Equity-focused analysis of tailoring strategies for overcoming risk factors in ethnic minorities (EQUATOR): a protocol for a scoping review with a realist analysis.

Abstract

Chronic diseases driven by modifiable risk factors (MRFs), such as poor diet, physical inactivity, tobacco use and harmful alcohol consumption, disproportionately affect ethnic minority groups worldwide and within multi‑ethnic societies such as Singapore. Although culturally tailored interventions and implementation strategies exist, there is limited synthesis of what has been used, for whom and under which contextual conditions these approaches produce equitable reductions in MRFs. EQUATOR aims to identify and synthesise policies, programmes and implementation strategies that have been tailored for ethnic and cultural minority populations and to develop explanatory mid‑range programme theories describing how, why and under what circumstances such tailoring produces equitable outcomes. We will conduct a scoping review with a realist synthesis as the analytical approach. Searches will be run in PubMed and Scopus for studies published from January 2010 onwards, restricted to English. Eligible studies include experimental, quasi‑experimental, qualitative, mixed‑methods studies and reviews that evaluate or report outcomes for tailored strategies addressing MRFs in ethnic minority populations and explicitly examine equity‑focused outcomes or mechanisms. A piloted data extraction form will capture study characteristics, contextual details, intervention/strategy descriptions, theoretical underpinnings and outcomes using a RE‑AIM lens (reach, effectiveness, adoption, implementation, maintenance) and equity indicators. Extracted data will support (1) an inductive typology of strategies/interventions for each MRF and (2) realist S/ICMO (Strategy/Intervention-Context-Mechanism-Outcome) configurations to generate mid‑range programme theories explaining how tailoring works (or fails) across contexts. Ethical approval is not required for this literature synthesis. Findings will be disseminated through peer‑reviewed publications, presentations to policymakers and practitioners and stakeholder briefings to emphasise actionable recommendations for culturally tailored strategies to reduce MRFs and promote health equity in multi‑ethnic settings.