Strategic Directions in Preventive Intervention Research to Advance Health Equity

Abstract

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.

QATCHEPP: A quality assessment tool for critical health promotion practice

“…This theoretical underpinning provides heuristic support to enable practitioners to engage in boundary critique through critical reflection to assess the extent to which a health promotion program aligns with critical health promotion. It provides the evidence for the reorientation of programs toward a more critical approach, which is essential for addressing structural and systemic determinants of health and wellbeing to enhance health equity ( 2 , 5 , 12 – 14 , 73 ). The structure of QATCHEPP is designed to enable the development of the critical reflection competence of practitioners to engage in systems thinking and reflective discourse to identify the dominant values of a health promotion program ( 65 – 67 ).…”

“…However, health promotion practice is still dominated by a selective health promotion approach which adopts a biomedical and behavioral health paradigm and tends to focus on populations that are structurally and systemically privileged. This results in health promotion programs focusing on changing individual level behaviors related to disease rather than the broader structural and systemic determinants of health and wellbeing (4)(5)(6). Recognizing the broader determinants of health but developing health promotion programs that focus on individual behaviors has been criticized as "lifestyle drift" (7,8) or "downstream drift" (6), and using the "lazy language of lifestyles" (9,10).…”

“…Recognizing the broader determinants of health but developing health promotion programs that focus on individual behaviors has been criticized as "lifestyle drift" (7,8) or "downstream drift" (6), and using the "lazy language of lifestyles" (9,10). The selective approach is insufficient to address the full range of health and wellbeing determinants and reduce health inequities (4)(5)(6)(11)(12)(13).…”

Cultural adaptations and cultural factors in EBI implementation with Latinx communities

“…This paper discusses approaches in the cultural adaptation of EBIs that can be enhanced by the utilization of cultural factors. A long-term goal of these cultural adaptations is to implement these strategies toward attaining health equity outcomes within various Latinx communities ( 7 ).…”

Using an Equity in Research Framework to Develop a Community-Engaged Intervention to Improve Preexposure Uptake Among Black Women Living in the United States South

“…T he National HIV/AIDS Strategy to end the HIV epidemic (EHE) by 2030 designates Black women as one of the five priority populations disproportionately affected by HIV and calls for HIV prevention efforts to focus on populations and parts of the country carrying the most burden of disease (The White House, 2021), but Black women have not been prioritized in HIV prevention research. Given the inequities in access to care, delivery, HIV outcomes, and biomedical prevention tools, such as preexposure prophylaxis (PrEP), there is an exigent need to thoughtfully partner with Black women in the research process if eliminating HIV among this population is to be achieved (Boyd et al, 2023). One strategic way to accomplish this is through community engagement and partnership where women are meaningfully included in the research process, from development to dissemination.…”