A more practical guide to incorporating health equity domains in implementation determinant frameworks

Abstract

Background Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. 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) culturally relevant 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 healthcare 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.

Enhancing equity, diversity, and inclusion in Families, Systems, & Health.

“…In addition, we commit to increasing the diversity of our editorial team, especially with respect to race and professional discipline, as the current team of editors and associate editors predominantly comprises White psychologists, which we acknowledge is a significant limitation that needs to be addressed (Roberts et al, 2020). Other ideas of action steps we will consider incorporating into our strategic plan include increasing invitations for commentaries addressing EDI; soliciting research article submissions using diversity science and/or participant-engaged research methods, narrative pieces conveying perspectives of minoritized individuals, and policy papers addressing EDI; increasing publicity for articles authored by people of color and others with minoritized identities; instituting regular reviews of journal communications to ensure we are modeling use of bias-free, person-first, and systems-centered language; requiring implicit bias training for editorial team members; developing compendiums of health equity articles published in FSH; and compiling EDI and health equity resources our readers may find helpful (e.g., Castillo & Harris, 2021; Kahn et al, 2022; Woodward et al, 2021).…”

Community engagement to improve access to healthcare: A comparative case study to advance implementation science for transgender health equity

“…They speci cally recommend integrating culturally relevant factors of recipients, clinical encounter or patient-provider interaction, and societal context. They note that some recent work is focused more on equity in relation to implementation strategies but point out that there is "considerably more work to be done on this…" (31). We saw this application of an equity lens to be an important opportunity for advancing transgender health equity using community engagement strategies.…”

Assessing researchers’ capabilities, opportunities, and motivation to conduct equity-oriented dissemination and implementation research, an exploratory cross-sectional study

“…Among health disparities researchers, there are growing opportunities for training in D&I research, such as Research in Implementation Science for Equity (RISE) Program ( https://cvp.ucsf.edu/programs/capacity-building-training/research-implementation-science-equity-rise ) and the Health Disparities Research Institute led by the National Institute for Minority Health and Health Disparities ( https://www.nimhd.nih.gov/programs/edu-training/hdri/ ). Among D&I researchers, there has been recent interest and integration of health equity principles into frameworks [ 1 , 4 , 6 , 7 ] and methods and measurement [ 8 – 10 ]; additionally, some D&I trainings have embedded an equity focus in their programs (e.g., The Institute for Implementation Science Scholars; IS-2).…”

“…The bidirectional learning and synthesis across these two fields, however, remains limited and siloed and thus, prevents the conduct of robust equity-oriented D&I research. Some challenges include the substantial underrepresentation of historically and systematically marginalized populations in research [ 1 ], limited development and testing of equity-oriented interventions to address underlying structural and social determinants of health [ 7 ], underdevelopment of equity-oriented measures and methods, inadequate attention to equity-relevant context, and misalignment of research processes with the needs of populations experiencing inequities [ 9 ]. Because research across all phases of the translational research pipeline, we must assume that majority of current D&I research does not adequately detect, understand, or improve upon disparities.…”