Background Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance. Methods We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework. Results We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures. Conclusion Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

Background: Due to limited systematic integration of health equity and implementation science, it is imperative to provide researchers and practitioners tools to guide implementation in settings where there is inequitable implementation of an intervention. Our prior work documented and piloted the first published adaptation of an existing implementation science framework with health equity determinants to create the Health Equity Implementation Framework. We suggested how others’ might adapt their preferred implementation science frameworks with three health equity domains: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal influences (including but not limited to social determinants of health). This manuscript is a practical guide to utilize three health equity domains in implementation research and practice.Methods: We describe in greater depth than in our previous publication domains typical in implementation determinants frameworks and three adaptations: domains known to affect health equity. For each domain, we compiled definitions with supporting literature, defined relevant subdomains, showcased an illustrative example, and suggested sample measures, both quantitative and qualitative.Results: We describe how to incorporate the three health equity domains in one’s preferred implementation science framework, or how to use the Health Equity Implementation Framework specifically. Practical guidelines follow ten published recommendations on how to use frameworks in implementation research and practice. We describe a new case study in which the framework guided evaluation.Conclusions: Incorporating health equity domains within implementation frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. The practical guidance and tools provided can assist implementation scientists and practitioners to concretely address inequity in implementation across populations to capture and analyze information used to assess health outcomes.Contributions to the LiteratureSpecific definitions of implementation and three health equity domains with examples of how they have been applied in published literature and sample measures.Practical tools, including a qualitative interview guide and codebookCase study of how the Health Equity Implementation Framework guided analysis in an implementation study

Background: Due to striking disparities in implementation of healthcare innovations, it is imperative researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of health care. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal context (including but not limited to social determinants of health). This framework was developed for health care and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance.Methods: We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework.Results: We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures.Conclusion: Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

Background: Lower tidal volumes and lower inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) and prone positioning in severe ARDS are evidence-based practices that improve patient survival but are inconsistently applied. The objective of this systematic review is to identify what barriers, facilitators, and factors (together called determinants) influence the use of lower tidal volumes and lower inspiratory pressures for adult intensive care unit patients with ARDS and prone positioning for those with severe ARDS.Methods: We performed a systematic review employing PubMed, Embase, and CINAHL for studies published between January 1, 2000 and February 1, 2020. Studies reporting qualitative, quantitative, or mixed-methods data about determinants of implementation of the three strategies of interest were identified. We extracted determinants of implementation, study type, and evidence-based practice(s) studied. We assigned determinants to the Consolidated Framework for Implementation Research (CFIR) to organize contextual factors influencing implementation.Results: 4,578 studies were screened and 32 manuscripts were included and analyzed. Lower tidal volumes was the most studied evidence-based practice (27 of 32 studies). 86 determinants were extracted. We assigned 62 (72%) of determinants to the CFIR, with Characteristics of Individuals and Inner Setting most represented. The other 24 (28%) determinants were related to the patient’s clinical condition and demographic factors. We assigned these to a domain developed through inductive reasoning, “Patient Factors,” with 15 (63%) assigned to the construct “Dynamic Patient Attributes” and 9 (38%) to “Static Patient Attributes.” 5 of 86 (6%) determinants related to prone positioning.Conclusions: Multiple determinants impact the delivery of lower tidal volumes and lower inspiratory pressures in patients with ARDS, but we identified few determinants for prone positioning in severe ARDS. Our application of implementation science theory enables clinicians to identify factors influencing this evidence-to-practice gap and may support investigations and interventions to improve guideline-concordant care in ARDS.Systematic Review Registration: We registered this systematic review on PROSPERO (PROSPERO 2019 CRD42019135160).

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