Terminology and Definitions of Racial Health Equity in Prominent Health Websites: Systematic Review

Abstract

Background: The websites of prominent public health and health care organizations play pivotal roles in ensuring access to quality health information, including information guiding health equity. Several initiatives have been developed in the United States to promote equitable, fair, and inclusive health information and practices across prominent health websites. Currently, health disparities across racial groups are recognized as a critical public health problem. Simultaneously, the use of the term "racial health equity/equities" has been rising in academic literature. However, the definition and findability of "racial health equity/equities" information have not yet been evaluated in health websites. Thus, we used a systematic review approach to assess the findability and availability of racial health equity terminology and definitions across prominent health organization websites.

Objective: The objective of this study was to systematically evaluate the definitions and findability of "racial health equity/equities and related terms" on prominent health organizations' websites.

Methods: We conducted a systematic review of websites from government agencies, professional organizations, and selected health care organizations with relevance to the US health care system. Google and the US Digital Analytics program were used for initial searches. Definitions, terms, and accompanying citations for racial health equity terms, including "racial health inequity" or "racial health disparities," were extracted from all websites. A findability tool was developed to evaluate the ease of finding the terms and definitions, with ratings ranging from "very easy" to "very difficult." Additionally, we analyzed the themes and sentiments of the retrieved definitions.

Results: We analyzed 69 websites from prominent health organizations. Approximately half (n=31) of the websites lacked any definitions for racial health equity and related terms, and of the 38 that included definitions, most did not include citations. The definitions varied across websites, and most were rated as "very difficult" to find.

Conclusions: This study highlights the absence of a systematic, standardized, and accurate approach to organizing, defining, and presenting racial health equity information on prominent health websites. Specifically, there is a lack of consistent definitions for racial health equity and related terms across prominent health organization websites.

Keywords: United States; definitions; health care; health equity; health information; inclusive; promotion; public health; race; racial; racial health equity; sentiment analysis; systematic Review; thematic analysis; web-based health information; websites.

Figure 1.. Procedure for browsing websites to find definitions and assigning findability. *Terms for extraction (racial health equity, racial health inequity, racial health disparity, health equity, health inequity, and health disparity). **Assigned findability score (0=Very difficult/no definitions found, 1=Somewhat difficult, 2=Somewhat easy, and 3=Very easy).

Figure 2.. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram for included and excluded websites.*Gray literature using the search string: Public Health Organizations” (n=51), Health and Human Services (n=16), National Institutes of Health (n=26), and US Government Google Analytics Digital Analytics Program (n=20). **For-profit health organizations, medical university and colleges, and state health organizations. RHE: racial health equity.

Figure 3.. Inclusion and definition of racial health equity and related terms in reviewed websites. *Term defined indicates websites that included the terms reviewed with their definitions; **Term not defined indicates websites that included only the terms with no definitions provided.

Figure 4.. Themes identified within the definitions. *Total indicates the total number of themes from all the extracted definitions.

Figure 5.. Sentiment analysis of definitions. (A) Polarity indicates whether the sentiment is negative (–1≤ × <–0.05), neutral (–0.05≤ × ≤0.05), or positive (0.05< × ≤1). (B) Subjectivity (~1) indicates that the definition is influenced by emotions while objectivity (~0) indicates no influence [5152].