Study design

This protocol was informed by the Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) (S1 Appendix) [47]. A scoping review study design was deliberately chosen due to its suitability for investigating topics characterized by diverse literature, which may include theoretical discussions and various types of empirical studies [48]. Unlike other review methodologies aimed at addressing specific research questions or evaluating measurable outcomes of strategies, actions and/or initiatives, the primary objective of this scoping review is to systematically map and elucidate key concepts and strategies, actions and/or initiatives focusing on EDI [48, 49]. Scoping reviews serve as valuable tools for providing an overview of the landscape of existing literature, allowing researchers to gain a comprehensive understanding of the breadth and scope of the topic under investigation [48]. To guide the review’s conduct, we will follow the Joanna Briggs Institute guidance [50]. For transparency and ease of access, the protocol for this review has also been uploaded to the Open Science Framework platform (osf.io/agyvw). This review does not involve human subjects, thus obviating the need for Institutional Review Board oversight. By addressing this gap, the study aims to contribute to the development of evidence-based approaches for enhancing EDI in geriatric healthcare professional education and ultimately improving the quality of care provided to older adults from diverse backgrounds.

Research questions

The research questions for this review are as follows:

1. What strategies, actions and/or initiatives designed to address issues of EDI in curriculum have been implemented to promote EDI within geriatric healthcare professional education?
2. How are these strategies, actions and/or initiatives described and evaluated in the literature? What are their outcomes?
3. What are the common trends, challenges, and opportunities identified in implementing EDI strategies, actions and/or initiatives within geriatric healthcare education?

Search strategy

The search strategy will aim to identify peer-reviewed academic literature. With guidance from an expert health librarian from an academic health center, the search strategy will be developed and peer-reviewed following the Peer Review of Electronic Search Strategies (PRESS) guideline statement [51]. The strategy will first be developed in MEDLINE (Ovid), and then a comprehensive search strategy will be created for PubMed, Embase, PsycINFO, CINAHL, ERIC (Education Resources Information Center), Scopus, Social Work Abstracts, SocINDEX with Full Text, Social Sciences Citation Index, and Web of Science. The following keywords and Boolean operators will be used (see S2 Appendix):

• Equity OR Diversity OR Inclusion OR EDI
• Geriatric care OR Geriatric healthcare OR Older adults OR Elderly care
• Education OR Training OR Curriculum OR Professional development
• Healthcare providers OR Geriatricians OR Nurses OR Caregivers
• Intersectionality OR Cultural competence OR Cultural humility
• Person-centered care OR Patient-centered care

The review will consider studies published in English, with no limitations imposed on the publication dates of the included studies. The reference lists of all included documents will be examined for additional studies using citationchaser [52]. We have also formed an advisory panel of geriatric educators from two Universities in Ontario, Canada, who will be consulted to identify any relevant papers within the field that our search may have missed.

Grey literature will also be searched through OpenGrey, UpToDate, Community Research and Development Information Services, and TSpace, as well as institutional repositories of universities, healthcare institutions, and professional associations. Conference proceedings and abstract databases in the fields of geriatrics, healthcare education, and diversity inclusion will also be searched. We will also search the first 100 pages of Google, as done in other reviews [8]. Grey literature will be limited to Canada and the United States. Limiting the grey literature search to North America will help manage the search process in the context of human and time resource constraints. Focusing on a narrower geographic scope allows us to allocate our time and resources more effectively, ensuring a comprehensive search within the selected regions.

Selection of articles

Using the PCC (Population, Concept, Context) framework by the Joanna Briggs Institute [53], the inclusion criteria for this review included:

Population:

• Learners (students, fellows) of geriatric healthcare education, including but not limited to education for physicians, nurses, social workers, and other health professionals (i.e., geriatric physical therapists, pharmacists, geriatric occupational therapists, speech-language pathologists, dieticians).

Concept:

• Articles that examine strategies, interventions, or curricula designed to promote EDI within geriatric healthcare professional education. This includes interventions to enhance cultural competence, address health inequities and improve care delivery for diverse older adult populations.

Context:

• Articles conducted in any educational setting relevant to geriatric healthcare professional education, including academic institutions, healthcare organizations, and community settings.
• No restrictions on geographical location or publication date.

After completing the search process, all identified citations will be gathered and uploaded into EndNote v.X20, where duplicate entries will be identified and removed [54]. Subsequently, the data will be imported into Covidence [55]. Titles and abstracts will be independently screened by pairs of reviewers to assess their eligibility based on the inclusion criteria for the review. The full texts of selected citations will be thoroughly evaluated against the inclusion criteria by two or more independent reviewers in Covidence, as well. Exclusion reasons for full-text documents not meeting the inclusion criteria will be documented and reported in the final review. Any disagreements arising during the selection process will be resolved through discussion. If an agreement cannot be reached, the first author (KMK) or the senior responsible author (MTH) will assign a vote. The search results and the study inclusion process will be comprehensively reported in the final review and presented using a PRISMA flow diagram [56].

Data charting

A standardized data extraction form using Covidence will be utilized to ensure consistent information retrieval from the included studies [55]. We will extract description of the study design employed in each included article (e.g., grey literature, scoping review, systematic review, empirical study, qualitative study, quantitative study, etc.), justification provided by authors for the chosen study design, presence of research questions or aims stated in the included studies, alignment of research questions with the objectives of the scoping review, identification of specific strategies and interventions described in the literature, description of how each strategy or intervention aims to promote EDI within geriatric healthcare education, documentation of examples or case studies illustrating the implementation of these strategies and interventions, exploration of challenges or barriers encountered in implementing EDI interventions within geriatric healthcare education, documentation of any recommendations or suggestions proposed in the literature to address challenges and leverage opportunities for promoting EDI.

The form will be piloted on the first 3 articles by all members of the research team. During the pilot testing phase, the authors will independently extract data from 3 articles deemed a representative sample of studies identified for inclusion in the scoping review. This sample will be chosen to reflect the diversity and breadth of the literature relevant to our research objectives. Reviewers will follow the above mentioned predefined data extraction form. They will document any ambiguities in form instructions or discrepancies in extracted data that they encounter, providing critical feedback on their experience. Upon completion of the pilot test, we will analyze the results to identify areas requiring refinement in the data extraction forms and procedures. This analysis will focus on improving consistency among reviewers and minimizing errors in data extraction. Insights gained from the pilot test will inform adjustments to the methodology, including clarifying instructions, revising data extraction forms, and enhancing training materials for data extractors.

Throughout the data extraction process, the form will be subject to modification and refinement as needed, with any alterations documented thoroughly by the research team to aid in transparency (decision audit trail) [57, 58]. In instances where data is missing, or additional clarification is required, authors of the included studies will be contacted by the first (KMK) or senior responsible author (MTH) for supplementary information.

As a scoping review does not typically involve a formal assessment of bias risk [59], a critical appraisal of included quantitative studies will be conducted using a tool adapted from the Quality Appraisal Checklist—Quantitative Studies Reporting Correlations and Associations developed by the National Institute for Health Care Excellence (NICE) [60]. The adapted NICE tool comprises five major items focusing on the study population, selection methods, outcomes, analysis, and summary, with any irrelevant items removed to ensure applicability to the scoping review context [60]. Qualitative studies will be appraised against the Critical Appraisal Skills Programme (CASP) specifically for assessing the quality of qualitative research studies [61]. It is designed to assist researchers and reviewers in evaluating qualitative research articles’ methodological rigor, credibility, and trustworthiness [61]. Lastly, mixed-methods studies will be appraised against the Mixed Methods Appraisal Tool (MMAT) (2018 version) [62]. Commentaries, editorials and grey literature will not be appraised. The decision to add a critical appraisal was to help identify high-quality studies for potential guidance and areas for improvement in future research endeavors. Two reviewers will independently assess the methodological rigor and trustworthiness of each study. The first (KMK) and senior author (MTH) will meet with the reviewers to discuss their appraisals to resolve any discrepancies and reach a consensus on the quality assessment of each included article.

Data analysis and reporting the results

The synthesized results will be presented through a structured approach that ensures clarity and transparency in data analysis and interpretation. Extracted data will be presented in a tabular format, outlining the study characteristics and outlines as aligned with the overarching objectives of the scoping review [59]. A descriptive analysis will be conducted based on the charted data and will also be reported as a narrative summary [59, 63]. Qualitative data extracted from the literature will undergo rigorous thematic analysis [64]. This process involves systematically identifying, organizing, and interpreting patterns, themes, and meanings within the data. Emerging themes will be derived from the study characteristics and outlines, aligning them with the overarching objectives of the scoping review. Furthermore, the literature evidence will be organized according to each research question.

For quantitative data, a comprehensive descriptive statistical analysis will be employed [65]. This approach will utilize appropriate statistical measures to quantify trends observed across the studies included in the review.

Both qualitative and quantitative findings will be synthesized and reported in a tabular format, facilitating a clear overview of the study characteristics and outcomes. A descriptive analysis will complement these tables, providing a narrative summary that synthesizes the key findings from the charted data. Furthermore, the literature evidence will be organized according to each research question, enhancing the clarity and relevance of the synthesized results to the scoping review’s objectives.

Consultation

We will actively engage stakeholders through a pre-project advisory panel comprising geriatric healthcare provider educators from two universities in Ontario, Canada. This panel will include participants from medicine, social work and the rehabilitation sciences. We will consult the advisory council to identify relevant literature and ensure comprehensive coverage of the field, seeking their insights to refine our search and avoid overlooking critical studies. After analyzing the results, we will share a concise summary of findings with the advisory council via email. We will encourage them to contribute additional thoughts and perspectives to deepen our understanding of the data. Their feedback will be systematically integrated into the final review, influencing the interpretation of results and shaping the discussion and recommendations. Their feedback will enrich our understanding of the findings and provide diverse perspectives that we will integrate into the final discussion and recommendations of the study.

This consultative approach with our advisory panel will enhance the robustness and applicability of our research, ensuring it addresses the needs and perspectives of geriatric healthcare educators effectively.

Timeline

The proposed timeline for the scoping review process is structured across twelve months, beginning with project initiation and planning in the first month. This phase involves forming a pre-project advisory panel comprised of geriatric healthcare provider educators from two Ontario universities. Initial planning meetings with the advisory panel will finalize research questions, objectives, and develop a comprehensive search strategy and inclusion/exclusion criteria. The literature search will span the first two months, encompassing a thorough exploration of databases and refining search strategies based on feedback from pilot testing. Months two to three will focus on screening identified studies against predefined criteria, with any conflicts resolved through consensus or third-party review. By month four, pilot testing of data extraction forms and procedures will commence, aiming to refine methodologies based on analysis of results Months four to five will be dedicated to the systematic extraction of data from selected studies, ensuring consistency and accuracy among data extractors. This phase will include addressing any discrepancies through consensus to maintain robust data quality. In months six to seven, data synthesis will occur, involving thematic analysis for qualitative data and statistical analysis for quantitative data where applicable. Writing and drafting activities will take place during months eight to nine, encompassing the drafting of the scoping review manuscript, incorporation of feedback from the advisory panel, and development of discussion and recommendations sections. Month ten will focus on the review and finalization of the manuscript, including revisions based on peer feedback, finalization of tables, figures, and preparation of the final report and executive summary. Month eleven will involve submission of the manuscript to the target journal or publication venue, preparation of presentations or summaries for dissemination, and sharing findings with stakeholders and the academic community. Post-review activities in month twelve will entail responding to any peer review comments, publishing the scoping review results, and archiving data and documentation for transparency and future reference.