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Public health
Research
Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework
  1. Jennifer L Ridgeway1,
  2. Zhen Wang2,
  3. Lila J Finney Rutten2,
  4. Michelle van Ryn4,
  5. Joan M Griffin2,
  6. M Hassan Murad2,
  7. Gladys B Asiedu1,
  8. Jason S Egginton1,
  9. Timothy J Beebe3
  1. 1 Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Timothy J Beebe; beebe026{at}umn.edu

Abstract

Objective There exists a paucity of work in the development and testing of theoretical models specific to childhood health disparities even though they have been linked to the prevalence of adult health disparities including high rates of chronic disease. We conducted a systematic review and thematic analysis of existing models of health disparities specific to children to inform development of a unified conceptual framework.

Methods We systematically reviewed articles reporting theoretical or explanatory models of disparities on a range of outcomes related to child health. We searched Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus (database inception to 9 July 2015). A metanarrative approach guided the analysis process.

Results A total of 48 studies presenting 48 models were included. This systematic review found multiple models but no consensus on one approach. However, we did discover a fair amount of overlap, such that the 48 models reviewed converged into the unified conceptual framework. The majority of models included factors in three domains: individual characteristics and behaviours (88%), healthcare providers and systems (63%), and environment/community (56%), . Only 38% of models included factors in the health and public policies domain.

Conclusions A disease-agnostic unified conceptual framework may inform integration of existing knowledge of child health disparities and guide future research. This multilevel framework can focus attention among clinical, basic and social science research on the relationships between policy, social factors, health systems and the physical environment that impact children's health outcomes.

  • health inequalities
  • life course/childhood circumstances
  • public health policy
  • systematic reviews

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015456

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    Footnotes

    • Contributors JLR reviewed articles, extracted data, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. ZW designed and conceptualised the study, developed the search strategy, designed the data collection instruments, coordinated and supervised data extraction and review, reviewed and revised the manuscript, and approved the final manuscript as submitted. LJFR, MVR and JMG reviewed articles, extracted data, reviewed and revised the manuscript, and approved the final manuscript as submitted. MHM designed and conceptualised the study, developed the search strategy, reviewed and revised the manuscript, and approved the final manuscript as submitted. GBA and JSE reviewed articles, extracted data, critically reviewed the manuscript, and approved the final manuscript as submitted. TJB designed and conceptualised the study, developed the search strategy, carried out the initial analysis, drafted the initial manuscript, and approved the manuscript as submitted. TJB is the guarantor. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Competing interests None declared.

    • Patient consent This research did not include data collection from human subjects.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data are available by emailing the corresponding author at beebe026@umn.edu.