This scoping review follows the Joanna Briggs Institute methodology for scoping reviews [53]. Consistent with this approach, the review will involve the identification of relevant evidence, screening and selection of sources, data charting, and synthesis and presentation of results. Review processes will be iterative and team based, with regular consultation among the research team to support methodological consistency, reflexivity, and interpretive rigor. This protocol is reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) alongside guidance for the development of scoping review protocols by Peters et al [55]. The review has been registered with PROSPERO (registration number: CRD42024623132).

This scoping review is grounded in CRT as its foundational lens and informed by CRL as its primary analytical framework. Within this review, CRT provides the structural basis for understanding race as socially constructed and racism as systemic, historically produced, and embedded within institutions and social relations rather than reducible to individual prejudice [9,11,32,56,57]. It also draws attention to how dominant claims of neutrality, objectivity, and color blindness can obscure racial power and institutional accountability [32-35]. Accordingly, CRT anchors the review’s focus on structural racism, the experiences of ACB populations, and the institutional production of health inequities.

Building on this foundation, CRL serves as the core interpretive framework. It is concerned with how racism is recognized, interpreted, and challenged across discourse, policy, professional practice, and organizational life [36,37,40,58]. In contrast to broader formulations of racial literacy, CRL emphasizes critical consciousness, historical and sociopolitical analysis, reflexive attention to positionality, structural analysis, and sustained antiracist action [36,37,40,59]. In health contexts, CRL is particularly valuable because it illuminates forms of racial silence, race evasiveness, normalization, and institutional denial while also providing a framework for analyzing how racism structures inequitable health care experiences, constrains opportunities for health, and contributes to disparities in health outcomes among ACB populations [22,29,30,39,47,52,60]. In this review, the specific contribution of CRL lies in its capacity to move the analysis beyond documenting inequities toward examining how racism is conceptualized, normalized, and challenged across health research, policy, and practice.

To deepen interpretation of the findings, the review also draws on intersectionality and ecosocial theory as complementary analytic lenses. Intersectionality highlights how racism intersects with gender, socioeconomic position, migration status, colorism, and other relations of power to produce heterogeneous experiences within and across ACB communities [31,42,56,61]. Ecosocial theory further informs the analysis by explaining how structurally produced racism becomes embodied through historically and institutionally organized pathways of exposure, exclusion, constrained opportunity, and differential accountability across the life course [2,62,63]. Together, these lenses broaden the analysis to the heterogeneity of racialized experience, the operation of institutional processes, and the embodiment of inequities.

Taken together, CRT, CRL, intersectionality, and ecosocial theory guide the review’s synthesis in complementary ways [2,32,33,36,40,52]. CRT anchors the structural analysis of racism; CRL guides the mapping and interpretation of how racism is conceptualized and operationalized in the literature; and intersectionality and ecosocial theory deepen analysis of differential experience, institutional power, and embodied inequities. Collectively, these frameworks support a synthesis attentive not only to descriptive patterns in the literature but also to the relations of power and structural conditions through which health inequities are produced and sustained.

This review will apply eligibility criteria structured according to the population, interest, context, and source type (PICoS) framework to identify literature relevant to how CRL is defined, conceptualized, and operationalized in health-related contexts. The criteria are designed to map the principal dimensions, practices, and applications of CRL, as well as the ways in which it has been mobilized to address structural racism and advance health equity for ACB populations in HICs (Table 1).

Following establishment of the eligibility criteria, a comprehensive search strategy will be developed to identify relevant published and unpublished literature across selected bibliographic databases and gray literature sources.

A comprehensive and sensitive multi-database search strategy will be developed and conducted by the review team in collaboration with an experienced health sciences librarian to identify relevant scholarly and gray literature. For scholarly literature, the following electronic databases will be searched: MEDLINE ALL via Ovid, Embase and Embase Classic via Ovid, CINAHL via EBSCOhost, APA PsycInfo via Ovid, Scopus, and ERIC. Ovid currently provides access to MEDLINE, Embase, Embase Classic, and APA PsycInfo on its platform [65].

A 3-step search strategy will be used. First, an initial limited search of MEDLINE ALL via Ovid will be undertaken to identify relevant articles and examine the keywords used in titles and abstracts, as well as the index terms assigned to relevant records. The preliminary MEDLINE search strategy will include a broad range of subject headings, such as “Racism” and “Health Equity,” along with keywords related to “Critical Racial Literacy,” “racial literacy,” “critical consciousness,” “anti-racism,” “structural racism,” “power,” “African, Caribbean, and Black populations,” and “health-related contexts.” Second, the MEDLINE search strategy will be refined and translated for use across the remaining bibliographic and gray literature sources. Third, all databases will be searched from inception to March 31, 2026. Moreover, the reference lists of all included sources will be screened to identify further relevant records not retrieved through database searching (see Multimedia Appendix 1 for the MEDLINE search strategy).

Because this review examines how CRL is conceptualized and operationalized across health research, policy, practice, and community contexts, targeted gray literature searches will also be conducted. These searches will be used to identify relevant policy documents, organizational reports, training resources, implementation frameworks, practice guidance, and toolkits. Gray literature sources will include government and public health websites, professional associations, health care organizations, Black-serving community organizations, and other relevant institutional websites in HICs. Gray literature searching will include ProQuest Dissertations and Theses Global, Google Scholar, the Canadian Agency for Drugs and Technologies in Health’s Grey Matters tool, and targeted website searching of relevant organizations, together with hand searching of identified documents and reference lists where appropriate. The Grey Matters tool remains an active resource for health-related gray literature searching, whereas OpenGrey was discontinued in December 2020 and preserved as an archive rather than maintained as a current database [66].

Records identified through the searches will be imported into the Covidence software (Veritas Health Innovation) for deduplication and screening. Screening will be conducted in 2 stages: title and abstract screening followed by full-text review. At each stage, records will be assessed independently by 2 reviewers against the population, interest, context, and source type–based inclusion and exclusion criteria (Table 1). For studies involving multiple racialized populations, inclusion will require that findings relevant to ACB communities be reported separately, analyzed as a distinct subgroup, or otherwise clearly identifiable through disaggregated qualitative or quantitative data. Where relevance to ACB populations is uncertain at the title and abstract stage, the record will be retained for full-text review. During full-text screening, decisions regarding whether findings can be meaningfully distinguished for ACB populations will be guided by prespecified criteria and discussed among reviewers to support consistency.

Disagreements that arise at any point in the screening process will be resolved through discussion between the 2 reviewers and, where necessary, through consultation with the senior author (JBE) or adjudication by a third reviewer. The reasons for exclusion during the full-text stage will be documented, and the study selection process will be reported in a PRISMA-ScR flow diagram [67,68].

A data extraction instrument will be developed by the review team in Microsoft Excel. To ensure alignment with the review question and objectives, data will be charted across seven primary domains: (1) bibliometric and source characteristics, including title, year, journal or source, and country of origin; (2) study or paper context, including publication type, population of focus, health-related setting, and methodological characteristics where applicable; (3) CRL definitions and conceptualizations; (4) the principal dimensions, components, and practices associated with CRL; (5) the ways in which CRL is implemented, integrated, or operationalized in health-related contexts; (6) reported barriers, facilitators, challenges, and strategies related to the operationalization of CRL in addressing structural racism and advancing health equity; and (7) implications for future research, policy, practice, and programmatic development. For studies involving multiple racialized populations, the extraction form will also capture how ACB populations were identified and analytically distinguished, including through separate subgroup analyses, disaggregated quantitative findings, qualitative quotations, case examples, or explicit ACB-specific discussion. Where extraction fields are not applicable to a given source type, these will be recorded as “not applicable.”

To calibrate the charting process, the review team will pilot the extraction form on a small sample of included sources and compare results through discussion to assess clarity, consistency, and alignment with the review objectives. The form will be refined iteratively as needed throughout the charting process. Data extraction will then be conducted by at least 2 reviewers, with uncertainties or discrepancies resolved through discussions and, if required, consultation with the senior author (JBE). Where relevant and feasible, the corresponding authors of included papers may be contacted to clarify ambiguous or missing information [53].

Analysis and reporting will proceed in 2 stages. First, the included sources will be descriptively mapped to provide an overview of the evidence base. Data will be presented in summary tables derived from the data charting form with a brief narrative summary to describe the scope, distribution, and general article characteristics of the included literature.

Second, thematic mapping, adapted from the 3-phase approach described by Etowa et al [69], will be used to collate, interpret, and synthesize key patterns across the included sources. This approach is appropriate for a scoping review of an emerging and conceptually heterogeneous field because it supports the integration of diverse forms of evidence while maintaining descriptive breadth and analytic depth. In this review, thematic mapping will be used to examine how CRL is defined and conceptualized in health contexts; the principal dimensions, components, and practices associated with CRL; and the ways in which CRL has been operationalized to address structural racism and advance health equity for ACB populations in HICs.

Thematic mapping will proceed in 3 phases [69]. In phase 1 (individual study analysis), initial codes and descriptive themes will be developed from the extracted data. This phase will identify how CRL is framed across the literature, including variation in definitions, conceptual boundaries, dimensions, practices, and reported applications. Coding will be informed by the review’s theoretical framework, including CRT, CRL, intersectionality, and ecosocial theory. In phase 2 (within-group analysis), descriptive themes will be compared, interpreted, and refined into broader analytic themes through iterative examination of similarities and differences across the included sources. This phase will support a deeper analysis of how CRL is articulated in the literature, which dimensions and practices are emphasized or underdeveloped, and how operational applications are described in relation to health equity for ACB populations in HICs. In phase 3 (cross-group analysis), higher-order themes will be developed across the included evidence base to generate a synthesized account of CRL conceptualizations, dimensions, and operational applications. These themes will also support identification of conceptual, methodological, and practice-based gaps in the literature. Theme development will occur iteratively through comparison, discussion, and refinement within the research team to enhance consistency and interpretive rigor. The final findings will be presented in tables; a thematic narrative summary; and, where appropriate, a visual thematic map illustrating relationships across CRL conceptualizations, dimensions, and operational applications.

This protocol does not require ethics approval as it is based solely on the analysis of publicly available secondary documents. No primary data collection involving human participants will be conducted.

This review will examine how CRL is defined, conceptualized, and operationalized across health-related contexts involving ACB populations in HICs. Given the emergent nature of this field, the review is likely to identify a limited and conceptually heterogeneous body of literature. The findings may reveal variation in how CRL is defined and framed across studies, as well as inconsistency in the dimensions, components, and practices associated with it. The review may also indicate that, although CRL is increasingly recognized as a promising framework for addressing structural racism in health, its application remains uneven and underdeveloped across policy, training, organizational, public health, and clinical settings.

The review is also expected to identify important gaps in the literature, including inconsistency in terminology, insufficient articulation of CRL dimensions in health contexts, and limited clarity regarding how CRL is translated into practice. In addition, the evidence base may be concentrated within a relatively small number of contributions, with few studies documenting applied or practice-based examples specifically with ACB populations. Studies that include broader racialized populations will be limited to sources in which findings related to ACB populations are clearly identifiable and can be meaningfully distinguished. By mapping these patterns, the review will help clarify the current state of the field and identify priorities for future research, policy, and practice.

This review has several strengths. It is guided by a rigorous scoping review methodology informed by Joanna Briggs Institute guidance and supported by a comprehensive multi-database search strategy, dual independent screening, calibrated data charting, and structured analytic synthesis. It is further strengthened by an integrated theoretical framework drawing on CRT, CRL, intersectionality, and ecosocial theory to support analysis of structural racism, institutional power, differential experience, and embodiment in health contexts affecting ACB populations. In addition, the review addresses an important gap in an emerging field by synthesizing how CRL has been defined, conceptualized, and operationalized in relation to health equity for ACB populations in HICs.

Several limitations should also be acknowledged. First, the emergent and potentially fragmented nature of CRL scholarship may make it difficult to identify and consistently chart all relevant definitions, dimensions, and operationalizations across studies. Second, the inclusion of heterogeneous evidence sources with varying levels of methodological detail and reporting may pose challenges for consistent data extraction despite piloting efforts. Third, the literature specific to ACB populations may be limited, and some potentially relevant studies may address broader racialized populations without providing sufficiently disaggregated findings for inclusion. Finally, the review will be limited to sources available in English and French, which may introduce language bias and exclude potentially relevant scholarship published in other languages.

The completed review will provide a foundation for future scholarship on CRL in health-related contexts involving ACB populations in HICs. By clarifying how CRL is currently defined, the dimensions and practices associated with it, and the ways in which it has been operationalized, the review will help inform the development of more conceptually coherent and structurally grounded research, policy, and practice. It may also help refine CRL-informed approaches in areas such as health professional education, organizational accountability, policy development, and community-based health equity work.

Future research may build on these findings by developing more explicit CRL frameworks for health contexts, examining barriers to and facilitators of operationalization, and exploring how CRL-informed approaches can be evaluated in relation to institutional change and health equity outcomes. Additional work may also be needed to strengthen indicators, measures, and practice-based applications of CRL while ensuring continued attention to anti-Black racism, intersectional inequities, and the structural conditions through which health inequities are produced and sustained.