The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews , to assess and synthesize the evidence in published and unpublished literature on individuals with disability from CALD backgrounds. The present scoping review protocol has been registered with the Open Science Framework (registration number: osf.io/hw2fb) and is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) statement  (see checklist in Additional file 1). The proposed review will be reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) . Any amendments made to this protocol when conducting the study will be outlined and reported in the final manuscript.
This scoping review will consider all published and unpublished studies relevant to individuals with disability from CALD backgrounds and their health and support service needs. Individuals from CALD backgrounds are defined mainly by their country of birth, language spoken at home, or characteristics including year of arrival in the adopted country and parents’ country of birth .
Disability is defined as the interaction between an individual’s impairment in their body structure or function and their personal and environmental factors that lead to activity limitations and participation restrictions, and prevent meaningful engagement in occupations .
The review will consider all studies that describe the health service and health service needs related to individuals with disability from CALD backgrounds. These services are practices that assess, document, maintain, or improve an individual’s health, treat and diagnose illness or disability, or prescribe medication .
Studies that describe support service and support needs related to disability will be considered. These services include government services that provide income support to individuals with disability and provision of services and/or funds to organizations to carry out services .
Studies that describe meaningful engagement in occupations at a healthcare level will be considered. Meaningful engagement in occupations is the degree to which an individual finds their occupations to be worthwhile, important, and in line with their values and sense of self [3, 11]. Occupation refers to a wide range of activities that individuals “need to, want to, are expected to do”  that are worthwhile, important, and compatible with their values and sense of self, ultimately bringing meaning to their life [2, 3, 12].
Research conducted in primary and secondary health and support care setting will be considered. Primary care is usually the first contact an individual has with the health system and covers the majority of an individual’s health needs, and delivers community-based care by various health professionals [37, 47, 48]. Secondary care requires more specific knowledge, skills, and equipment and is provided by a specialist or hospital upon referral by a primary care professional .
This scoping review will consider experimental and quasi-experimental studies, analytical observational studies, descriptive observational studies, qualitative studies, systematic reviews, and text and opinion papers that meet the inclusion criteria. Studies published in the English language will be included. Studies published since January 1974 will be included in order to be comprehensive and attempt to “cover the field”. The index year was chosen as it was the year after the Immigration Restriction Act 1901 was definitively abolished. This Act restricted immigration of people of non-European ethnic origin to Australia; the abolition of this legislation removed the direct discrimination of individuals based on race.
A three-step search strategy will be undertaken . An initial search strategy was devised in consultation with a librarian (KC) and employed on CINAHL (EBSCOhost) in January 2020 to identify relevant articles, the text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles to develop a full search strategy (see Additional file 2). Initial keywords include disability, culturally and linguistically diverse, multicultural, culturally diverse, linguistically diverse, ethnic minority, minority group, immigrant, migrant, health service, support service, and disability service. A second search will be undertaken including all identified keywords and index terms, which will be adapted for each database. The databases to be searched include PubMed, Embase (Ovid), Scopus, PsycInfo (EBSCOhost), and Johanna Briggs Institute and Cochrane Library, as well as searching for grey literature in Trove, Mednar, OpenGrey, and Google Scholar. Boolean operators and wildcards were applied to search terms to ensure a comprehensive search. Thirdly, the reference list of identified reports and articles will be searched for additional sources. The final search strategies will be reported in the final scoping review report.
This review will include studies relevant to individuals with disability from CALD backgrounds and their health and support service needs. Following the search, all identified citations will be collated and uploaded into Endnote X9 (Clarivate Analytics, PA, USA), and duplicates will be removed. Prior to each stage of screening, reviewers will pilot the eligibility criteria on a random sample of 20 titles/abstracts and 5 full-text studies, with further pilot rounds conducted on an as-needed basis. Titles and abstracts will be screened by at least two independent reviewers (JP, DL, AT, KC) for assessment against the inclusion criteria for the review. An initial calibration will be conducted on 5 randomly selected articles to ensure high inter-rater agreement. The full text of selected literature will be retrieved and assessed in detail against the inclusion criteria (see Additional file 3). Full-text papers that do not meet the inclusion criteria will be excluded, and reasons for exclusion will be provided in an appendix in the final scoping review report. The results of the search will be reported in full in the final report and presented in a PRISMA flow diagram  (see Additional file 4). Any disagreement that arises between the reviewers will be resolved through discussion and consensus.
Data will be extracted from papers included in the scoping review as free-text variables using a modified JBI data extraction instrument  (see Additional file 5) by at least two reviewers (JP, DL, AT). The data extraction instrument was pilot tested on five eligible studies retrieved from the initial pilot-literature search conducted in January 2020. Further piloting will be conducted on an as-needed basis. Microsoft Excel will be used to manage the data extracted including the citation and study information (author, year of publication, aim, study population, study design, setting, and methodology), as well as results relevant to the scoping review (type of CALD groups, type of disability, micro-meso-macro system factors, and relevant key findings on the health and support services needs and gaps in existing services). Where required, authors of papers will be contacted to request missing or additional data. Throughout the extraction process, reviewers will meet and compare findings to ensure reliability and reproducibility among data collection approaches. Disagreement or discrepancies between reviewers, during any phase of the review process, will be recorded, and an independent reviewer (SH and VI) will be an arbiter, if necessary.
Quality appraisal will be undertaken independently by two reviewers for all included studies using the appropriate JBI appraisal tools  to assess the methodological quality of the studies and ROBINS-I tool for assessing the risk of bias in observation studies . Risk of bias will be assessed independently, in duplicate, by two reviewers. Any discrepancy, including the quality appraisal of observational studies using the JBI and ROBINS-I tools, will be discussed between reviewers to obtain consensus. A kappa coefficient will be obtained. Given the aim of the scoping review to capture the breadth of available literature, the function of the quality appraisal was not selective but rather descriptive and aid in data analysis and interpretation, especially in the context of gaps in the evidence base . Thus, all studies will remain included. Random audit of five included studies will be conducted by SH and VI.
Data presentation and analysis of results
To illustrate and summarize the main findings, the results of the scoping review will be presented, where appropriate, in a tabular form or as a diagram in a manner that aligns with the objective of this scoping review. A narrative summary will accompany the tabulated results and will describe how the results relate to the review objective and questions . The results will be classified under key conceptual categories that will be obtained during the data extraction process. Common key health and support service needs of individuals with disability from CALD backgrounds to meaningfully engage in occupation identified through the review will be presented as a summary to help illustrate the unique challenges and gaps in existing health and support services, and provide information on how policy may be improved for better engagement in meaningful occupation.
A deductive content analysis framework will be employed to summarize and search for the gaps in health and support services and needs of individuals with disability from CALD backgrounds in accordance with the JBI scoping review methodology . The framework will be used to organize findings from the studies within the individual (micro), interpersonal (meso), organizational (exo), community (macro), and public policy (chrono) level system. Frequency (proportion) of barriers and enablers, patients’ quality of life (based on patients’ score in scale), and satisfaction (based on patients’ score in scale) from the quantitative analysis may be tabulated. Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality and categorizing these findings on the basis of similarity in meaning.
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