Conceptual framework of equity-focused implementation research for health programs (EquIR)

Eslava-Schmalbach, Javier; Garzón‐Orjuela, Nathaly; Elias, V.; Revéiz, Ludovic; Tran, Nhan; Langlois, Étienne V

doi:10.1186/s12939-019-0984-4

Cited by 85 publications

(83 citation statements)

References 42 publications

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“…For an implementation process framework that incorporates an equity lens, see frameworks proposed by Nápoles and Stewart [12] and Eslava-Schmalbach and colleagues. [60] For an implementation evaluation framework that incorporates an equity lens, see preliminary equity-focused implementation outcomes [60] and the proposed extension of RE-AIM framework. [66] There are limitations to our practical guidance presented here.…”

Section: Discussionmentioning

confidence: 99%

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

Woodward

Singh

Ndebele-Ngwenya

et al. 2020

Preprint

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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

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Section: Discussionmentioning

confidence: 99%

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

Woodward

Singh

Ndebele-Ngwenya

et al. 2020

Preprint

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“…However, our rapid review combining searches from Google Scholar, Google (to identify grey literature) and the databases of MEDLINE and PubMed did not nd an explicit de nition of health equity mainstreaming nor did we identify any initiatives that sought to embed a health equity focus across a research organisations. These ndings are con rmed by a forthcoming review of English-language papers/resources aiming to strengthen the equity focus in health research, which has found that with notable exceptions (Eslava-Schmalbach et al, 2019;Plamondon and Bisung, 2019) published evidence on the processes and effectiveness of attempts to integrate a health equity focus across research organisations are lacking (Halliday et al, personal communication). Finally, our de nition of health equity mainstreaming draws heavily on ENPT and gender mainstreaming literature and understands mainstreaming as a strategy to in uence the implementation, integration and institutionalisation of ways of thinking and acting to tackle the root…”

Section: Conceptualising Mainstreamingmentioning

confidence: 94%

“…We conclude by emphasising the need for a robust strategy for mainstreaming a focus on healh equity as an important building block for creating transformative change in applied health research, in policy and practice, as well as amongst research funders. The inequalities exposed by COVID-19 are a timely reminder of the need to integrate a routine health equity focus in research that could unveil "context-speci c factors related to real world health program, policy and system decision" as well as "the negative impact of implementing new interventions or technologies on health inequalities" (Eslava-Schmalbach et al, 2019: 3) Though ndings are focused in the UK, there are implications for anyone concerned with putting health inequalities centre stage in the research agenda.…”

Section: Introductionmentioning

confidence: 99%

From Fringe to Centre-Stage: experiences of mainstreaming health equity in a health research collaboration

Porroche-Escudero

Popay

Ward

et al. 2020

Preprint

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Background: Action to address the structural determinants of health inequalities is prioritised in high level initiatives such as the UN Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address upstream structural determinants of behaviour and health outcomes. In health research most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce health inequalities that can be developed and implemented at a local level. Objective: To describe an initiative that aimed to mainstream a focus on health equity in a large scale research collaboration in the UK and to assess the impact on organisational culture, research processes and individual research practice. Methods: The study used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n=131 respondents including Public Advisers, university, NHS and local and document review.. Results: Utilising Extended Normalisation Process Theory (ENPT) and Gender Mainstreaming theory the evaluation illuminated: (i) the processes developed by CLAHRC NWC to integrate ways of thinking and acting to tackle the upstream social determinants of health inequities (i.e. to mainstream a health equity focus) and, (ii) the factors that promoted or frustrated these efforts. Conclusions: Findings highlight the role of contextual factors and processes aimed at developing and implementing a robust strategy for mainstreaming health equity as building blocks for transformative change in applied health research.

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“…The novel coronavirus responsible for coronavirus disease 2019 (COVID- 19), has infected 38 million individuals worldwide and 7.9 million in the United States as of October 12, 2020 (Ref. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Implementation Science to Address Health Disparities During the Coronavirus Pandemic

et al. 2020

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The coronavirus disease 2019 (COVID-19) pandemic is disproportionally affecting racial and ethnic minorities. In the United States, data show African American, Hispanic, and Native American populations are overrepresented among COVID-19 cases and deaths. As we speed through the discovery and translation of approaches to fight COVID-19, these disparities are likely to increase. Implementation science can help address disparities by guiding the equitable development and deployment of preventive interventions, testing, and, eventually, treatment and vaccines. In this study, we discuss three ways in which implementation science can inform these efforts: (1) quantify and understand disparities; (2) design equitable interventions; and (3) test, refine, and retest interventions.

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Conceptual framework of equity-focused implementation research for health programs (EquIR)

Cited by 85 publications

References 42 publications

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

From Fringe to Centre-Stage: experiences of mainstreaming health equity in a health research collaboration

Implementation Science to Address Health Disparities During the Coronavirus Pandemic

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