021 X X
Taniguchi, 2022 X X X X
X
X X X
Rodriguez, 2022 X X
Pearlman, 2022 X X
Nguyen, 2022 X X
Larsson, 2022 X X X
X X X X X
X
X X X X
Janevic, 2022 Snowden, 2022 Lieff, 2022 Porteny, 2022
X X X
X
X
X X
X
X X X
X X X
X
X X
Mixed economic engagement methods
Self-reflection
DiPetrillo et al. Systematic Reviews (2024) 13:266 Page 15 of 23
Table 1 (continued)
Intervention characteristics
Social and structural determinants of health
Socio-ecological levels
Equity principles
First author, year
Transportation
Politico-legal
Individual
Inter-personal
Community Institutional
Structural env.
Structural law/ policy
Structural economic
Multi-sector Community engagement
Mixed methods
Self-reflection
Corbie, 2022
X X
X
X X X X X X
X X
X
Casey, 2022
X
X
Assoumou, 2022
X
Francis, 2023
X
X
X
X
PR peer-reviwed, D dissertation, R report, AI American Indian, AN Alaska Native, H/L Hispanic/Latino(a), B/AA Black/African American, BIPOC communities of color or populations that are historically racially and ethnically minoritized, A Asian (including Asian American), IM immigrants, low income families with low income, PWD people with disabilities, RU rural resident, UR urban residents, ESRD people with end-stage-renal disease, ACA
Patient Protection and Affordable Care Act, WIC Program for Women, Infants and Children, NAT nationwide, RE review, I impact evaluation, DS descriptive
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Most records reported the racialized group impacted by an intervention, of which the majority were racial- ized as African American or Black (n = 42) and His- panic or Latino/a/x (n = 18). Eight records reported that their intervention impacted people racialized as American Indian/Alaska Native, and four records reported their intervention prioritized people racial- ized as Asian/Asian-American. Some records used the terms “racially or ethnically minoritized” or “his- torically disadvantaged” to describe the participants or program recipients (n = 8).
We observed that the term “low income” has his- torically been used in research as a proxy to describe racialized and minoritized groups. At other times, “low income” was used to describe eligibility criteria for a federal program (e.g., SNAP, WIC). In other cases, the term “low income” may have been used instead of describing or naming the race of a group of people par- ticipating in a program or intervention. To that end, 17 records reported participants were from families with lower incomes (e.g., at or below the federal poverty level), and 6 records reported that the intervention par- ticipants or program recipients were refugees, immi- grants, or undocumented individuals.
Few records described primary intervention par- ticipants or program recipients as individuals who required specialized care, including people with dis- abilities and people experiencing end-stage-renal dis- ease (n = 2) or people who smoke or were exposed to secondhand smoke (n = 2). Few records described the primary intervention participants based on where they live or age and stage in life. Among those that did reported urban residents (n = 2), rural residents (n = 1), older adults (n = 3), and pregnant women, postpartum women, and infants (n = 1) (Table 1).
Frameworks employed in the intervention
Most records (n = 56, 62%) did not report a theoretical or conceptual framework. Among the 35 (38%) records that reported a framework, 7 (20%) reported using an ecological framework, 4 (11%) reported using the Behav- ioral Model of Health Care Utilization, 4 (11%) included a conceptual model that was developed for the interven- tion, and 4 (11%) utilized a social cognitive model. The remaining frameworks were employed 2 (5%) or fewer times (less than 1%). Several frameworks named some aspects of racism, including the Institute of Medicine’s strategies and approaches for addressing racism in healthcare settings [27], People’s Institute for Survival and Beyond Undoing RacismTM, critical transformative theories, and racist nativism (Supplemental file 5).
Funding
Among the 91 included studies, funders were reported 170 times. Thirty-five (39%) records reported multiple funders. Nineteen (10%) records did not report funding or reported that their study was not funded. Most funders were a fed- eral agency or department (n = 86, 51%). Private founda- tions were reported 43 times (25%). Further, 12 (7%) were nonprofit organizations, 10 (6%) were private universi- ties, and 4 (2%) were public universities. Other funders included state agencies (n = 4, 2%), independent agencies (n = 4, 2%), and corporations (n = 2, 1%). The following funders were referenced once (0.6%): city, individual, and public/private hospitals. Table 2 displays the number and percentage of funding sources across the interventions.
Study design
Sixty-six (73%) interventions were reported to have con- ducted an impact evaluation (e.g., a randomized control trial, quasi-experimental). Twelve (13%) interventions included a descriptive study (e.g., cross-sectional), and 6 (7%) interventions reported a pilot study. Five (5%) interventions conducted a review of the literature (e.g., systematic, scoping), and two (2%) interventions were qualitative.
To address the second and third research questions regarding what these studies tell us about interventions that address racism across social and structural determi- nants of health as well as socio-ecological levels and the gaps, we report the number of interventions that operate at each socio-ecological level and across the seven vital conditions for health and well-being domains.
Socio-ecological levels
All interventions within the included records were multi-level, as this was a criterion for study inclusion. Most interventions focused on the individual level (89%, n=81). Fifty-one (56%) interventions focused on the community level, while 50 (55%) addressed the inter- personal level. Fifty (55%) interventions focused on the institutional level. Whereas 25 (27%) addressed the struc- tural (e.g., law, policy) elements, 22 (24%) addressed the structural-economic component, and 2 (2%) focused on structural-environmental factors (Table 1). Twenty-two interventions (24%) addressed 2 distinct levels, 43 (47%) of interventions targeted 3 levels, 22 (24%) of interven- tions concentrated on 4 levels, and 4 (5%) of interven- tions included 5 levels.
Examples of individual-level interventions included training, professional development, or skills building to strengthen knowledge on a particular health-related topic [28–30]. Other individual-level interventions were designed to impact or assess individuals’ experiences or
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Table 2 Number and percentage of funders reported across interventions (n = 170)
smoke-free and tobacco control policies [43] on indi- vidual or population health outcomes. Other records examine how laws and policies impact racial inequi- ties or access to services and resources [44, 45]. Cases of structural-level (economic) interventions include laws, policies, or regulations that incentivize access to healthy foods [38, 46, 47] or bolster individual or household eco- nomic stability [33, 48–50]. Examples of structural-level (environmental) interventions examine policies that increase access to parks and green space [47] or how zon- ing ordinances shape the neighborhood-built environ- ment [51]. Table 3 shows examples of interventions by socio-ecological level (Table 3).
Systems
Interventions mainly reported health outcomes (n=81). Forty interventions were reported addressing a politico- legal aspect. Across the interventions, 16 address educa- tion, 15 focus on work and wealth, 15 focus on belonging and civic muscle, 11 address food systems or nutrition, 4 report on housing, 4 report on public safety, 2 on trans- portation, and 1 on the natural environment (Table 1).
To address the fourth research question regarding how interventions incorporated core equity principles in their conceptualization, implementation, or evaluation, we report the number of interventions that employed a mixed-methods approach, community engagement, or researcher self-reflexivity.
Thirteen (14%) interventions reported a mixed-meth- ods approach. Forty-one (45%) interventions engaged communities in the research process (Table 1). Sev- eral categories emerged from the 41 interventions that reported a community engagement aspect.
Community engagement
Nine (22%) interventions reported establishing a com- munity board (e.g., advisory council, coalition), and nine (22%) reported partnering with a community-based organization. Seven (17%) reported employing com- munity health workers, and 4 (10%) reported employ- ing capacity building or training as a form of community engagement. Three (7%) named a specific partnership (e.g., community-academic, clinical-community).
Several interventions reported a specific role played by a community member. Twenty-one (51%) described community involvement supporting project design or implementation. Roles associated with project design and implementation were grouped into the following subcat- egories: (1) intervention planning or conceptualization of a project or strategy (e.g., consultation, design); (2) lead- ership and accountability during the project cycle (e.g., culturally appropriate content, budget oversight); and (3) research and evaluation (e.g., monitoring and evaluation,
Funding source
Federala
Private foundationb Nonprofit organizationc Private universityd Public universitye
Statef
Independent agencyg Corporateh
City
Individual Public/private hospital
Thirty-five records reported multiple funders
Number (%)
86 (51) 43 (25) 12 (7) 10 (6) 6 (4)
4 (2) 4 (2) 2 (1) 1 (0.6) 1 (0.6) 1 (0.6)
a Health and Human Services was the most referenced federal funding source. The Department of Agriculture and the Department of Education were also mentioned
b Robert Wood Johnson Foundation was the most referenced private foundation. Other private foundations named as founders included the Annie E. Casey Foundation, Smith Richardson Foundation, David and Lucile Packard Foundation, Edna McConnell Clark Foundation, and Geroge Gund Foundation
c American Cancer Society, American Heart Association, and Patient-Centered Outcomes Research Institute were referenced as funders multiple times. The other nonprofits were mentioned once
d Johns Hopkins University was the most referenced private university funder e University of California was the most referenced public university funder
f All state funders were unique
g Independent agencies include the National Science Foundation, the Institute of Education Sciences, and the Corporation for National and Community Services
h Corporations referenced as funders include Procter & Gamble and Barclays Bank
practices around contraceptive use [31], food prepara- tion and diet [32], or parental leave [33]. Cases of inter- personal level interventions include interactions with a community health worker [30], health advisor [34, 35], or navigator [36] to access information, services, or resources. Other examples include peer mentoring [28, 37] and group training guided by a health professional [29]. Community-level interventions may include those implemented in community-based settings [38, 39], in churches within the faith-based community [28], and in neighborhoods [34, 40]. Examples of institutional- level interventions include changes to protocols, poli- cies, and practices within schools or childcare settings [29, 41], integrating culturally responsive practices in a nurse training curriculum [37], embedding anti-racist approaches in medical residency training curriculum and rank/tenure systems [42], and employer-based parental leave policies [33].
Records that demonstrate structural-level (law/policy) interventions include those that examine the impact of laws and policies, including Medicaid expansion [32] and
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Table 3 Examples of intervention approaches by socio-ecological level (n = 91)
Individual level
Interpersonal level
Community level
Institutional level
Structural level (law/policy)
Structural level (economic)
Structural level (environmental)
All interventions were multi-level
dissemination). Fourteen (34%) reported using commu- nity-based participatory research approaches.
Policy, advocacy, and self-reflexivity
Few interventions (n=2, 5%) reported how community engagement supported a policy outcome. In one exam- ple, community members played a role in passing an
• Web-based training on cognitive-behavioral pain management skills [29]
• Nurse training for American Indian/Native American nursing students in culturally responsive healthcare service delivery [36]
• Postabortion contraceptive use [30]
• Distribute recipes, ingredients, and cooking activities to children to increase vegetable intake [40]
• Deliver a fotonovela educational intervention to increase individual’s confidence in cancer survivorship care manage- ment [34]
• Experiences of postnatal parental leave and paid parental leave [32]
• Access to healthy foods and food purchasing power [31]
• Train family medicine physicians through an anti-racism residency program [41]
• Professional development for pre-K and kindergarten teachers, mental health professionals, and paraprofessionals
on child mental health [28]
• Life skills training for adolescents/youth [27]
• Coaching sessions with a community health worker [29]
• Peer mentoring/peer education [27, 36]
• Health advocate led educational sessions with cancer survivors and family members on cancer survivor care [34]
• Group training and support from mental health professionals (coach) on supporting child emotional self-regulations and other strategies to promote socio-emotional development in children [28]
• “Lay health advisor” provides support and access to resources for cardiovascular disease and diabetes [33]
• Nurse navigators connect patients to information, screening, and treatment for colorectal cancer [35]
• Deliver vaccines at community-based sites and create a vaccination program implemented by community-based “trusted messengers” [38]
• Community capacity-building workshops on food sovereignty [40]
• Implement mixed-income housing developments and tenant-based rental assistance to impact community health outcomes (e.g., improved mental and physical health, community connectedness) [39]
• Faith-based substance use and HIV/AIDS prevention program implemented in church settings [27] • Neighborhood farmers market [33]
• Healthy Corner Store Coalition to create a healthy retail ordinance [37]
• Menu modification in early childhood education program implemented at childcare settings [40]
• Impact of employer-paid parental leave on parental leave access and use [32]
• Change medical residency curriculum to address the historical context of racialization, privilege, and bias [41] • Change institutional rank system from process to goal-orientated approach [41]
• School-based intervention to promote positive parenting and school readiness [28]
• Impact of Oregon’s Reproductive Health Act on reproductive justice for “low-income immigrants” [30]
• Examine the impact of Medicaid expansion on the prevalence of food security [31]
• Impact of smoke-free air laws and policies and tobacco control policies on tobacco use among youth [42]
• Impact of State Offices of Minority Health on racial and health disparities [43]
• Impact of the Deferred Action for Childhood Arrivals program on educational and socioeconomic outcomes for young adults [44]
• Impact of the Family and Medical Leave Act on job protection and unpaid parental leave [32]
• Healthy retail ordinance to incentivize small stores to sell healthy foods and decrease tobacco and alcohol products [37]
• Impact of Supermarket Tax Exemption program on grocery store location [46]
• Impact of tobacco tax on smoking cessation [46]
• Impact of welfare reform initiative on child outcomes [47]
• Impact of the state earned income tax credits on infant birth weight [48] and infant health [49]
• Colorectal cancer reimbursement policies [35]
• Impact of changes to the Special Supplemental Nutrition Program for Women, Infants, and Children on access
to healthy food [45]
• Evidence of policies that increase access to parks and green space [46]
• Evidence of zoning ordinances (land use) on the number and location of liquor stores on health equity and popula- tion health [50]
ordinance in support of healthy food retail. One (1%) record included a statement by the author, including the author’s unique perspective, biases, and privileges they bring to their work. This record was a dissertation and qualitative research study on Deferred Action for Child- hood Arrivals. It is possible that other authors practiced self-reflexivity. Still, authors may have limitations in
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reporting on reflective practices due to manuscript sub- mission guidelines, word limitations, and disciplinary practices.
Discussion
This scoping review sought to understand the character- istics of interventions that address racism, examine how core equity principles are integrated within and across interventions, and understand how HEART equity prin- ciples might inform a standard approach to how racism and equity influence intervention research. Our review revealed that most interventions prioritized people who are racialized as Black or African American. Most reported health outcomes: while all were multi-level, most were designed to influence individual-level change. Less than half integrated the perspectives of those with lived experience, few interventions employed a mixed- methods approach, and one reported the researcher’s self-reflexivity.
Notable gaps emerged in how interventions attempted to address racism. While academic literature connects health outcomes to racism through a myriad of systems and structural-level inequities, interventions mainly focused on short-term individual-level outcome data without addressing systemic and structural factors. Few interventions included in this study addressed upstream drivers of racial health inequities that could lead to long- term change for racialized and ethnically minoritized groups, including those embedded in housing, food systems, the built and natural environment, and trans- portation. Additionally, the interventions examined do not include the perspectives of those who are racialized. Finally, funding mechanisms are essential when examin- ing and evaluating the interventions undertaken because funders often focus on the individual level.
Housing
Limited scholarship is available for designing and imple- menting housing interventions emphasizing housing locations’ safety, stability, and diversity. Most studies focused on housing were multi-level and multi-sectoral. Still, they narrowly addressed specific short-term out- comes, including reductions in property and neighbor- hood crime [40] or changes in children’s physical and behavioral health [52]. Our study’s findings support the lack of literature connecting the housing system to other interrelated systems acting as upstream health drivers.
Food access and nutrition
While many records in this study describe interventions that addressed nutrition and access to healthy foods [41, 53, 54] to improve physical and mental health, few interventions addressed the systemic exclusion and
long-standing impact of redlining on accessible and affordable healthy foods in areas where racialized and minoritized groups reside [55]. Moreover, the litera- ture demonstrates that interventions that address food access (e.g., supermarkets and farmers markets) often fail because interventions and research neglect to inte- grate community perspectives regarding decisions on food accessibility, affordability, and culture (e.g., familiar brands and ingredients that honor heritage [56]).
Built and natural environments
Few interventions included in this study examined the relationship between racism and the built and natural environments. While most interventions concentrated on individual health outcomes, none discussed in this study explored zoning and planning policies. It is well known that current zoning and urban planning practices disproportionately place communities with people racial- ized as Black, American Indian/Alaska Native, Asian American, Pacific Islander, and Hispanic/Latinx in prox- imity to floodplains, highways, toxic landfills, and indus- trial plants, which are detrimental to physical and mental health [57].
Transportation
Transportation emerged as a gap that warrants atten- tion as an essential connector to services, food, employ- ment, and housing [58]. Two records in the present study addressed active transportation by evaluating an urban Bikeshare program. In both instances, Bikeshare pro- grams were not associated with improved accessibility or health among racialized residents in Washington D.C. and New York City since most bike stations were situ- ated where wealthier residents, often racialized as White, resided [47, 59].
Procedural equity and community voice play critical roles in transportation planning, safety (e.g., bike and pedestrian safety, access to public transit at night), and affordability [60]. Transportation interventions can lev- erage the perspectives and integrate decisions of people with lived experience, particularly around the proximity of services, safety, and cost. This ensures that transporta- tion interventions are safe, affordable, clean, and acces- sible to all.
Community voice
One of the core equity principles of the HEART frame- work is elevating the perspectives of people with lived experiences into the conceptualization, implementa- tion, evaluation, and dissemination of intervention research. Our review revealed that less than half of the interventions in the included studies reported commu- nity engagement. The literature supports our findings
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regarding the barriers and challenges researchers and collaboratives face in conducting community-based and community-centered research.
Policies and procedures stipulating proprietary owner- ship over intellectual property in academic and private settings and restricting funding mechanisms that support intervention research impede community engagement. Academic institutions, especially public universities, fre- quently experience budget cuts. To remain competitive and to secure external funding, researchers are encour- aged to strategically pursue partnerships and commer- cialize knowledge generated through research [61].
The role of funding
Related to disciplinary practices that impact intervention research, we examined the funding sources in our review. Most interventions were funded by discretionary fed- eral funding sources, which are inherently tied to politi- cal motivations and focus. For that reason, these funding mechanisms do not focus on structural interventions but on individual-level interventions that can quickly be evaluated within a short time frame to match political cycles. Few studies were funded by nonprofit organiza- tions, which have a better understanding of and access to groups most impacted by the interventions and are more interested in long-term population change.
Additionally, funding mechanisms structurally dis- advantage nonprofit and grassroots organizations from being the primary applicants and decision-makers for intervention grants. In our study, nonprofit organizations were named as a funding source only 12 times. Lengthy and resource-intensive application processes, mandated fiduciary requirements, requirements of academic knowl- edge production, and inaccessible language in granting applications exclude smaller organizations from access- ing and applying through many funding mechanisms.
Examples of multi-level interventions in action
By default, multi-level interventions are intricate, and it can be challenging to disentangle all the components. Hence, we offer two examples of how interventions employ multi-level approaches to address systemic ineq- uities. One example demonstrating the complexity of operationalizing a multi-level intervention is the Linkages for Prevention intervention implemented in Durham, NC, USA, to improve maternal and children’s health through coordinated care between primary care prac- tices and community-centered agencies to address the social and structural determinants of maternal and infant health [62]. At the politico-legal level, Linkages for Pre- vention implemented a process for coordinated preven- tive care among state, county, and local agencies. State agencies implemented a policy to use Medicaid to pay for
a home visiting program, which the health department later implemented as an ongoing service.
At the institutional level, an academic pediatric prac- tice, a community health center, a health maintenance organization, private pediatric practices, and private fam- ily practices agreed on changing practices and policies in preventive care and service delivery. At the community level, community health centers were engaged as partners, volunteers supported outreach, and community agencies were engaged to connect this intervention with other com- munity-wide health projects. At the interpersonal level, home visiting was provided by a public health nurse to support pregnant mothers and their families in connecting with services and support, bolstering parenting practices and skills, and mental and physical health and well-being.
Overall, this short intervention demonstrated improved outcomes, including policy-level changes that finance home visiting programs and changes in primary care practices that improve coordination and service delivery. Mothers and families that received home visiting services were more likely to complete child well visits, elect to have their child immunized, implement safety measures at home, and report strong social support systems.
Another complex and multifaceted intervention is the Healthy Food Retailer Incentive Program Ordinance implemented in San Francisco, CA, USA [38]. This inter- vention underscores the value of a community-based participatory research approach that generated a lasting policy change through a healthy retail ordinance, incen- tivizing corner stores to sell healthy foods and fresh produce instead of processed foods, sugary beverages, tobacco products, and alcohol. At the grassroots com- munity level, a youth-driven Tenderloin Healthy Corner Store Coalition mapped community corner stores replete with tobacco and unhealthy food products. Community- based organizations, residents, academic partners, and representatives from the local health department joined the coalition to advance action. Working together, resi- dents were trained as “food justice leaders” to support research, community engagement, and advocacy.
At the intersection of community and institutions, food retailers, corner store owners, and merchants were involved in assessments, research, and educational activi- ties and supported the development and passage of the Healthy Food Retailer Ordinance. After the ordinance was passed, additional efforts translated this policy into prac- tice, impacting the individual and interpersonal levels by offering nutrition education to residents, strengthening the workforce development on food advocacy and food security issues, building the skills of healthy retailers, and establishing local partnerships between healthy retailers and community-based organizations which have imple- mented other healthy food projects in the community.
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Limitations and future research
Notwithstanding the valuable insight the present study provided, it had limitations. As this was a systematic scop- ing review with a broad scope, we could not conduct an exhaustive review, including evaluations and reports pub- lished on websites or elsewhere outside of academic out- lets. We, therefore, may have missed interventions even though we employed a multifaceted strategy. Addition- ally, funding mechanisms may have specific stipulations regarding the nature of the project where racism might not be named or addressed. Interventions that address systemic and structural racism exist outside of academic literature and would require a mixed-methods approach or a more exhaustive gray literature analysis, which was outside the scope of the present study. Since this study examines interventions implemented within a specific system or sector, the findings and outcomes are expan- sive, which is helpful to see the full scope. Still, it presents a challenge when comparing interventions with different aims, methods, and contexts. One of the inclusion crite- ria was literature published or made available in English. Examining and including literature published in other languages would be beneficial, interesting, and equitable.
Conclusions
Despite the mounting evidence that connects racism to the systems everyone relies upon to sustain optimal health and well-being, contemporary intervention research lacks a standard approach in which to define racism and integrate core equity principles to advance health equity. Novel approaches are needed to move from conventional intervention research focused on intervention efficacy to the next generation of research guided by nonconven- tional research archetypes. The HEART framework offers a systematic approach for researchers and practitioners to practice disciplinary critique and interrogate the role that racism plays in producing disparate outcomes instead of perpetuating a false monolithic narrative that inherent biological traits and stereotypes are to blame for disease prevalence and risk among racialized and minoritized groups [63, 64]. Interventions seeking to address racism must institute practices that elevate community voice and overcome challenges related to intellectual property, tradi- tional research practices, knowledge creation, and dispro- portionate funding mechanisms for intervention research. Employing the HEART can guide interventionists and practitioners seeking to address the root causes of racism within the context of health equity research, which pro- vides an alternative to the dominant epistemic narrative.
Abbreviations
HEART Health Equity Action Research
PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analysis
Supplementary Information
The online version contains supplementary material available at https://doi. org/10.1186/s13643-024-02679-x.
Additional file 1: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
Additional file 2: Supplemental Table A. Author’s Positionality Statement (Authors are listed in alphabetical order).
Additional file 3: Supplemental Table B. Search Strings.
Additional file 4: Supplemental Table C. Data extraction coding categories.
Additional file 5: Supplemental Table D. Theoretical or conceptual frame- works employed in the 91 interventions that reported using a model or framework (n = 35).
Acknowledgements
We thank Georgia State University librarians Bethany Havas and Charlene Martoni-McElrath for their generous time and dedication in developing a com- prehensive and thorough search strategy for this research and for graciously volunteering their time and expertise in library sciences. We would also like to thank Matilda Odera and Christina Bernhardt for their support during screening and Matilda’s support in testing the codebook and coding procedures.
Authors’ contributions
All authors contributed to the review’s concept, the theoretical data collec- tion, and the analysis. BD led the analysis and writing; TP guided the develop- ment of the methodological approach. All authors contributed to the writing and editing.
Funding
A portion of the B. D., A. L., A. P., and M. L. salaries were funded by a grant
from the Robert Wood Johnson Foundation (RWJF) (Grant No. 79024). The Robert Wood Johnson Foundation had no role in the study design; collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication. The content is solely the authors’ responsibility and does not necessarily represent the official views of the RWJF.
Data availability
All data generated and/or analyzed during this current study are available in the OSF project repository: https://osf.io/7e9dj.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1Andrew Young School of Policy Studies, Georgia Health Policy Center, Geor- gia State University, 55 Park Place NE, Atlanta, GA 30303, USA. 2Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032, USA. 3Moritz College of Law, The Ohio State University, 55 West 12 Avenue, Drinko Hall, Colum-
bus, OH 43210, USA. 4Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA. 5Greensboro Health Disparities Collaborative, Worrell Professional Center, No. 1154, P.O. Box 7868, Winston-Salem, NC 27109, USA. 6College of Education and Human Development, Georgia State University,
30 Pryor St. SW, Atlanta, GA 30303, USA. 7OHSU-PSU School of Public Health, Portland State University, 1810 SW 5 Ave, Portland, OR 97201, USA.
Received: 12 July 2024 Accepted: 5 October 2024
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