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Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework
Jennifer L Ridgeway1, Zhen Wang2, Lila J Finney Rutten2
1Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Existing models for childhood health disparities lack consensus. A systematic review identified common factors across 48 models, leading to a unified conceptual framework to guide future research on children's health outcomes.
Area of Science:
- Child Health Disparities Research
- Theoretical Framework Development
- Public Health Policy Analysis
Background:
- Childhood health disparities are linked to adult chronic diseases, yet specific theoretical models are underdeveloped.
- Existing models often focus on individual factors, neglecting broader societal influences.
- A unified framework is needed to integrate knowledge and guide research on children's health inequalities.
Purpose of the Study:
- To systematically review and analyze existing theoretical models of childhood health disparities.
- To inform the development of a unified conceptual framework for child health disparities.
- To identify common themes and gaps in current theoretical approaches.
Main Methods:
- Systematic review of articles reporting theoretical or explanatory models of child health disparities.
- Searched multiple databases including Ovid MEDline, Embase, Cochrane, and Scopus.
- Utilized a metanarrative approach for thematic analysis of 48 identified models.
Main Results:
- 48 distinct models of child health disparities were identified across 48 studies.
- No single consensus model emerged, but significant overlap was observed.
- Common domains included individual characteristics (88%), healthcare systems (63%), and environment/community (56%).
- Health and public policy domains were underrepresented (38%).
Conclusions:
- A unified, disease-agnostic conceptual framework can integrate current knowledge on child health disparities.
- This multilevel framework can guide future research across clinical, basic, and social sciences.
- The framework highlights the interplay of policy, social factors, health systems, and the physical environment on children's health.
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.
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