Applying an Equity Lens to Evidence-Based Preventive Interventions: a Systematic Review of Subgroup Findings from Experimental Evaluations.

Abstract

Evidence reveals that minoritized groups face disparities, underscoring the need for interventions to address behavioral health inequities. This review examined which minoritized populations are represented in evidence-based preventive interventions (EBPIs) and whether they equitably benefit from these programs. Using the Blueprints for Healthy Youth Development online clearinghouse, we synthesized findings from 240 high-quality experimental evaluations of EBPIs conducted in the U.S. between 2010 and 2023 and performed a descriptive analysis based on consensus coding to assess (1) the prevalence of culturally tailored EBPIs; (2) how frequently tests for subgroup effects were conducted; and (3) whether subgroup tests indicated differential benefits for minoritized groups. We found few culturally tailored interventions (31%), with 4% evaluating EBPIs developed for African American or Black populations and 1% for Hispanic or Latino youth. Additionally, only 25% and 15% tested for subgroup effects by race and ethnicity, respectively. For other subgroups, few (28%) evaluations included effects by economic disadvantage while 47% examined outcomes by binary gender categories. Essentially no reports tested for subgroup effects by sexual identity, location, or nativity status. Encouraging findings were that EBPIs more often benefited racial and ethnic minoritized groups, and there was an upward trend in reporting subgroup tests across time. EBPIs should test for subgroup effects to answer the questions of "what works for whom?" and "in which settings?" and to better understand the generalizability of findings. Investments are needed in culturally grounded programs developed for historically marginalized populations and trials of EBPIs that investigate mitigating health disparities.