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. 2017 Aug 4;7(8):e015456.
doi: 10.1136/bmjopen-2016-015456.

Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework

Jennifer L Ridgeway  1 , Zhen Wang  2 , Lila J Finney Rutten  2 , Michelle van Ryn  3 , Joan M Griffin  2 , M Hassan Murad  2 , Gladys B Asiedu  1 , Jason S Egginton  1 , Timothy J Beebe  4
Affiliations

Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework

Jennifer L Ridgeway et al. BMJ Open. .

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.

Keywords: health inequalities; life course/childhood circumstances; public health policy; systematic reviews.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Process of study selection and screening using the PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
This unified conceptual framework presents a multilevel view of factors related to paediatric health disparities. SES, socioeconomic status; WIC, Special Supplemental Program for Women, Infants, and Children.
See this image and copyright information in PMC

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