Toward the Development of a Multilevel Measure of Structural Racism: Theory and Methods

Structural racism adversely affects the health and well-being of many Black and Hispanic/Latino Americans. This study sought to establish a theoretical foundation for developing a novel multilevel structural racism measure for use within Black and Hispanic/Latino communities in the United States (US). Based on a framework developed by the National Institute on Minority Health and Health Disparities (NIMHD), a content development team (n = 4 social epidemiologists) pre-selected 68 candidate indicators to be included in the ecological level index based on published literature. Subsequently, an expert panel consisting of leaders of community organizations (n = 3), health equity researchers (n = 5), and social stratification researchers (n = 2) participated in a modified three-phase Delphi panel process. This process yielded thirty-eight ecological-level indicators earmarked for inclusion, 30 for elimination, and 76 newly proposed. After revision of the newly proposed indicators, the final list included 71 indicators for structural racism measurement and spanned various domains of the NIMHD framework. This study sets the stage for a practical tool that can help researchers, clinicians, and policymakers identify structural racism's effects and guide efforts toward equity and justice in healthcare and beyond.