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Background: Rapid, strategic action is required to mitigate the negative and unequal impact of the COVID-19 pandemic on the financial well-being (FWB) of global populations. Personal financial strain (FS) worsened most significantly among systematically excluded groups. Targeted government- and community-led initiatives are needed to address these inequities. The purpose of this applied research was to identify what works for whom, under what conditions, and why in relation to community and government initiatives that promote personal and household FWB and/or address FS in high income economies. Methods: We employed a critical realist analysis to literature that reported on FWB/FS initiatives in high income countries. This included initiatives introduced in response to the pandemic as well as those that began prior to the pandemic. We included sources based on a rapid review. We coded academic, published literature (n=39) and practice-based (n=36) reports abductively to uncover generative mechanisms – i.e., underlying, foundational factors related to community or government initiatives that either constrained and/or enabled FWB and FS. Results: We identified two generative mechanisms: 1. neoliberal ideology; and, 2. social equity ideology. A third mechanism, social location (e.g., characteristics of identity, location of residence), cut across the two ideologies and demonstrated for whom the initiatives worked (or did not) in what circumstances. Neoliberal ideology (i.e., individual responsibility) dominated initiative designs, which limited the positive impact on FS. This was particularly true for people who occupied systematically excluded social locations (e.g., low-income young mothers). Social equity-based initiatives were less common within the literature, yet mostly had a positive impact on FWB and produced equitable outcomes. Conclusion: Equity-centric initiatives are required to improve FWB and reduce FS among systemically excluded and marginalized groups. These findings are of relevance now as nations strive for financial recovery in the face of the ongoing global pandemic.

What is already known on this topic? Financial strain is associated with poor physical and mental health outcomes. Most financial strain-related programs focus on behavioral change and, therefore, produce short-term effects.What is added by this report?Our study introduces a guidebook of evidence-informed strategies for governments and organizations to address the determinants of financial strain. It also provides sample indicators to support assessment of policies and programs.What are the implications for public health practice?The guidebook offers a road map for decision makers, alone or in partnership with other actors, to design and implement sustainable initiatives for long-term financial well-being.