The global number of international migrants continues to rise, reaching more than 280 million in 2020 [1]. This increase reflects a significant shift in global mobility, as individuals relocate for diverse reasons, including escaping repression, insecurity, and poverty. According to the Organization for Economic Cooperation and Development (OECD) [2], the 5 countries that received the highest numbers of new asylum applications in 2023 were the United States (1,176,050), Germany (329,120), Spain (160,470), Canada (146,730), and France (145,210). For instance, Canada ranked fourth among OECD countries, marking a 55% increase compared with 2022, when it ranked eighth. In 2021, Canada welcomed more than 8.3 million migrants, representing nearly one-quarter (23.0%) of its total population [3], positioning it among the most multicultural nations globally.

Among new arrivals to OECD countries, an increasing number are migrating for educational purposes. Universities in these countries attract large cohorts of international students annually from diverse global regions. This trend, known as the internationalization of higher education, continues to grow [4]. In Canada, for instance, 682,889 study permit holders entered the country in 2023 [5], reflecting significant diversity in terms of race, culture, religion, and social background.

This diversity gives rise to sociopolitical challenges related to coexistence, including the interaction of different cultures, identity tensions, and unequal access to resources and opportunities within academic environments. It also places institutional capacities under strain, particularly in terms of their ability to embrace, recognize, and value otherness [6-9]. This is reflected, for instance, in efforts to promote the academic success of students from racialized minority groups, implement inclusive and antiracist policies, and integrate non-Western knowledge and lived experiences into curricula.

However, within this social context, where multiple realities and diverse identities intersect, many racialized individuals encounter a range of personal and systemic barriers in their daily lives as they seek acceptance, recognition, and validation [6,9,10]. In academic settings in particular, individuals from visible-minority groups are disproportionately affected by discrimination [10,11]. Such discrimination may manifest in the form of racial microaggressions and macroaggressions (RMMAs), biased academic evaluations, social exclusion, and limited access to mentoring and professional development opportunities. RMMAs, although often subtle and invisible, constitute very real forms of violence that individuals may experience due to their skin color, accent, or religious affiliation [11,12].

Racial macroaggressions refer to systemic and institutionalized forms of prejudice and oppression. These can manifest, for example, within the education system, the workplace, the health care system, the legal and policing systems, and more. Systemic racism is a form of macroaggressions that encompasses a whole system of policies, laws, practices, attitudes, and societal structures that produce discrimination based on skin color or national origin [11].

Racial microaggressions, on the other hand, refer to incivilities, verbal assaults, hostile gestures, disrespectful comments, or negative attitudes directed at an individual or group based on phenotypic or cultural characteristics. These often occur unconsciously, not only through subtle and disdainful looks, gestures, or tones but also through indifference, deliberate ignorance, or systematic exclusion from social interactions. They are pervasive in everyday conversations and interactions and are often perceived as harmless or innocent [11,12].

A growing body of evidence indicates that Black individuals are disproportionately exposed to racism in academic settings, including overt discrimination and everyday microaggressions [13-17]. In nursing education, qualitative studies have shown that Black students frequently experience microaggressions from peers and faculty, as well as in clinical environments, which can negatively affect their learning and contribute to psychological distress [16]. Moreover, these experiences occur within broader structural inequities, including underrepresentation and systemic barriers that hinder academic success and a sense of belonging among Black nursing students [15].

RMMAs have a significant impact on the well-being, academic performance, and sense of belonging of those affected [18-22]. Exposure to racism is associated with significant adverse health outcomes, including increased symptoms of anxiety, depression, and sleep disturbances, particularly in the context of more overt discrimination [23-25]. It is also linked to physiological stress responses, such as elevated blood pressure, as well as maladaptive coping behaviors, including alcohol misuse and other health-risk behaviors [26-28].

Despite institutional commitments to equity, diversity, and inclusion, academic environments in OECD member countries continue to be marked by racial aggressions targeting Black individuals [29-31]. These acts of aggression, often minimized or overlooked, take various forms, including microaggressions, systemic discrimination, and symbolic exclusion. Such discriminatory practices restrict access to employment opportunities, support services, and funding for research and scholarships. This unequal access to resources and opportunities directly contributes to the persistence and reinforcement of both social and health inequalities [21,32].

The various forms of RMMAs at universities in OECD countries have not yet been extensively studied [33]. Addressing RMMA remains a “taboo” subject in several countries. For example, in northern European countries, such as Sweden and Norway, although racism is recognized as a problem, it is very difficult to address it publicly without provoking resistance or without the discussion quickly turning into a debate on freedom of expression, which can minimize or deflect criticism [34]. As a result, it is difficult to develop and implement effective strategies that would better prevent these aggressions. It is important to note that institutional policies vary greatly from one country to another, from one administrative region to another, and even from one academic institution to another. These policies are constantly evolving and require research support to document, evaluate, and renew them.

In this context, an integrative review is needed to synthesize the existing knowledge, identify gaps, and inform practices and policies that can effectively prevent and respond to racial aggression in higher education institutions. More specifically, we chose to focus on Black individuals, as they experience distinct forms of discrimination, often linked to anti-Black racism, which shape their experiences within academic environments [10,11,20]. Anti-Black racism is rooted in a historical legacy shaped by colonialism and slavery [35,36], which has contributed to the construction and persistence of racial hierarchies that continue to influence contemporary institutions.

Documenting the racism experienced by Black individuals is essential to make visible systemic inequities, understand their impact on health and well-being, and inform the development of contextually relevant and effective antiracism interventions. Despite growing evidence of the impact of racial discrimination on the health and well-being of Black individuals [20,22], the literature remains fragmented, particularly regarding the forms of racial aggressions and the coping strategies developed to address them in academic settings. Moreover, there is a lack of an integrative synthesis that comprehensively examines how these forms of racial aggressions manifest, how Black individuals respond to them, and the implications for health and overall well-being.

The integrative review proposed in this protocol aims specifically to address this gap by providing a comprehensive synthesis of the existing literature.

This integrative review aims to analyze and synthesize existing knowledge of racial aggressions, both macroaggressions and microaggressions, in academic settings, as experienced by Black individuals as students or members of the teaching staff (including lecturers and professors) in university settings across OECD countries. In this regard, it will answer the following research questions:

By examining the manifestations of racial aggressions, the coping strategies developed by Black individuals, and the institutional responses implemented, this review seeks to provide a comprehensive and integrated understanding of how these experiences collectively influence health and well-being.

This integrative review protocol is reported in accordance with PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines [37] (Checklist 1). The integrative review will be conducted following the methodological framework proposed by Whittemore and Knafl [38]. This approach allows for the inclusion of studies using diverse methodologies—quantitative, qualitative, and mixed methods—thus offering a comprehensive understanding of the phenomenon under investigation. The use of an integrative review is particularly well suited to our study, as it enables a multidimensional exploration of macro-level and micro-level racial aggression in academic settings. It also helps identify gaps in the existing literature, supports the development of new conceptual or theoretical frameworks, and informs university policies aimed at fostering more inclusive environments. The review will be conducted in 7 distinct phases: (1) problem identification, (2) literature search, (3) study selection, (4) data evaluation, (5) data extraction and analysis, (6) data synthesis, and (7) presentation of findings.

The identified problem is presented in the “Background” section of the protocol. The research process began with discussions among the research team to define the primary objective and formulate the research questions. Once these elements had been established, a working session was conducted with a professional librarian, who is also a coauthor of this study, to develop and validate the search strategies.

Following this, the research team received training in database searching and screening procedures. The identification of relevant studies was subsequently carried out through systematic searches of electronic databases using validated search strategies. The search process was designed to ensure comprehensive coverage of literature relevant to the research questions.

Two reviewers will independently select the literature to be included in the review, following a 2-step selection process using the Rayyan platform and in accordance with the predefined inclusion and exclusion criteria. The first step after removing duplicates will be to screen titles and abstracts to identify relevant documents based on predefined eligibility criteria. Studies meeting the initial screening criteria will be retained for full-text review. In the second step, the full texts of the selected papers will be assessed to confirm eligibility.

All reasons for exclusion will be systematically documented. In cases of disagreement among the 3 evaluators, a discussion will be held to reach a consensus. If consensus cannot be achieved, the third evaluator will serve as an arbitrator to make the final decision. The entire paper selection process will be transparently summarized using a PRISMA-P flow diagram.

Due to the integrative nature of this review, a standard risk-of-bias assessment will not be conducted. The quality assessment of the studies included in this integrative review will be conducted using the Mixed Methods Appraisal Tool (MMAT; 2018 version) [40], which is recognized for its relevance in evaluating qualitative, quantitative, and mixed methods research. This step will be carried out rigorously, in collaboration with researchers who possess specific methodological expertise: quantitative method specialists for the appraisal of quantitative studies and qualitative method specialists for the appraisal of qualitative studies. This collaborative approach aims to ensure the validity and reliability of the critical analysis of the selected sources.

After selecting the relevant studies, a systematic data extraction and mapping strategy will be implemented to organize the information according to the type of racial aggression (“micro” or “macro”) that occurred in universities across various OECD countries. An extraction grid (Multimedia Appendix 3) will be developed with the research team to systematically collect relevant information from the selected studies. The software for data extraction and presentation will be Microsoft Excel and Rayyan.

Three team members will participate in the data extraction process. Data analysis will be conducted in 2 stages. First, the studies will be categorized based on the type of racial aggression identified in the selected papers, either microaggressions or macroaggressions. Subsequently, a thematic synthesis will be conducted to integrate the findings related to coping strategies and health outcomes.

We will use a concept-mapping approach, defined by Osei-Kwasi et al [41], as “seeing things as a whole,” inspired by system thinking. This method involves several steps: generating a list of factors, classifying them, and then structuring them into groups by consensus based on their interrelationships [41]. This grouping will help develop a systemic framework illustrating the manifestations of racial aggressions experienced by Black individuals in academic settings in developed countries, and how the intersection of these manifestations affects their well-being.

A qualitative, integrative approach will be used to synthesize the findings across studies. Results will be organized around the main categories of racial aggression (microaggressions and macroaggressions) and presented within key thematic domains that reflect their manifestations, contexts, and affected populations.

A synthesis table will be developed to present the key characteristics of the included studies, including authorship, year of publication, country, research objectives, study design, population characteristics, reported findings, and study limitations. This table will support structured comparison across studies. It will be performed using both tabular and narrative approaches. The narrative synthesis will be structured around predefined analytical categories aligned with the objectives of the review.

The synthesis will highlight the relationships among different forms of racial aggression and incorporate an intersectional perspective to capture the complexity of these experiences. The findings will also be structured according to their impact on well-being (psychological, academic or professional, and social). The results will be presented in a summary table to map the studies according to the identified categories and subcategories. The results obtained will highlight the main trends as well as gaps in the literature that require special attention in future research.

Potential meta-biases, including publication bias, selective reporting, and language bias, will be considered during the interpretation of the findings. Efforts will be made to include studies from diverse sources and contexts to minimize the impact of these biases. However, due to the heterogeneity of study designs and the nature of the integrative review, a formal statistical assessment of meta-biases will not be performed.

As part of an integrative review, data presentation is a critical step that goes beyond merely listing the findings. Its purpose is to organize, compare, and interrelate the collected information to highlight both the specific contribution of each study and the overarching understanding that emerges from the entire body of work.

To this end, a synthesis table will be developed. It will provide a clear and structured overview of the included studies, listing key elements for each study, such as the authors and year of publication, the country where the research was conducted, the research objectives, the methodology used, the characteristics of the study population, the main findings, and the identified limitations. This format will facilitate comparison across studies and highlight areas of convergence and divergence.

As a complement, a narrative presentation will be developed in the form of an in-depth textual synthesis, structured around predefined analytical categories. These may include, for example, contextual factors, lived experiences, and proposed interventions. Each section will be illustrated with findings from the selected studies, thereby enhancing the understanding of the phenomenon under investigation and offering an integrated analysis that goes beyond the mere juxtaposition of individual data.