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

Objectives To identify anti-racist interventions which aim to reduce ethnic disparities in health and care. Eligibility criteria for selecting studies Only 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. Results A 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. Discussion Many 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. ### Competing Interest Statement SP is funded by a National Institute for Health Research Academic Clinical Lecturer Fellowship; there are no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; there are no other relationships or activities that could appear to have influenced the submitted work. ### Funding Statement SP is an Academic Clinical Lecturer and is funded by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, the Office for Health Improvement and Disparities or the UK Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors