This study was designed using a scoping review approach given that the intersection of climate change, health and community action represents an emerging area of research with undefined disciplinary boundaries. Our broadly formulated research questions require mapping relevant literature that was expected to reside in various disciplines using several interpretive approaches as our aim was to identify the nature and extent of research evidence dedicated to this topic [21–23].

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to guide our study. We relied on Arksey and O’Malley’s five-stage framework to inform and guide our process [23]. These stages comprise developing research questions, identifying relevant studies, study selection, synthesizing and interpreting key pieces of information (i.e., “charting the data”) and collating, summarizing, and reporting the results. The scope and study terms are described in the Box 1.

We systematically searched several databases including Medline/OVID, PsychInfo, VHL, Sociological Abstracts, Google Scholar, and Scopus to capture a broad range of multi- and interdisciplinary studies. Our exclusion criteria limited publications to English and peer-reviewed journal articles and excluded conference or workshop proceedings, abstracts, and dissertations. The inclusion criteria stipulated that articles focus on all four topical areas: geographic area within the anglophone Caribbean, community-based stakeholders, groups, or organizations, climate change and health and wellbeing.

The timeframe includes articles published between 1999 until July 2021. The search strategy was designed and conducted by an information specialist at the Norwegian Institute of Public Health. The full search strategies for each database are available in Supplementary Appendix SA1 (Supplementary Material). Two independent researchers screened records by title and abstracts using Covidence. Disagreements were resolved by discussions among the two researchers that led to a conclusion. Full text screening was completed independently by two researchers resulting in the identification of the final set of articles. This search strategy was supplemented by a consultation with co-authors as well as a review of citations using Web of Science that identified three additional records.

In terms of researcher reflexivity, our team was multidisciplinary which was important since we collectively needed to be familiar with literature originating from different disciplines. Moreover, one of the main researchers is from the Caribbean which added critical insight to the review process. Several pilot searches were conducted to assess the relevance of the retrieved articles and to optimize the search strategy. How articles are indexed can differ among databases, especially social science and biomedical databases. To minimize the risk of overlooking relevant articles, authors familiar with the literature from this field and region compiled tracer articles to enhance the robustness of the search.

Two researchers independently extracted data from each article into a predefined Excel format. A third researcher compared the two data extraction files and documented areas of agreement and dissimilar findings. The two researchers then resolved discrepancies in the data extraction file. Data extracted from each article included information pertaining to first author’s institutional affiliation, study design, country/setting, methods (qualitative, quantitative, mixed methods, case study), analytic, theoretical, or conceptual framework, type of community organization, intervention, outcomes, focal topic of article, climate change focus, indirect or direct health impact, and government and community interaction.

After reviewing frameworks on climate change, community action, and coastal communities [24, 25], we opted to modify the local adaptive capacity framework developed by Jones’ framework with the primary difference reflecting the category of agency that Jones and others refer to as a cross-cutting issue [24, 25]. We used this framework as a guiding tool to assist in structuring our analysis. The five dimensions of adaptive capacity that we explore include: resources/assets, education/information, organization/governance, innovation/flexibility, and agency/efficacy. These categories are broad in scope, interdependent and often have overlap. While we acknowledge that many different frameworks, models, and perspectives offer other viable ways to analyze content, we suggest that a modified framework offers a useful lens to understand factors that influence, interact, enable and/or constrain local level adaptive capacity. Table 1 provides descriptions of these dimensions with examples from the literature.

We identified 3,828 potential records (excluding duplicates) for title and abstract review. This screening process led to the full-text screening of forty-one records of which eleven were deemed suitable for full data extraction. A review of the citations list of each of these eleven articles identified additional relevant articles bringing the total to fourteen (See Figure 3: PRISMA).

Table 2 provides details on the articles and study characteristics. Date of publication ranges from 1999 to 2020 with the preponderance of articles published after 2015. These articles focused on the following countries in the anglophone Caribbean: Anguilla, the Bahamas, Belize, Dominica, Grenada, Jamaica, St. Vincent and the Grenadines, Trinidad and Tobago, and Turks and Caicos. The majority of first authors had affiliations in high income countries with one from the Caribbean: United Kingdom [6], Germany [2], Ireland [2], Norway [2], Canada [1], and Jamaica [1]. In terms of the focal group of interest, the studies focused on fishing community groups, farming and agricultural groups, conservation and environmental groups, forestry management groups, tourism operators, water management, disaster risk management organizations, and civil society stakeholders.

Most studies described their approach as a case study often using mixed methods approaches that included both qualitative and quantitative methods. Studies, for example, cited the use of semi-formal questionnaire surveys, semi-structured interviews with experts and key informants, focus groups, attendance at committee meetings, conferences, workshops, document review of annual reports, legal and policy documents, and organizational material. In some cases, ecological, meteorological, and coastal mapping data was collected.

The studies address several different impacts related to climate change, including sea level rise [26], ocean warming, acidification [27], and environmental degradation (e.g., destruction of coral reefs [28], seagrass meadows [29], and mangroves [30]; an increase in non-indigenous/invasive species; changes in sedimentation processes and surface run-off; water pollution [31]; threats to ecosystems such as biodiversity loss in coastal and inland habitats [30]; increasing volatility and extremes in storms and weather patterns [9, 32, 33]; and higher temperatures [26, 34]).

Several articles discussed the impact of climate change on fishing such as more intense and frequent hurricanes that can prohibit, alter, or reduce fishing or challenges brought on by the influx of sargassum [30] and the effects on local tourism, marine biodiversity, and fishing [29, 30, 35]. Climate-related impacts on agriculture were mentioned in several articles that focused on droughts affecting crop yields, landslides impacting arable land and roads, declines in agricultural production, increased food insecurity, and diminishing freshwater availability [9, 11, 36].

A notable finding of this review is that few studies discussed direct health impacts from climate change. Although some studies mentioned direct impacts from extreme weather and storms in terms of safety, injury, and mental health [9, 32], articles generally discussed indirect health impacts related to effects on wellbeing and economic livelihoods [27, 28, 35, 36].

Studies, for example, discussed health determinants such as food insecurity [29], freshwater availability [11], the nutritional impact of ecosystem imbalance (e.g., increase in food imports, invasive lionfish species) on local communities [31], and biodiversity loss [29]. Health determinants related to livelihoods, particularly in terms of nutrition and food security, were recurrent themes in articles focusing on marine-dependent livelihoods (e.g., tourism, fishing) [29, 35] as well as the agricultural sector that can be heavily impacted by climate change [36].

This body of literature suggests that community action at the local level in anglophone Caribbean islands use several different approaches to address climate change and wellbeing. Community action efforts addressed several different issues including:

• Environmental education and conservation efforts (e.g., mangrove restoration, sea grass production, natural resource management) [29, 30, 37].

A variety of strategies were utilized at the community level to address these issues. Using Noble’s classification system, these can be broadly categorized as structural/physical, social, and institutional adaptation options. Approaches falling under the category of structural/physical may include engineered and the built environment, technological and ecosystem-based responses. From our sample of included studies, building a solar-powered water desalination plant, promoting rainwater harvesting and storage [11], and restoring mangroves are examples of this type of approach [30].

Many studies described strategies that relied on educational, informational or behavioral approaches [26, 30, 31]. Selby and others, for example, described a climate change school curriculum initiative and other informal educational and informational options designed to share knowledge among students, adults and the community [30]. Farmer field schools offer another example of an educational strategy promoting agricultural practices, peer to peer learning, and sharing local agricultural practices [36]. Given the review’s dedicated focus on community action studies, fewer studies discussed institutional approaches utilizing economic, regulatory, legal, policy or programmatic options.

One key gap identified by the scoping review was the lack of empirical investigation of health systems responses to climate change impacts and the role of community action in these efforts. One reason may be that empirical studies of health systems responses to climate-related events, such as natural disasters, do not explicitly include a community-level focus [43]. Accordingly, such studies would not have been identified by our search strategy. Another factor may be how health systems have historically responded to climate change related health vulnerabilities. Increasingly, health policy and systems researchers are encouraged to give the climate change and health nexus greater attention [44]. There has been a trend towards greater attention to this nexus, as, for example, in the recently funded EU-CARIFORUM project on Strengthening Climate Resilient Health Systems in the Caribbean [45].

A limitation of this study is that some relevant articles addressing issues within the scope of the study may have been missed if their title and/or abstract did not include health. Thus, future research should extend the search strategy to include articles that do not include health in their title or abstract but that investigate community-based responses to the wider determinants of health affected by climate change in the anglophone Caribbean.

As the first scoping study to investigate the current research dedicated to the nexus of climate change, community action, and health in the anglophone Caribbean, this study reveals a diverse set of studies that can inform the field of community action of unique approaches to addressing climate change and health challenges.