How equity is operationalised in learning health systems: a scoping review protocol

Learning health systems (LHS) aim to improve care through repeated cycles that link data, learning and action. These systems have a goal to uphold equity through purposefully including patients and other stakeholders in co-design and using real-world data to identify and respond to inequities. However, evidence shows that LHS do not automatically produce equitable outcomes, and a gap persists between stated equity goals and the practical mechanisms used to build equity into system design, measurement and decision-making. This scoping review examines how equity and related concepts, including antiracism and Indigenous self-determination, are operationalised within LHS.

We will conduct a scoping review using the Joanna Briggs Institute methodology and report the findings in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. To capture equity-oriented learning beyond formally labelled systems, we define LHS by function rather than name, focusing on systems that demonstrate linkages between data use, learning and action. We will search PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science and PsycINFO, supplemented by hand searches of relevant journals for peer-reviewed articles published from 2015 to July 2026. Two reviewers will independently screen titles, abstracts and full texts. Using a structured extraction form, we will chart how equity is defined and operationalised within LHS, including governance and decision-making processes, data and measurement practices, learning activities and contextual factors that shape equity-oriented learning. We will synthesise findings descriptively and thematically to map where in the LHS cycle equity is operationalised, what equity dimensions are addressed and where reporting gaps remain. Findings will inform researchers, health system leaders and communities on how equity can be built into routine LHS processes.

Ethics approval is not required as this review synthesises published literature. Findings will be disseminated through peer-reviewed publications and conference presentations.