What is the effectiveness of antiracist interventions for ethnic minority healthcare staff? A systematic review

Abstract

BackgroundThe National Health Service (NHS) has the most diverse workforce in the United Kingdom (UK), 25% (n= 309,532/1,200,000) of staff belong to ethnic minority groups. However, there is evidence of longstanding issues of racism within the NHS and discrimination towards ethnic minority healthcare staff has been rising since 2016. In the first wave of the COVID-19 pandemic, 95% of COVID-19 deaths among doctors were in an ethnic minority group. There has been no definitive answer for the disproportionate COVID-19 mortality but socioeconomic factors due to structural racism have been suggested as the main drivers. No studies have assessed the effectiveness of antiracist interventions for healthcare staff.MethodsWe conducted a systematic review; databases searched included: AMED, Medline via OVID, CINAHL, APA Pyscinfo, Web of Science and OVID Emcare 25th– 31stJanuary 2022. The interventions were structured using a model of antiracist interventions and analysed using narrative synthesis methods.Results16 papers were reviewed with interventions at different levels: personally mediated (n=9), multilevel (n=4) and institutional (n=3). Personally mediated interventions were workshops (n=8) and a mentorship scheme (n=1). Institutional interventions were policies (n=2) and increasing diversity initiative (n=1). Multilevel interventions were a mix of both. Study designs and risk of bias tools indicated that the quality of evidence was of low quality. Only two studies included control groups. Countries included the USA (n=11), Canada (n=1) and the UK (n=4).ConclusionThere is a lack of robust evidence for antiracist interventions for healthcare staff, especially at an institutional level. High quality research is required to evaluate the long-term effects of interventions.Funding statementThe Wales COVID-19 Evidence Centre was funded for this work by Health and Care Research Wales on behalf of Welsh Government.