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How equity is operationalised in learning health systems: a scoping review protocol
Erica Y Lau1,2,3, Justin J Koh4, Chenoa Cassidy-Matthews5
1Department of Emergency Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada erica.lau@ubc.ca.
BMJ Open
|July 20, 2026
Summary
Learning health systems (LHS) aim for equity, but practical application lags behind goals. This review examines how equity is operationalized within LHS to identify gaps and inform improvements for equitable care delivery.
Area of Science:
- Health Services Research
- Health Equity Studies
- Implementation Science
Background:
- Learning health systems (LHS) aim to improve healthcare via data-driven cycles of learning and action.
- A core goal of LHS is to promote health equity by involving stakeholders and using data to address disparities.
- However, evidence indicates a persistent gap between the stated equity aims of LHS and their practical implementation in design, measurement, and decision-making.
Purpose of the Study:
- To conduct a scoping review examining the operationalization of equity, antiracism, and Indigenous self-determination within learning health systems.
- To identify how these equity concepts are defined and integrated into the various components of LHS.
- To map the extent to which equity is addressed across the LHS cycle and pinpoint areas needing further development.
Main Methods:
- A comprehensive scoping review following Joanna Briggs Institute methodology and PRISMA-ScR guidelines.
- Systematic searches across multiple databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, PsycINFO) and hand searches.
- Independent screening and data extraction by two reviewers, focusing on how equity is defined and operationalized in governance, data practices, learning, and contextual factors within LHS.
Main Results:
- The review will map the operationalization of equity across the LHS cycle, detailing dimensions addressed and reporting gaps.
- Findings will illuminate how concepts like antiracism and Indigenous self-determination are (or are not) integrated into LHS.
- The synthesis will identify specific mechanisms and strategies used to embed equity within LHS processes.
Conclusions:
- LHS do not automatically achieve equity; intentional strategies are required for operationalization.
- This review will provide critical insights for researchers, leaders, and communities on building equity into routine LHS processes.
- Findings will inform the development of more effective and equitable learning health systems.
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