Improvement studies for equitable and evidence-based innovation: an overview of the ‘IM-SEEN’ model

Abstract

Background Health inequalities are ubiquitous, and as countries seek to expand service coverage, they are at risk of exacerbating existing inequalities unless they adopt equity-focused approaches to service delivery. Main text Our team has developed an equity-focused continuous improvement model that reconciles prioritisation of disadvantaged groups with the expansion of service coverage. Our new approach is based on the foundations of routinely collecting sociodemographic data; identifying left-behind groups; engaging with these service users to elicit barriers and potential solutions; and then rigorously testing these solutions with pragmatic, embedded trials. This paper presents the rationale for the model, a holistic overview of how the different elements fit together, and potential applications. Future work will present findings as the model is operationalised in eye-health programmes in Botswana, India, Kenya, and Nepal. Conclusion There is a real paucity of approaches for operationalising equity. By bringing a series of steps together that force programme managers to focus on groups that are being left behind, we present a model that can be used in any service delivery setting to build equity into routine practice.

Identifying barriers and potential solutions to improve equitable access to community eye services in Botswana, India, Kenya, and Nepal: a rapid exploratory sequential mixed methods study protocol

“…This project constitutes the 'Engage' element of the broader 'IM-SEEN' continuous improvement approach. 60 It is preceded by activity to gather sociodemographic data from those being screened in each setting and the identification of which groups experience the lowest access rates (Figure 2). The purpose of the current 'Engage' project is to gather and prioritise a list of barriers and potential solutions, grounded in the perceptions of left behind groups.…”

Comparison of telephone and in-person interview modalities: duration, richness, and costs in the context of exploring determinants of equitable access to community health services in Meru, Kenya

“…6 The work in Kenya is part of a broader overall project to develop equity-driven and evidencebased approaches to improve access to community-based services across Kenya, Botswana, India and Nepal. 7 Hundreds of thousands of people are being screened and referred to local services each year, however only around half are able to access care. We wanted to develop an interview approach that could be taken to scale across these four countries -and potentially beyond -to deliver timely insights into how these programmes can be made more accessible, especially for 'left behind' groups.…”

Identifying barriers and potential solutions to improve equitable access to community eye services in central Kenya: a rapid exploratory sequential mixed methods study

“…This involves identifying which groups are being left behind in a given programme; engaging with these groups to understand the unique barriers they face and their ideas for service improvements; and then testing these potential solutions with embedded randomised controlled trials (RCTs). 5 We are applying this model in the context of community-based eye screening programmes in Botswana, India, Kenya, and Nepal. Uncorrected visual impairment affects over a billion people worldwide, levying major social and economic costs, despite the availability of highly cost-effective treatments like spectacles and cataract surgery.…”