A systematic review of the 60 year literature: Effects of outreach programs in supporting historically marginalized and first-generation, low-income students in healthcare education

We have reviewed over 60 years of studies on healthcare education outreach programs that are aimed to support first-generation, low-income, as well as underrepresented racial and ethnic minority groups (historically marginalized students) to pursue pre-health professions. As a systematic literature review, we present the challenges studies on healthcare education outreach programs had as three main categories: 1) Design, 2) Evaluation, and 3) Analysis. 1) Designs of studies on healthcare education outreach programs often lacked theoretical foundations whereby a) the interventions did not present theories underlying a causal mechanism of inequity in health professions; and/or 1b) the defined outcome measures were not clearly aligned with the problem the intervention tried to address. 2) Evaluations of studies on healthcare education outreach programs were not always conducted effectively whereby: 2a) controlled groups were commonly absent for comparison with the intervention group; and/or 2b) post measures were solely used without pre-measures. 3) Analyses of studies on healthcare education outreach programs were not adequate whereby: 3a) the response rates and effect size were commonly low; and/or 3b) qualitative results commonly did not supplement quantitative results. Overall, our findings reveal studies on healthcare education outreach programs have common challenges that hinder the reliability of their effects supporting historically marginalized students in pursuing pre-health professions. To address such challenges with studies on healthcare education outreach programs aimed at supporting historically marginalized students, we created a decision flow chart for researchers to ask themselves: 1) how is the design guided by theoretical goals; 2) how are measurements used to evaluate success; and 3) how does the analysis lead to reliable results?