Equity, Diversity, and Inclusion in Health Research: Gaps and Opportunities in Qualitative Systematic Reviews

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In the past few years, there has been more of a focus on equity, diversity, and inclusion (EDI) within health research. With an increasing amount of research on EDI in healthcare, an argument can be made that a considerable amount of health-related research has excluded a number of diverse populations and worldviews.

In a study published in JBI Evidence Synthesis, researchers aimed to discover how often qualitative systematic review teams are addressing EDI based on JBI guidelines. The study included a sample of one-year published reviews found from MEDLINE (Ovid) and CINAHL (EBSCOhost). From the extracted data, 43 English-language qualitative systematic reviews that were published in 2022 met the criteria for inclusion and utilized all the steps outlined in JBI guidance for qualitative reviews. Additionally, the review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Results found that 30 out of 43 reviews used a generic approach rather than explicitly focusing on EDI issues, with only six reviews justifying their population focus in terms of EDI-related concerns. Additionally, only one review included a knowledge user, indicating a significant gap in stakeholder involvement.

The authors of the study also noted that sociodemographic and other key characteristics of the samples in underpinning studies were poorly reported, making it more difficult to differentiate EDI-related issues or to undertake EDI-related analyses. Thirteen reviews included non-English language sources, while 31 incorporated gray literature.

While this suggests that there has been some effort to broaden the scope of evidence, the authors suggests that there is room to grow. Lastly, only 10 reviews demonstrated elements of intersectional or critical approaches in their analyses, and only eight discussed the composition of their review team and included reflections on the review process, suggesting a lack of transparency.¹

“A recent JBI position paper states that ‘working with clinical and academic experts in universities and health facilities from all health professions across the world ensures that the research evidence we seek to synthesize, transfer and implement is culturally inclusive and relevant across the diversity of healthcare internationally,’” reports the authors of the study. “This methodological review aimed to characterize the ways in which qualitative review teams are currently addressing EDI within their reviews and associated methodological processes. The enquiry is particularly salient, as an analysis undertaken in 2022 estimated that QES currently comprise 22.5% of all reviews published in JBI Evidence Synthesis”

The authors also suggested that these findings have a number of major implications for the pharmaceutical industry. They stated that there’s potential for systematic reviews to inadvertently amplify existing gaps and biases if EDI is not systematically addressed. It is suggested that review teams should strive to explicitly frame research questions with EDI considerations in mind, improve reporting of sociodemographic characteristics in study samples, incorporate more diverse language and literature sources, adopt intersectional and critical approaches in analysis, and enhance transparency regarding team composition and reflexivity.¹

“Overall, this methodological review found that EDI is currently not being addressed in an explicit or systematic way in the context of QES,” reported the study authors. “In order to stimulate further debate in this area, we suggest that two overlapping issues may benefit from further methodological investigation: i) incorporating an EDI focus within review methods, and ii) adopting EDI-related research practices within a review.”

Reference

1. Addressing equity, diversity, and inclusion in JBI qualitative systematic reviews: a methodological scoping review. Wolters Kluwer. September 3, 2024. Accessed September 5, 2024. https://journals.lww.com/jbisrir/fulltext/9900/addressing_equity,_diversity,_and_inclusion_in_jbi.348.aspx