{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:27:47Z","timestamp":1787570867386,"version":"build-2736575974"},"reference-count":31,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,3]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic diseases driven by modifiable risk factors (MRFs), such as poor diet, physical inactivity, tobacco use and harmful alcohol consumption, disproportionately affect ethnic minority groups worldwide and within multi\u2011ethnic societies such as Singapore. Although culturally tailored interventions and implementation strategies exist, there is limited synthesis of what has been used, for whom and under which contextual conditions these approaches produce equitable reductions in MRFs. EQUATOR aims to identify and synthesise policies, programmes and implementation strategies that have been tailored for ethnic and cultural minority populations and to develop explanatory mid\u2011range programme theories describing how, why and under what circumstances such tailoring produces equitable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a scoping review with a realist synthesis as the analytical approach. Searches will be run in PubMed and Scopus for studies published from January 2010 onwards, restricted to English. Eligible studies include experimental, quasi\u2011experimental, qualitative, mixed\u2011methods studies and reviews that evaluate or report outcomes for tailored strategies addressing MRFs in ethnic minority populations and explicitly examine equity\u2011focused outcomes or mechanisms. A piloted data extraction form will capture study characteristics, contextual details, intervention\/strategy descriptions, theoretical underpinnings and outcomes using a RE\u2011AIM lens (reach, effectiveness, adoption, implementation, maintenance) and equity indicators. Extracted data will support (1) an inductive typology of strategies\/interventions for each MRF and (2) realist S\/ICMO (Strategy\/Intervention\u2013Context\u2013Mechanism\u2013Outcome) configurations to generate mid\u2011range programme theories explaining how tailoring works (or fails) across contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required for this literature synthesis. Findings will be disseminated through peer\u2011reviewed publications, presentations to policymakers and practitioners and stakeholder briefings to emphasise actionable recommendations for culturally tailored strategies to reduce MRFs and promote health equity in multi\u2011ethnic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-123148","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:15:34Z","timestamp":1787570134000},"page":"e123148","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Equity-focused analysis of tailoring strategies for overcoming risk factors in ethnic minorities (EQUATOR): a protocol for a scoping review with a realist analysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5663-2398","authenticated-orcid":false,"given":"Jumana","family":"Hashim","sequence":"first","affiliation":[{"name":"Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Luck","sequence":"additional","affiliation":[{"name":"Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niharika","family":"Rustagi","sequence":"additional","affiliation":[{"name":"Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.J.","family":"Melendez-Torres","sequence":"additional","affiliation":[{"name":"University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-8924","authenticated-orcid":false,"given":"Nick","family":"Sevdalis","sequence":"additional","affiliation":[{"name":"Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"2026082404152693000_16.8.e123148.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-16198-2","article-title":"The societal cost of modifiable risk factors in Singapore","volume":"23","author":"Tan","year":"2023","journal-title":"BMC Public Health"},{"key":"2026082404152693000_16.8.e123148.2","unstructured":"Singapore, D.o.S . Census of population 2020. 2026."},{"key":"2026082404152693000_16.8.e123148.3","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1007\/s00125-021-05441-3","article-title":"Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10 year observational study in Singapore","volume":"64","author":"Riandini","year":"2021","journal-title":"Diabetologia"},{"key":"2026082404152693000_16.8.e123148.4","first-page":"24","article-title":"The Role of Behavioral Factors on Chronic Diseases-Practice and Knowledge Gaps","volume":"12","author":"Raheli\u0107","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"2026082404152693000_16.8.e123148.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2024-004345","article-title":"Type 2 diabetes complications in ethnic minority compared with European host populations: a systematic review and meta-analysis","volume":"12","author":"Beulens","year":"2024","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2026082404152693000_16.8.e123148.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.ahr.2025.100231","article-title":"Contribution of chronic conditions to mortality: Differences by race and ethnicity","volume":"5","author":"Elman","year":"2025","journal-title":"Aging Health Res"},{"key":"2026082404152693000_16.8.e123148.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05554-9"},{"key":"2026082404152693000_16.8.e123148.8","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13098-021-00751-3","article-title":"Ethnic disparity in metabolic syndrome and related obesity and health behavior: a community study in Taiwan","volume":"13","author":"Lin","year":"2021","journal-title":"Diabetol Metab Syndr"},{"key":"2026082404152693000_16.8.e123148.9","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph22060888","article-title":"Culturally Adapted, Clinician-Led, Bilingual Group Exercise Program for Older Migrant Adults: Single-Arm Pre-Post-Intervention","volume":"22","author":"Kirwan","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"2026082404152693000_16.8.e123148.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15667-y","article-title":"Heart health for South Asians: improved cardiovascular risk factors with a culturally tailored health education program","volume":"23","author":"Vafaei","year":"2023","journal-title":"BMC Public Health"},{"key":"2026082404152693000_16.8.e123148.11","doi-asserted-by":"crossref","unstructured":"Radu I , Scheermesser M , Spiess MR , et al . 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