Social
Creating a Comprehensive Framework for Structural Racism Measurement: Insights from a Modified Two-Phase Delphi Panel Ester Villalonga-Olives* Alisha Crump Yusuf Ransome Wendy Camelo Castillo Ichiro Kawachi Salene Jones Bryce B. Reeve Ester Villalonga-Olives
Aim:
Structural racism is a public health hazard. This study aimed to apply a theoretical foundation for identifying ecological level data that will contribute to developing a novel multilevel and multidimensional structural racism measure for use within Hispanic/Latino and Black communities.
Methods:
The National Institute on Minority Health and Health Disparities framework guided the selection of ecological level indicators for measure development. A content development team (N=4 social epidemiologists) pre-selected 68 ecological indicators from previous literature followed by a two-phase modified Delphi approach. A panel of health inequality experts, community members, economic inequality specialists and psychometricians participated in the process. In the initial Delphi round, indicators were categorized for inclusion, further discussion, or removal. In a subsequent Delphi session, panel members discussed indicators that did not have agreement from the first round and provided additional indicators. The content development team then evaluated these results to create a final selection based on criteria such as appropriateness for measuring structural racism. Lastly, the expert panel reviewed this finalized list and added weights to the indicators according to their importance.
Results:
We identified 71 ecological level indicators. The indicators spanned from educational metrics like high school graduation rates to financial measures such as credit loan access disparities, with economic and housing discrimination indicators receiving a stronger relevance score (Figure 1).
Conclusion:
This work serves as the foundation for a multilevel structural racism measure focused on Hispanic/Latino and Black populations, addressing a gap in epidemiologic research. Next steps include conducting community interviews to validate that selected indicators reflect lived experiences of racism and merging ecological level with individual level indicators to create the multilevel measure.
