Advancing healthcare equity through dissemination and implementation science

Abstract

ObjectiveTo provide guiding principles and recommendations for how approaches from the field of dissemination and implementation (D&I) science can advance healthcare equity.Data Sources and Study SettingThis article, part of a special issue sponsored by the Agency for Healthcare Research and Quality (AHRQ), is based on an outline drafted to support proceedings of the 2022 AHRQ Health Equity Summit and further revised to reflect input from Summit attendees.Study DesignThis is a narrative review of the current and potential applications of D&I approaches for understanding and advancing healthcare equity, followed by discussion and feedback with Summit attendees.Data Collection/Extraction MethodsWe identified major themes in narrative and systematic reviews related to D&I science, healthcare equity, and their intersections. Based on our expertise, and supported by synthesis of published studies, we propose recommendations for how D&I science is relevant for advancing healthcare equity. We used iterative discussions internally and at the Summit to refine preliminary findings and recommendations.Principal FindingsWe identified four guiding principles and three D&I science domains with strong promise for accelerating progress toward healthcare equity. We present eight recommendations and more than 60 opportunities for action by practitioners, healthcare leaders, policy makers, and researchers.ConclusionsPromising areas for D&I science to impact healthcare equity include the following: attention to equity in the development and delivery of evidence‐based interventions; the science of adaptation; de‐implementation of low‐value care; monitoring equity markers; organizational policies for healthcare equity; improving the economic evaluation of implementation; policy and dissemination research; and capacity building.

Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association

“…21 A recent narrative review of implementation science and equity identified 4 principles that should guide implementation science to improve equity: (1) Racism must be recognized as a fundamental driver of inequities; (2) improved equity requires engagement of community members and other relevant partners; (3) equitable health care requires multisector partnerships; and (4) context is central to health care equity. 22 A key aspect of implementation science includes involving community partners early in the development and testing of interventions and including outcomes such as reach and representativeness of the intervention to ensure that a therapy does not have the unintended consequence of exacerbating disparities. Including community partners as investigators may enhance uptake and sustainability of the intervention through the insights they provide into population needs and adaptations required for longterm use.…”

Disseminating for Impact: Developing a translational dissemination curriculum for the clinical and translational research workforce

“…Novel frameworks are needed to support translational dissemination in a manner that is equityoriented, or working to reduce the power imbalances represented by research participants, illness-oriented communities, historically marginalized groups, and/or geographic communities (Baumann et al, 2023). The clinical and translational science workforce represents individuals from a wide range of prior educational experiences and multidisciplinary background.…”

Promoting Equity in Hepatitis C Care: A Qualitative Study Using an Intersectionality Lens to Explore Barriers and Facilitators to Point-of-Care Testing Among People Who Inject Drugs and Service Providers

“…[30][31][32][33] People who inject drugs face stigma and discrimination which shape their interactions with healthcare systems, and access to care.2,34, 35 Recent shifts towards equity-focused implementation science underscore the importance of acknowledging and addressing these unique challenges to enhance health outcomes for all. 30,[36][37][38] The use of an equityfocused theoretical lens can complement determinant frameworks such as the Theoretical Domains Framework (TDF) by providing a deeper understanding of how intersecting social identities and structural inequities in uence individuals' behaviors and attitudes, enriching the analysis of barriers and enablers to behavior change in healthcare settings.33,37,39,40 By considering the complex interplay of intersecting identities and structures of power within society (e.g., racism, classism, drug policy, stigmatization of HCV infection), an intersectionality lens has the potential to provide a more nuanced perspective on the factors in uencing the implementation of point-of-care HCV testing within needle and syringe programs. [41][42][43] Objective and research questions The HepCAST study aimed to use an intersectionality lens to explore the theory-informed barriers and enablers to point-of-care HCV antibody and RNA testing in a needle and syringe program in Montreal, Canada.…”