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Targeting health equity through complex health interventions: Which evaluation methods and designs are used? A scoping review

Author

Listed:
  • Iñaki Blanco-Cazeaux

    (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale)

  • Thomas Ferté

    (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale)

  • Coline Bruzek
  • Marie Gaudart
  • Karelle Ngabdo
  • Jérôme Wittwer

    (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale)

  • Florence Francis-Oliviero

    (BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale)

Abstract

Objectives: Health inequalities (HI) are systematic and avoidable disparities. While many public health interventions target HI reduction, their impact is not always evaluated. We assessed the extent to which economic indicators and methods are used to evaluate HI reduction in complex health interventions. Study design: We performed a scoping review following Arksey and O'Malley's framework. Methods: We searched PubMed, Scopus, CINAHL, EconLit, and PsycINFO for studies evaluating public health interventions aimed at reducing HI. Results: Of 490 screened articles, 19 met inclusion criteria. Most studies (n = 10) used randomised controlled trials. The predominant evaluation method was subgroup analyses based on socioeconomic categories (n = 10), followed by interaction terms (n = 5) and difference-in-differences (n = 4). However, no study directly assessed HI reduction using dedicated economic indicators. Conclusions: Despite the stated goal of reducing HI, evaluations often fail to measure this impact explicitly. This omission poses methodological risks, as some interventions may unintentionally widen disparities. We advocate for systematic inclusion of economic indicators, such as the Gini index or methods, such as Distributional Cost-Effectiveness Analysis, to ensure a more rigorous assessment of HI in public health interventions.

Suggested Citation

  • Iñaki Blanco-Cazeaux & Thomas Ferté & Coline Bruzek & Marie Gaudart & Karelle Ngabdo & Jérôme Wittwer & Florence Francis-Oliviero, 2025. "Targeting health equity through complex health interventions: Which evaluation methods and designs are used? A scoping review," Post-Print hal-05308468, HAL.
    • Handle: RePEc:hal:journl:hal-05308468
    DOI: 10.1016/j.puhe.2025.105962
    Note: View the original document on HAL open archive server: https://hal.science/hal-05308468v1
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    References listed on IDEAS

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    2. Nanna Lien & Leen Haerens & Saskia te Velde & Liesbeth Mercken & Knut-Inge Klepp & Laurence Moore & Ilse Bourdeaudhuij & Fabrizio Faggiano & Frank Lenthe, 2014. "Exploring subgroup effects by socioeconomic position of three effective school-based dietary interventions: the European TEENAGE project," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(3), pages 493-502, June.
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