Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 3;6(1):e2250654.
doi: 10.1001/jamanetworkopen.2022.50654.

Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review

Crystal W Cené  1   2 , Meera Viswanathan  3 , Caroline M Fichtenberg  4   5 , Nila A Sathe  3 , Sara M Kennedy  3 , Laura M Gottlieb  5 , Yuri Cartier  4 , Monica E Peek  6
Affiliations

Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review

Crystal W Cené et al. JAMA Netw Open. .

Abstract

Importance: Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities.

Objective: To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity.

Evidence review: Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity).

Findings: Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences.

Conclusions and relevance: In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gottlieb reported receiving grants from the Robert Wood Johnson Foundation during the conduct of the study. Dr Peek reported receiving grants from Merck Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Identifying Social Needs Intervention Studies That Are Conceptually Thoughtful
This figure outlines a process for assessing the conceptual thoughtfulness for understanding root causes of racial health inequities of social needs interventions studies with multiple racial or ethnic groups.
Figure 2.
Figure 2.. Identifying Social Needs Intervention Studies That Are Analytically Informative for Advancing Racial Health Equity Research
This figure outlines a process for assessing analytical informativeness for advancing racial health equity of studies of social needs interventions. These studies examine whether intervention effects differ by race or ethnicity. aResults could be reported in brief (eg, as a statement of no differences), in detail, in the main report, or in supplemental material.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Braveman P, Arkin E, Orleans T, Proctor D, Plough A. What is health equity? and what difference does a definition make? Robert Wood Johnson Foundation. 2017. Accessed December 6, 2022. https://resources.equityinitiative.org/handle/ei/418
    1. Walker RJ, Garacci E, Ozieh M, Egede LE. Food insecurity and glycemic control in individuals with diagnosed and undiagnosed diabetes in the United States. Prim Care Diabetes. 2021;15(5):813-818. doi:10.1016/j.pcd.2021.05.003 - DOI - PMC - PubMed
    1. Firebaugh G, Acciai F. For blacks in America, the gap in neighborhood poverty has declined faster than segregation. Proc Natl Acad Sci U S A. 2016;113(47):13372-13377. doi:10.1073/pnas.1607220113 - DOI - PMC - PubMed
    1. Quillian L. Segregation and poverty concentration: the role of three segregations. Am Sociol Rev. 2012;77(3):354-379. doi:10.1177/0003122412447793 - DOI - PMC - PubMed
    1. Badger E. Black poverty differs from white poverty. Washington Post. August 12, 2015. Accessed February 14, 2022. https://www.washingtonpost.com/news/wonk/wp/2015/08/12/black-poverty-dif...

Publication types