Learning Health Systems, Equity, and Bounded Justice: A Critical Scoping Review

The science of learning health systems (LHSs) has expanded to include equity aims. However, efforts toward this end are nascent. The purpose of this study was to critically examine how equity has been discussed in LHS literature.

We conducted a critical scoping review informed by the bounded justice concept. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Pubmed, Embase, Scopus, and CINAHL Complete (Ebsco) databases were searched to identify relevant literature from inception to June 2024. We used qualitative descriptive analysis for detailed extraction and to identify patterns across equity conceptions in the literature.

The search strategy generated 420 articles. Forty articles met the selection criteria. Our analysis generated four interrelated themes: (1) equity as central, (2) equity as reducing risk, (3) equity as process, and (4) equity defined as population of interest. Most articles fell into the equity as central theme. Notably, 35 (87.5%) articles were published between 2020 and 2024. We also identified five emerging equity-centered LHS approaches.

LHS equity science is emerging, though it still privileges narrow, Westernized approaches. It is imperative that future work more deeply engages health justice traditions to inform LHS theory, research, and practice.