Josephine Etowa

Background: Race-based data collection and governance remain inconsistent across Canadian health systems, limiting the visibility of African, Caribbean, and Black (ACB) communities. This paper presents a data profile of people working in or alongside ACB-serving organizations in Canada. Methods: A national cross-sectional survey captured sociodemographic characteristics, organizational affiliations, research roles, perceptions of data governance, training needs, barriers to participation, and self-rated research capacities of individuals engaged in ACB research and data governance. Eligible participants were individuals engaged in research, evaluation, data collection, data administration, or related activities in ACB-serving organizations across Canada. We conducted descriptive analysis. Results: Among 384 respondents, 45.8% lived in Ontario and 23.7% in Quebec. Most identified as female (72.1%), and 59.9% held a bachelor’s degree or higher. Many reported involvement in data collection (48.2%), data analysis (41.7%), and data management (41.4%). Training needs were frequently identified in cultural competency (48.7%), research methodology (44.3%), and data analysis (44.3%). Common barriers included lack of representation (46.1%), language challenges (41.4%), historical mistrust (37.5%), and concerns about data sovereignty (37.5%). Confidence was highest for data collection (56.4% rating 7–9) and lowest for securing research funding (34.8% rating 1–3). Conclusions: This data profile provides foundational evidence to support equitable, community-aligned data governance policy and practice within ACB-serving organizational contexts in Canada.

Background: African, Caribbean, and Black (ACB) populations in high-income countries (HICs) continue to experience long-standing health inequities rooted in structural and anti-Black racism embedded in health systems, policies, and institutional practices. From an ecosocial perspective, these inequities reflect the embodiment of intersecting forms of oppression structured through racialized, gendered, and socioeconomic relations. Critical racial literacy (CRL) has emerged as a promising framework for recognizing and addressing structural racism in ways that foster critical reflection and support justice-oriented action in health contexts. However, evidence on how CRL is conceptualized and operationalized in health research, policy, and practice concerning ACB communities remains fragmented and limited. Objective: This scoping review aims to map how CRL is conceptualized and operationalized in HICs and examine its potential to advance health equity for ACB populations. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute guidance. Comprehensive searches will be conducted in MEDLINE (Ovid), Embase, CINAHL, PsycInfo, ERIC, Scopus, and ProQuest Dissertations and Theses Global from inception to March 31, 2026. Peer-reviewed articles and theses or dissertations will be included, with no restrictions on study design or publication type. At least 2 independent reviewers will conduct screening, charting, and analysis of the data. A 3-phase thematic mapping process guided by critical race theory, intersectionality, and ecosocial theory will be used to analyze and interpret the findings. Results: Searching, screening, data charting, and analysis will be undertaken between April 2026 and July 2026. Manuscript preparation will be completed by July 31, 2026, and dissemination will occur between August 2026 and October 2026. The findings will identify key CRL components, applications, strategies, barriers, and equity pathways across clinical, policy, and community contexts. Conclusions: This scoping review will provide a comprehensive overview of how CRL is conceptualized and applied in health contexts involving ACB populations in HICs. By clarifying current conceptualizations, applications, and gaps in the literature, the review will identify priorities for future theoretical, methodological, and practice-based development. In doing so, the findings will inform more critically grounded, praxis-oriented, and structurally focused antiracism efforts across health systems. Results will be disseminated through open access publications, conference presentations, and stakeholder engagement activities to advance evidence-informed health equity action. Trial Registration: PROSPERO CRD42024623132; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623132 International Registered Report Identifier (IRRID): PRR1-10.2196/79361

Background: In Canada, racialized communities, including African, Caribbean, and Black (ACB) people, are disproportionately affected by HIV and COVID-19. Experiencing multiple forms of discrimination in healthcare settings compromises care engagement and health outcomes. The objective of this study was to assess the forms of discrimination ACB people experienced during the COVID-19 pandemic, discrimination levels experienced before and during the pandemic and the demographic factors associated with the increased experiences of discrimination among ACB people when accessing healthcare services during the pandemic. Methods: Data were collected via an online survey co-led by the Public Health Agency of Canada, University of Ottawa, ACB community leaders and researchers across Canada. Participants were recruited via email contact. To be eligible, a participant had to be living in Canada, be aged 18 years or older, be able to read English or French, and self-identify as an ACB individual. The survey captured information on access to health services and experiences of multiple forms of discrimination before and during the pandemic. We used multivariable logistic regression to identify factors associated with discrimination. Results: Of 1556 participants, 39.6% were aged 25–39, 42.7% were resident in Ontario, and 63.2% were of African origin. Prior to the COVID-19 pandemic, 62.1% reported having experienced at least one form of discrimination in a healthcare setting. During the COVID-19 pandemic, over 66% reported having experienced at least a form of discrimination, with 25% reporting a perceived increase in the frequency with which they experienced discrimination. The perceived increase in the frequency of discrimination was 10.8%, 15.3%, 15.9%, 17.0%, 18.1%, 18.7%, and 31.2% among participants who reported having experienced sexual orientation-, gender-, substance use-, disability-, age-, economic status-, and race-based discrimination, respectively. In the multivariate logistic regression, the odds of reporting increased experiences of discrimination in participants aged 50 and above were 0.38 times (95%CI: 0.21, 0.69) those in participants who were 31–40 years of age. Conclusions: The proportion of participants who reported an increased experience of discrimination during the pandemic was high. Although there is variation in levels of experienced discrimination, the different forms of discrimination (race-, gender-, sexual orientation-, substance use-, economic status-, disability- and age-based discrimination) that participants experienced are alarming. This underscores the need for concerted efforts to address multiple forms of discrimination in healthcare settings to improve care engagement and health equity among ACB communities. There was a significant association between perceived increased experience of discrimination and only one sociodemographic factor—older age (50 and above); other factors contributing to participants’ perceived increased experience of discrimination when accessing healthcare services need to be explored.

Background: In Canada, racialized communities, including African, Caribbean, and Black (ACB) people, are disproportionately affected by HIV and COVID-19. Experiencing multiple forms of discrimination in healthcare settings compromises care engagement and health outcomes. The objective of this study was to assess the various forms of discrimination experienced by ACB people during the COVID-19 pandemic, changes in the levels of discrimination experienced before and during the pandemic and the demographic factors associated with increased experience of discrimination among ACB people when accessing healthcare services during the pandemic. Methods: Data were collected via an online survey co-led by the Public Health Agency of Canada, University of Ottawa, ACB community leaders and researchers across Canada. Participants were recruited via email contact. Eligibility criteria included living in Canada at the time of the survey, aged 18 years or older, ability to read English or French, and self-identifying as African, Caribbean or Black. The survey queried access to health services, and experiences of multiple forms of discrimination when accessing healthcare services before and during the COVID-19 pandemic. Multivariable logistic regression was used to identify factors associated with discrimination. Results: Of 1,556 participants, 39.6% were aged 25-39, 42.7% were resident in Ontario, and 63.2% were of African origin. Prior to the COVID-19 pandemic, 75% experienced at least one form of discrimination in a healthcare setting. During the COVID-19 pandemic, over 66% experienced at least a form of discrimination, with 25% reporting a perceived increase in the frequency with which they experienced discrimination. The perceived increase in the frequency of discrimination was 10.8%, 15.3%, 15.9%, 17.0%, 18.1%, 18.7%, and 31.2% among participants who experienced sexual orientation, gender, substance use, disability, age-based, economic status, and race-based discrimination, respectively. In the multivariate logistic regression, the odds of experiencing discrimination in participants aged 50 and above was 0.38 times (95%CI:0.21, 0.69) that in participants who were 31-40 years of age. Conclusion: The proportion of participants with perceived increased experience of discrimination when accessing healthcare services during the COVID-19 pandemic was high. Although there is variation in levels of experienced discrimination, the different forms of discrimination participants experienced (race, gender, sexual orientation, substance use, economic status, disability and age-based discrimination) are alarming. This underscores the need for concerted efforts to address multiple forms of discrimination in healthcare settings to improve care engagement and health equity among ACB communities. There was a significant association between perceived increased experience of discrimination and only one sociodemographic factor - older age (50 and above), other factors that could possibly contribute to participants perceived increased experience of discrimination when accessing healthcare services needs to be explored.

Background: African, Caribbean, and Black (ACB) communities in high-income countries continue to experience persistent health inequities, driven by systemic anti-Black racism, socioeconomic disadvantage, and exclusion from health decision-making. Historically, data have been extracted from ACB communities without transparency, accountability, or community ownership. These inequitable practices have produced data systems that reinforce harm rather than promote equity. Equitable data governance, which promotes community ownership over data collection, access, and use, is increasingly recognized as a critical but underresearched determinant of health equity. Objective: This protocol outlines the methodology of a scoping review to identify and synthesize evidence on the determinants of equitable data governance in health research involving ACB communities in high-income countries. Methods: The review follows the 6-stage Arksey and O’Malley methodological framework, supplemented with updated guidance from the Joanna Briggs Institute. The searches were conducted in the Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, APA PsycInfo, and Scopus databases. Peer-reviewed articles are considered, with no limits placed on study design, publication type, or date. Multiple reviewers will independently extract data by using a standardized form. A 3-phase thematic mapping process, conceptually informed by critical race theory, intersectionality, and community-based participatory research principles, will be conducted to analyze the data, generate themes, and interpret findings. Results: The final comprehensive database searches were completed on December 17, 2024. The search strategy targeted literature on data management, governance, sharing, security, and ethical principles in relation to ACB populations in high-income countries. A total of 4365 records were screened at the title and abstract level, after deduplication, of which 247 studies were deemed potentially relevant and advanced to full-text screening. Following full-text screening and reference list searching a total of 15 articles were deemed eligible for analysis. The data extraction stage is scheduled to overlap and occur between November 2025 and February 2026. The thematic mapping and stakeholder consultations processes are scheduled between December 2025 and February 2026. The final review and manuscript submission are expected by March 2026, with dissemination activities planned for mid-2026. Conclusions: This review will synthesize existing information on key pillars, barriers, facilitators, promising data governance policies and practices, and recommendations relevant to ACB communities. The findings may inform the expansion of Ontario’s Engagement, Governance, Access, and Protection guidelines and support tailored research and national data governance frameworks. The review is expected to contribute to policy, research, and community-led data initiatives. Dissemination will occur through academic publications, conferences, and community-based knowledge-sharing events. As the review relies solely on publicly available data, ethics approval is not required. Trial Registration: OSF Registries 10.17605/OSF.IO/Z82AY; https://osf.io/z82ay International Registered Report Identifier (IRRID): PRR1-10.2196/82403

Healthcare providers are often faced with a unique set of challenges when providing services to African, Caribbean, and Black (ACB) populations, including include lack of access to culturally appropriate care, language barriers, limited knowledge of specific health issues and practices, and limited resource availability. Furthermore, the ACB community may face social determinants of health that can contribute to disparities in healthcare outcomes. The present study aimed to assess the perspective of service providers regarding their knowledge and difficulties in providing care for ACB populations who represent a large immigrant population subgroup in Ontario. Methods: Data were collected through an online survey of 518 healthcare providers (303 from Toronto and 215 from Ottawa) from June to September 2021. The association between the outcome variables and the sociodemographic factors was measured using multivariate regression techniques. Results: More than a quarter (26.8%) of the participants disagreed about having the knowledge of the health access needs of ACB communities, while 44% agreed about having the knowledge. Less than half of the participants agree about having enough resources to provide COVID‐19 care for ACB clients (49.5%) and being able to engage with clients effectively (45.4%). City‐stratified revealed that a relatively higher percentage of participants in Ottawa (4.4 vs 3.8%) strongly agreed that they are able to engage effectively with ACB clients, whereas participants in Toronto had a higher percentage of agreeing with having knowledge of health needs, and having enough resources to provide COVID‐19 care for ACB clients. Results of binary regression analysis showed that female participants were significantly less likely to disagree that they have enough resources to provide COVID‐19 care for the ACB clients (average marginal effect [AME] = 1.34, 95%CI = 1.07,1.68), and that they are able to effectively engage with the ACB clients (AME = 1.12, 95%CI = 1.01,1.25). Conclusion: In conclusion, our findings revealed significant sociodemographic patterns in having adequate knowledge of health access needs, having enough resources to provide COVID‐19‐related care, and being able to engage effectively with ACB clients. These findings provide crucial information regarding the gaps and areas for improvement not only for COVID‐19‐related care but also to promote the patient–physician interaction and more effective resource allocation to meet the health needs of ACB populations in this region.

Background: The COVID-19 pandemic emerged as an unprecedented challenge for health care systems across the world, disproportionately impacting immigrant and racialized populations. Canadian African, Caribbean, and Black (ACB) communities represent some of the populations considered most vulnerable in terms of their susceptibility to health-related risks, receipt of adequate care, and chances of recovery. Objective: The COVID-19 ACB Providers Project 2.0 aims to strengthen the ability of health care providers to address this community’s COVID-19–related health care needs. Informed by the COVID-19 ACB Providers Project 1.0, a mixed methods study that examined the COVID-19 pandemic’s impact on African, Caribbean, and Black communities in Ontario (Ottawa and Toronto), this second study seeks to develop and implement educational programs in 5 key areas (modules) to strengthen the capacity of service providers (SPs) working with African, Caribbean, and Black populations. These modules (topics) include (1) the COVID-19 pandemic and its impacts on health, (2) social determinants of health and health inequities, (3) critical health literacy, (4) critical racial literacy, and (5) cultural competence and safety. Methods: An implementation science approach is used to guide the development, implementation, and evaluation of the evidence-informed interventions. The intersectionality lens, socioecological model, and community-based participatory research frameworks are informing the research process. To ensure active stakeholder engagement, the project advisory committee includes 16 African, Caribbean, and Black community members, health providers, and partner agency representatives. Five modules have been developed: 2 web-based simulation games in collaboration with leading simulation experts and 3 nonsimulation modules. The analysis, design, development, implementation, evaluation instructional design method was used as a framework to design and develop the educational modules. Results: The module development was completed in early 2024, and the training program was officially launched in April 2024 at the University of Ottawa. The synchronous format was delivered until November 2024, and the asynchronous format remained available until the end of May 2025. By January 2025, a total of 322 SPs from 33 organizations had completed training. The focus groups were held in November and December 2024 and surveys were administered between June 2024 and May 2025. Data cleaning will continue until September 2025, analysis is scheduled for September and October 2025, and findings are expected to be submitted for publication in November 2025. Conclusions: This protocol outlines a scalable, community-informed intervention to build SP capacity in delivering equitable care to African, Caribbean, and Black communities. The findings will inform future health equity training and policy development across Canada and beyond. The results of this study will be disseminated in community workshops, web-based learning platforms, at academic conferences, and in peer-reviewed publications. International Registered Report Identifier (IRRID): DERR1-10.2196/66546

BACKGROUND African, Caribbean, and Black (ACB) communities in high-income countries continue to experience persistent health inequities, driven by systemic anti-Black racism, socioeconomic disadvantage, and exclusion from health decision-making. Historically, data have been extracted from ACB communities without transparency, accountability, or community ownership. These inequitable practices have produced data systems that reinforce harm rather than promote equity. Equitable data governance, which promotes community ownership over data collection, access, and use, is increasingly recognized as a critical but underresearched determinant of health equity. OBJECTIVE This protocol outlines the methodology of a scoping review to identify and synthesize evidence on the determinants of equitable data governance in health research involving ACB communities in high-income countries. METHODS The review follows the 6-stage Arksey and O’Malley methodological framework, supplemented with updated guidance from the Joanna Briggs Institute. The searches were conducted in the Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, APA PsycInfo, and Scopus databases. Peer-reviewed articles are considered, with no limits placed on study design, publication type, or date. Multiple reviewers will independently extract data by using a standardized form. A 3-phase thematic mapping process, conceptually informed by critical race theory, intersectionality, and community-based participatory research principles, will be conducted to analyze the data, generate themes, and interpret findings. RESULTS The final comprehensive database searches were completed on December 17, 2024. The search strategy targeted literature on data management, governance, sharing, security, and ethical principles in relation to ACB populations in high-income countries. A total of 4365 records were screened at the title and abstract level, after deduplication, of which 247 studies were deemed potentially relevant and advanced to full-text screening. Following full-text screening and reference list searching a total of 15 articles were deemed eligible for analysis. The data extraction stage is scheduled to overlap and occur between November 2025 and February 2026. The thematic mapping and stakeholder consultations processes are scheduled between December 2025 and February 2026. The final review and manuscript submission are expected by March 2026, with dissemination activities planned for mid-2026. CONCLUSIONS This review will synthesize existing information on key pillars, barriers, facilitators, promising data governance policies and practices, and recommendations relevant to ACB communities. The findings may inform the expansion of Ontario’s Engagement, Governance, Access, and Protection guidelines and support tailored research and national data governance frameworks. The review is expected to contribute to policy, research, and community-led data initiatives. Dissemination will occur through academic publications, conferences, and community-based knowledge-sharing events. As the review relies solely on publicly available data, ethics approval is not required. CLINICALTRIAL OSF Registries 10.17605/OSF.IO/Z82AY; https://osf.io/z82ay INTERNATIONAL REGISTERED REPORT PRR1-10.2196/82403

African, Caribbean, and Black (ACB) communities face increased COVID-19 morbidity and mortality, coupled with significant barriers to vaccine acceptance and uptake. Addressing these challenges requires innovative, multifaceted strategies. Peer-led interventions, grounded in critical health literacy (CHL) and critical racial literacy (CRL), and integrating collaborative equity learning processes, can enhance community capacity, empowerment, and health outcomes, contributing to long-term health equity. This paper describes and presents the evaluative outcomes of a peer-led intervention aimed at enhancing COVID-19 vaccine confidence and acceptance. The Peer-Equity Navigator (PEN) intervention consisted of a specialized training curriculum grounded in CHL and CRL. Following training, PENs undertook a 5-month practicum in community or health settings, engaging in diverse outreach and educational activities to promote vaccine literacy in ACB communities. The evaluation utilized a modified Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, using quantitative and qualitative methods to collect data. Sources of data included tracking records with community feedback, and a PEN focus group, to assess program feasibility, outreach, and effectiveness. From 16 September 2022, to 28 January 2023, eight trained PENs conducted 56+ community events, reaching over 1500 community members. Both PENs and community members reported high engagement, endorsing peer-led, community-based approaches and increased vaccine literacy. The PEN approach proves feasible, acceptable, and effective in promoting positive health behaviors among ACB communities. This intervention has clear implications for health promotion practice, policy, and research in equity-deserving communities, including immigrants and refugees, who also face multiple and intersecting barriers to health information and care.