Racism and health service utilisation: a systematic review and meta-analysis

Although racism has been posited as driver of racial/ethnic inequities in healthcare, the relationship between racism and health service use and experience has yet to be systematically reviewed or meta-analysed. This paper presents a systematic review and meta-analysis of quantitative empirical studies that report associations between self-reported racism and various measures of healthcare service utilisation. Data were reviewed and extracted from 83 papers reporting 70 studies. Studies included 250,850 participants and were conducted predominately in the U.S. The meta-analysis included 59 papers reporting 52 studies, which were analysed using random effects models and mean weighted effect sizes. Racism was associated with more negative patient experiences of health services (HSU-E) (OR = 0.351 (95% CI [0.236,0.521], k = 19), including lower levels of healthcare-related trust, satisfaction, and communication. Racism was not associated with health service use (HSU-U) as an outcome group, and was not associated with most individual HSU-U outcomes, including having had examinations, health service visits and admissions to health professionals and services. Racism was associated with health service use outcomes such as delaying/not getting healthcare, and lack of adherence to treatment uptake, although these effects may be influenced by a small sample of studies, and publication bias, respectively. Limitations to the literature reviewed in terms of study designs, sampling methods and measurements are discussed along with suggested future directions in the field

Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis

Background Racism is increasingly recognized as a key determinant of health. A growing body of epidemiological evidence shows strong associations between self-reported racism and poor health outcomes across diverse minority groups in developed countries. While the relationship between racism and health has received increasing attention over the last two decades, a comprehensive meta-analysis focused on the health effects of racism has yet to be conducted. The aim of this review protocol is to provide a structure from which to conduct a systematic review and meta-analysis of studies that assess the relationship between racism and health. Methods This research will consist of a systematic review and meta-analysis. Studies will be considered for review if they are empirical studies reporting quantitative data on the association between racism and health for adults and/or children of all ages from any racial/ethnic/cultural groups. Outcome measures will include general health and well-being, physical health, mental health, healthcare use and health behaviors. Scientific databases (for example, Medline) will be searched using a comprehensive search strategy and reference lists will be manually searched for relevant studies. In addition, use of online search engines (for example, Google Scholar), key websites, and personal contact with experts will also be undertaken. Screening of search results and extraction of data from included studies will be independently conducted by at least two authors, including assessment of inter-rater reliability. Studies included in the review will be appraised for quality using tools tailored to each study design. Summary statistics of study characteristics and findings will be compiled and findings synthesized in a narrative summary as well as a meta-analysis. Discussion This review aims to examine associations between reported racism and health outcomes. This comprehensive and systematic review and meta-analysis of empirical research will provide a rigorous and reliable evidence base for future research, policy and practice, including information on the extent of available evidence for a range of racial/ethnic minority group

Racism in Australia : a protocol for a systematic review and meta-analysis

Background: Racism has been identified as a major source of injustice and a health burden in Australia and across the world. Despite the surge in Australian quantitative research on the topic, and the increasing recognition of the prevalence and impact of racism in Australian society, the collective evidence base has yet to be comprehensively reviewed or meta-analysed. This protocol describes the first systematic review and meta-analysis of racism in Australia at the national level, focussing on quantitative studies. The current study will considerably improve our understanding of racism, including its manifestations and fluctuation over time, variation across settings and between groups, and associations with health and socio-economic outcomes. Methods: The research will consist of a systematic literature review and meta-analysis. Searches for relevant studies will focus on the social and health science databases CINAHL, PsycINFO, PubMed and Scopus. Two reviewers will independently screen eligible papers for inclusion and extract data from included studies. Studies will be included in the review and meta-analysis where they meet the following criteria: (1) report quantitative empirical research on self-reported racism in Australia, (2) report data on the prevalence of racism, or its association with health (e.g. mental health, physical health, health behaviours) or socio-economic outcomes (e.g. education, employment, income), and (3) report Australian data. Measures of racism will focus on study participants’ self-reports, with a separate analysis dedicated to researcher-reported measures, such as segregation and differential outcomes across racial/ethnic groups. Measures of health and socio-economic outcomes will include both self-reports and researcher-reported measures, such as physiological measurements. Existing reviews will be manually searched for additional studies. Study characteristics will be summarised, and a meta-analysis of the prevalence of racism and its associations will be conducted using random effects models and mean weighted effect sizes. Moderation and subgroup analyses will be conducted as well. All analyses will use the software CMA 3.0. Discussion: This study will provide a novel and comprehensive synthesis of the quantitative evidence base on racism in Australia. It will answer questions about the fluctuation of racism over time, its variation across settings and groups, and its relationship with health and socio-economic outcomes. Findings will be discussed in relation to broader debates in this growing field of research and will be widely disseminated to inform anti-racism research, action and policy nationally. Systematic review registration: PROSPERO CRD42021265115

Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

Ambivalent motion: Eritreans’ work pursuits and intercultural connections in Melbourne

This research examines how Eritrean professionals navigate work and intercultural connections in Melbourne. Drawing on ethnographic fieldwork, I engage with my interlocutors&rsquo; movements through novel social environments over time, and expand theoretical discussions on discrimination, localness, precarity, mobility and conviviality

A critical examination of the youth foyer model for alleviating homelessness: strengthening a promising evidence base

This article assesses the quality of 15 primary studies that examined the effectiveness of youth foyer or foyer-like programs on the lives of young homeless people. The youth foyer model provides an integrated approach to tackling youth homelessness, connecting affordable accommodation to training and employment. In Australia, there is growing support from government for the development and funding of foyer programs. However to date, there has been very limited development and investment in the evidence base on the effectiveness of this model in Australia or internationally. Following an extensive literature search, we argue that there is a need to lift the standard of the evidence base of youth foyer effectiveness. We discuss two main issues: the difficulty studies had validating claims of foyer effectiveness, and limitations of research design and methodology. The implications of the lack of rigour in the research reviewed are three-fold. Firstly, youth foyer evaluation study quality could be improved by: clearer methodological and model documentation; post intervention follow-up design; comparison of data to non-randomised comparison groups; and a pre-publication peer-review process. This would be supported with clearer expectations from the research community regarding the production and assessment of grey literature. Secondly, while the standard of reporting needs to be raised, the ‘gold standard’ (i.e. randomised controlled trials) of research design in the scientific community is not a relevant benchmark in the field of homelessness research. This is due to the complexity of homelessness interventions and the inadequate funding of the homelessness research field. Greater investment in robust research and evaluation should accompany the substantial investment in youth foyer programs in order to accurately appraise the effectiveness of the youth foyer model. Thirdly, the lack of rigour in the studies reviewed suggests gaps in the service development of the youth foyers that were evaluated in the articles considered in this evidence review. The research reviewed was mostly unable to report key program mechanisms, pointing to a lack of program documentation. Ideally, strong service development practices would enable evaluative studies to explore the link between foyer model mechanisms and outcomes. Policy implications include putting in place a system for ensuring adequate program documentation with robust research design and methods, using a theoretical framework for the interpretation of findings, and adopting a peer-review process. To achieve this, public sector commissioners of youth foyers need to tighten the evaluation and research components when funding new foyers, recognising the critical relationship between service development and research

Descriptive analysis.

<p>Descriptive analysis.</p