Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies

Omar Dewidar; Georgia McHale; Ali Al Zubaidi; Mostafa Bondok; Leenah Abdelrazeq; Jimmy Huang; Alyssa Jearvis; Khadija Aliyeva; Amjad Alghamyan; Fatima Jahel; Regina Greer-Smith; Janice Tufte; Lucy C Barker; Nour Elmestekawy; Melissa K Sharp; Tanya Horsley; Clara Juandro Prats; Janet Jull; Luke Wolfenden; Luis Gabriel Cuervo; Billie-Jo Hardy; Janet Hatchet Roberts; Elizabeth Ghogomu; Ekwaro Obuku; Ebenezer Owusu-Addo; Stuart G Nicholls; Lawrence Mbuagbaw; Sarah Funnell; Bev Shea; Anita Rizvi; Peter Tugwell; Zulfiqar Bhutta; Vivian Welch; G J Melendez-Torres

doi:10.1016/j.jclinepi.2024.111283

Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies

J Clin Epidemiol. 2024 Apr:168:111283. doi: 10.1016/j.jclinepi.2024.111283. Epub 2024 Feb 16.

Authors

Omar Dewidar¹, Georgia McHale², Ali Al Zubaidi³, Mostafa Bondok⁴, Leenah Abdelrazeq⁵, Jimmy Huang², Alyssa Jearvis², Khadija Aliyeva², Amjad Alghamyan², Fatima Jahel², Regina Greer-Smith⁶, Janice Tufte⁷, Lucy C Barker⁸, Nour Elmestekawy², Melissa K Sharp⁹, Tanya Horsley¹⁰, Clara Juandro Prats¹¹, Janet Jull¹², Luke Wolfenden¹³, Luis Gabriel Cuervo¹⁴, Billie-Jo Hardy¹⁵, Janet Hatchet Roberts¹⁶, Elizabeth Ghogomu², Ekwaro Obuku¹⁷, Ebenezer Owusu-Addo¹⁸, Stuart G Nicholls¹⁹, Lawrence Mbuagbaw²⁰, Sarah Funnell²¹, Bev Shea¹⁹, Anita Rizvi²², Peter Tugwell²³, Zulfiqar Bhutta²⁴, Vivian Welch²⁵, G J Melendez-Torres²⁶

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: Odewi090@uottawa.ca.
² Bruyère Research Institute, University of Ottawa, Ottawa, Canada.
³ Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Medicine, University College Cork, Cork, Ireland.
⁴ Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada.
⁵ Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Department of Health Sciences, Carelton University, Ottawa, Canada.
⁶ Healthcare Research Associates, LLC/S.T.A.R. Initiative, CA, USA.
⁷ Hassanah Consulting, Seattle, WA 98122, USA.
⁸ Department of Psychiatry, University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada.
⁹ Department of General Practice, Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁰ Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.
¹¹ Applied Health Research Center, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹² School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada.
¹³ Cochrane Public Health, School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia.
¹⁴ Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO/WHO), Washington, DC, USA; Department of Paediatrics, Obstetrics & Gynaecology, and Preventive Medicine, Doctoral School, Universitat Autònoma de Barcelona, Barcelona, Spain.
¹⁵ Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁶ WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Canada.
¹⁷ Africa Centre for Systematic Reviews & Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda.
¹⁸ Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
¹⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
²⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
²¹ Department of Family Medicine, Queen's University, Kingston, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
²² School of Psychology, University of Ottawa, Ottawa, Canada.
²³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
²⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre for Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan.
²⁵ Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
²⁶ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.

PMID: 38369078
DOI: 10.1016/j.jclinepi.2024.111283

Abstract

Objectives: To enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic.

Study design and setting: We searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low-middle-income), COVID-19 topic (vs non-COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations.

Results: We identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base.

Conclusion: Understanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.

Keywords: Discourse; Equity; Motivation; Observational studies; Qualitative study design; Reporting guidelines; Themes.

MeSH terms

Health Equity*
Health Inequities
Humans
Motivation*
Pandemics
Publications