This review will follow the procedures outlined in the Preferred Reporting Items of Systematic Review of Interventions and Meta-Analyses (PRISMA) 2020 statement and has been registered with the International Prospective Register of Systematic Reviews (CRD42021245772).
Inclusion Criteria
Detailed inclusion criteria can be found in Table 1.
Table 1
Black Adults (≥18 years of age)
Possible Terms:
-African American
-Black Canadian
-Black British
-Afro-Caribbean
-Afro-Brazilians
-Afro- (other countries of Central or South America)
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Other Terms for Title Abstract Screening
-Minorities
-Visible Minority
-People of Color
-Racialized
-Ethnic Minority
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Community-Based (CB)
-CB approach brings people together with the intention of sharing knowledge, experiences, and to develop a common understanding29
-Members of the community have roles in the intervention
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Culturally-Tailored
-Culturally Appropriate
-Culturally Competent
-Culturally Adapted
-Cultural Targeting
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Program includes at least one of the 5 Strategies of Culturally Appropriate Programs
(1) peripheral strategies; (2) evidential strategies; (3) linguistic strategies; (4) constituent-involving strategies; and, (5) sociocultural strategies
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At least One Education Component
Examples:
-Diet/ Nutrition
-Medication adherence
-Behavioral
-Exercise
-Self-Management
-Health Literacy
-Strategy (term)
-self-management (term)
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Participant has Cardiovascular Disease/Hypertension/ Diabetes/ Stroke
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Existing Program
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Patient Focused
-Program developed for Patients rather than Clinicians
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Published 2000-2021
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English Studies Only
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Study Type & Designs
-Primary Source
-Any Empirical Study Design
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Study design
We will include published empirical studies of any study design that gather evidence from a CBCT program for Black adults with cardiovascular disease, hypertension, diabetes, or stroke. The use of primary source studies will provide an opportunity for reviewers to extract data from the original source and ensure data specific to our topic of interest will be recorded. The inclusion of quantitative and qualitative data will allow us to generate an understanding of the effects of CBCT programs on health outcomes using quantitative data as well as patient-reported outcomes by the target community through qualitative inquiry.
Setting
No restrictions will be placed on the country in which the program occurred. However, this review will limit to programs that take place in the community setting (i.e. outside of a hospital setting).
Participants
The participants in this review will be Black adults (>18 years of age) with hypertension, cardiovascular disease, diabetes, or stroke.
Intervention
This review will include programs which deliver culturally-tailored education to the Black adults with cardiovascular disease, hypertension, diabetes, or stroke. The education should relate to the management of one of these conditions (i.e. hypertension, cardiovascular disease, diabetes, or stroke). To be considered culturally-tailored, the intervention must include at least one of the following culturally appropriate strategies outlined by Kreuter and colleagues: (1) peripheral strategies, (2) evidential strategies, (3) linguistic strategies, (4) constituent-involving strategies, and (5) sociocultural strategies.
Type of Outcome Measure
As the intent of this review is to inform the design and structure of future programs, all outcome measurements will be reported in this systematic review, including participant-level (e.g. health-related outcomes, health literacy, medication adherence, psychosocial measurements) as well as program-level outcome measures (e.g. program adherence, satisfaction).
Study Records
Search Methods
The search will be conducted by the lead author (JF) and Information Specialist (EMU) on the relevant databases. To ensure we maximize our results, we will hand search the reference lists of included studies.
Selection Process
All articles identified from the search will be uploaded into Covidence, a reference management software. Duplicates will be removed in Covidence. The titles and abstracts of the identified articles will be independently screened by two reviewers based on the inclusion criteria (see Table 1). However, prior to beginning title and abstract screening, interrater reliability with title and abstract screening among the researchers will be tested using a random sample of 50 articles. A Kappa score of >0.80 will be deemed acceptable as it indicates almost perfect agreement amongst the research team.30
Once studies are identified for the full-text screening, a similar process will be followed with two reviewers deciding if inclusion or exclusion criteria. All articles excluded at the full-text review will be categorized based on predefined terms to document the reasoning behind the exclusion. To resolve any discrepancies between reviewers during title/abstract and full-text review, meetings will be held at regular intervals to discuss disagreements and reach a team consensus.
Data Items and Collection Process
For each article, one researcher will complete a data extraction form to record: program names, study participants, setting, study design, duration, evaluation measure, intervention, outcome, outcome measurements and study results, to summarize the existing data.15,31,32 A customized data extraction form will be created based on the Joanna Briggs Institute Manual for Evidence Synthesis to identify essential program characteristics32 and Kreuter’s five strategies of culturally appropriate interventions to determine the number and type of strategies used for each program included in the review.16
Quality Appraisal
Quality assessment and risk of bias will be evaluated independently by two researchers using AMSTAR: A Measurement Tool to Assess Systematic Reviews33 for all articles included in the systematic review to note the quality and detect any bias present in the study. This tool is appropriate for this review as it demonstrates substantial interrater agreement and has acceptable reliability, construct validity, and feasibility.34
Data Synthesis
This systematic review of the literature will aggregate data from all studies that have used CBCT programs to improve health outcomes of Black adults with diabetes, hypertension, cardiovascular disease, or stroke using a thematic analysis.35 A textual description of key program characteristics (e.g. populations served, type of intervention) and outcomes of each program will be provided. Following this, an inductive thematic analysis will be used to identify similarities and differences among and within programs.35 A deductive thematic analysis using Kreuter and colleagues’ five categories of cultural appropriateness (i.e. peripheral, evidential, linguistic, constituent-involving, and sociocultural) will be used to determine how many, which and how these components have been used within the design and delivery of culturally-tailored education programs.16 These insights will inform the creation of recommendations that can guide the design and implementation of future CBCT programs for Black communities.