A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

Abstract

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.

Amplification of school-based strategies resulting from the application of the dynamic adaptation process to reduce sexual and gender minority youth suicide

“…Selecting implementation strategies for behavioral health interventions is complicated and comes with little instruction (Powell et al, 2017), especially as they relate to marginalized populations. This analysis describes implementation strategies that school personnel found useful to address LGBTQ adolescent suicide, contributing to the call to more systematically address health care inequities in implementation science (Woodward et al, 2020). The implementers in our analysis were involved in culturally aligning the strategies to their school in their efforts to integrate the EIPs.…”