Systematic review of family-based interventions integrating cultural and family resilience components to improve Black adolescent health outcomes

Ann Behav Med. 2024 Dec 11:kaae079. doi: 10.1093/abm/kaae079. Online ahead of print.

Abstract

Background: Past reviews have shown that culturally salient resilience interventions buffer the negative effects of racial discrimination on psychological and behavioral outcomes among Black youth. However, these prior reviews neglect to integrate trials targeting physical health and/or health-promoting outcomes, synthesize trials based on methodological rigor, or systematically assess efficacy or resilience intervention components.

Purpose: This systematic review expands on past research by (1) providing an up to-date literature review on family-based cultural resilience interventions across a range of health-related outcomes (physical health, health behaviors, health risk-taking behaviors, and psychological), (2) evaluating the rigor of these interventions, (3) analyzing the efficacy of rigorous interventions, and (4) describing the resilience intervention components of rigorous interventions.

Methods: Using the PRISMA guidelines, a systematic search was conducted from 1992 to 2022. Studies were included if they were family-based resilience interventions targeting health-related outcomes among Black adolescents ages 10-17 years.

Results: Fifteen studies met inclusion criteria, 10 of which were not included in past reviews. Overall, 10 trials demonstrated high methodological rigor, 9 of which were efficacious. Most rigorous, efficacious trials targeted health risk-taking behaviors outcomes (~66%), whereas none targeted health promotion behaviors (physical activity, diet). Resilience components of rigorous efficacious interventions included racial socialization (racial coping, cultural pride) and family resilience (communication, routine), with fewer integrating racial identity (self-concept, role models) and cultural assets (spirituality, communalism).

Conclusions: These findings suggest the need to replicate existing rigorous strengths-based resilience interventions and address broader outcomes, including health-promoting behaviors, in the future.

Keywords: Black adolescents; cultural; family; intervention; resilience.

Plain language summary

Growing evidence suggests that strengths-based cultural and family resilience interventions may buffer the negative impacts of discrimination and promote positive health-related outcomes in Black adolescents and families. However, only 3 systematic reviews have been conducted and these prior reviews are limited in scope. The current systematic review aimed to expand on prior reviews by (1) providing an up to-date literature review on family-based cultural resilience interventions across a range of health-related outcomes (physical health, health behaviors, health risk-taking behaviors, and psychological), (2) evaluating the rigor of these interventions, (3) analyzing the efficacy of rigorous interventions, and (4) describing the resilience intervention components of rigorous interventions. We conducted a systematic search of relevant studies published between 1992 and 2022 and identified eligible studies using a comprehensive study screening process. Fifteen studies were eligible and included in this review. Ten of these trials had high methodological rigor, with 9 showing intervention efficacy, suggesting initial support for such trials. Many of these rigorous, efficacious trials targeted health risk-taking behavior outcomes but none targeted health promotion behaviors. Regarding resilience intervention components, rigorous efficacious trials included racial socialization and family resilience resources, but fewer of these trials integrated racial identity or cultural assets.