Chronic Disease Among African American Families

A Systematic Scoping Review

Katrina R. Ellis, PhD, MPH, MSW; Hillary K. Hecht, MSW; Tiffany L. Young, PhD; Seyoung Oh, MSW; Shikira Thomas, MSPH; Lori S. Hoggard, PhD; Zaire Ali, EdM; Ronke Olawale, MPA, MSW; Dana Carthron, PhD, RN; Giselle Corbie-Smith, MD, MSc; Eugenia Eng, DrPH


Prev Chronic Dis. 2020;17(12):e167 

In This Article


This systematic scoping review aims to understand the characteristics of research addressing concurrent family member chronic diseases, identify research gaps, and summarize findings from diverse bodies of literature.[34] Key steps to complete the review were 1) design the research questions, 2) develop the search strategy, 3) pilot test and refine the search strategy, 4) screen titles and abstracts using the inclusion/exclusion criteria, 5) screen full-text of articles using the inclusion/exclusion criteria, 6) extract data from included articles, and 7) summarize the findings. Team members were undergraduates, graduate students, postdoctoral fellows, clinicians, and doctoral-level researchers. The lead author trained participating team members to ensure familiarity with the protocol and methods.

Data Sources

In consultation with an experienced academic librarian, our search was conducted in PsycInfo, PubMed, Social Work Abstracts, Sociological Abstracts, CINAHL, and Family and Society Studies Worldwide. We reviewed articles published from January 1, 2000, through September 27, 2016. The search included Medical Subject Headings (MeSH), CINAHL headings, and related text and keyword searches when appropriate. Disease-related search terms were "chronic disease," "chronic illness," "comorbidity," "multimorbidity," and specific conditions (eg, "arthritis," "depression," "hypertension"). Family-related search terms included "family" and relationship types (eg, "father," "sister," "sibling"). We identified 11,762 articles through database searching, of which 9,170 were nonduplicated.

Study Selection

We included studies with samples of at least 50% African Americans or Black Americans, or a subgroup analysis of this population. Inclusion criteria specified studies that reported data for at least 2 family members. Family was defined broadly as people related biologically, emotionally, or legally, including fictive kin networks, which are of noted importance among African Americans.[35–37] Included studies focused on chronic diseases in 2 or more family members (similar or dissimilar conditions). Chronic diseases were defined as conditions lasting at least 3 months, requiring ongoing care, and generally not preventable by vaccine or curable by medication.[38] A member of the research team with clinical nursing expertise provided consultation on chronic condition designations. Inclusion criteria were studies focused on lived experiences with coexisting chronic conditions in families that were original research published in a peer-reviewed journal, in English, with full-text availability. Exclusion criteria were studies focused primarily on genetic susceptibility or future risk of disease, systematic reviews, gray and white literature, dissertations, and conference proceedings.

Covidence software ( was used to complete article screening and full-text review. The lead author independently screened all titles and abstracts for inclusion based on eligibility criteria. If abstracts lacked adequate information to determine inclusion/exclusion, the articles underwent full-text review. During full-text review, 2 team members independently screened each article for inclusion. Disagreements were resolved through a discussion between the 2 full-text reviewers or independent review by a third member of the research team. In total, 8,640 articles were excluded during the title and abstract screening phase, leaving 530 for full-text review (Figure). Of these, 412 articles were excluded, leaving 118 articles. During the data extraction phase, an additional 4 articles were excluded because they did not provide enough information to answer the research questions. Thus, 114 articles met all inclusion criteria.


Flow diagram of article identification, screening, and selection; scoping review of comorbidity and multimorbidity in African American families, January 2000–September 2016.

Data Extraction

Pertinent data from the 114 articles were entered into a spreadsheet (Google Sheets, Google LLC). The study codebook (Google Sheets, Google LLC) detailed the type of data to be extracted from articles to answer the guiding questions, including family size and relationships, racial composition, assessment of chronic conditions, methodology, objectives, and outcomes. Four team members extracted data. Reliability was assessed by having team members extract data from a subsample of articles; interrater reliability was above 90%.