Critical considerations for the practical utility of health equity tools: a concept mapping study

Abstract

BackgroundPromoting health equity within health systems is a priority and challenge worldwide. Health equity tools have been identified as one strategy for integrating health equity considerations into health systems. Although there has been a proliferation of health equity tools, there has been limited attention to evaluating these tools for their practicality and thus their likelihood for uptake.MethodsWithin the context of a large program of research, the Equity Lens in Public Health (ELPH), we conducted a concept mapping study to identify key elements and themes related to public health leaders and practitioners’ views about what makes a health equity tool practical and useful. Concept mapping is a participatory mixed-method approach to generating ideas and concepts to address a common concern. Participants brainstormed responses to the prompt “To be useful, a health equity tool should…” After participants sorted responses into groups based on similarity and rated them for importance and feasibility, the statements were analyzed using multidimensional scaling, then grouped using cluster analysis. Pattern matching graphs were constructed to illustrate the relationship between the importance and feasibility of statements, and go-zone maps were created to guide subsequent action.ResultsThe process resulted in 67 unique statements that were grouped into six clusters: 1) Evaluation for Improvement; 2) User Friendliness; 3) Explicit Theoretical Background; 4) Templates and Tools 5) Equity Competencies; and 6) Nothing about Me without Me- Client Engaged. The result was a set of concepts and themes describing participants’ views of the practicality and usefulness of health equity tools.ConclusionsThese thematic clusters highlight the importance of user friendliness and having user guides, templates and resources to enhance use of equity tools. Furthermore, participants’ indicated that practicality was not enough for a tool to be useful. In addition to practical characteristics of the tool, a useful tool is one that encourages and supports the development of practitioner competencies to engage in equity work including critical reflections on power and institutional culture as well as strategies for the involvement of community members impacted by health inequities in program planning and delivery. The results of this study will be used to inform the development of practical criteria to assess health equity tools for application in public health.

Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis

“…Knowledge of Māori consumer experiences of health care to inform understanding of structural determinants and intermediaries of health inequities may support healthcare quality improvements that sustainably reduce the unequal distribution of quality health care. Empirical analysis has demonstrated the necessity of critical reflections of power and institutional culture in the sustainable delivery of programs that are aimed to impact on health inequity [78, 79].…”

Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience

“…This is aligned with literature suggesting that for scenarios to be relevant, consistent and useful, the scenario building process should involve “people whose futures are being discussed are part of the scenario development process” ([8], p. 346). Also, health research has recognised the importance of participatory processes in recent years [15], with a growing understanding that participation of both researchers and stakeholders potentiates dialogue towards health improvements and ways of addressing health inequalities [16–18].…”

The social context of substance use among older adults: Implications for nursing practice

“…Health equity is a social justice issue, defined by the WHO () as the absence of systematic and potentially remediable differences in one or more characteristics of health across population groups defined socially, economically, demographically, and geographically. Individuals experiencing problematic substance use are highly vulnerable to inequities in health and access to health care as a result of unjust social and living conditions shaped by various factors and values discussed previously (Pauly et al, ; Public Health Agency of Canada, & Pan‐Canadian Public Health Network, ). People with problematic substance use experience significant health disparities; they have higher rates of morbidity and mortality than the general population and are at increased risk of HIV, overdoses, suicides, and infections (Pauly, McCall, Browne, Parker, & Mollison, ).…”

“…Because older populations are more likely to experience stigmatization and thus be less likely to seek treatment or services, a non‐judgemental, harm reduction approach is necessary. Harm reduction is a helpful stance in practice because it can encourage rather than dissuade people, including older adults, to seek adequate care, facilitate access to medical and social services, and encourage care providers to be non‐judgmental in their care (Pauly et al, ). As a philosophy, harm reduction shifts the focus from stigma and discrimination to a focus on moral worth—and by promoting a view of older people as deserving of care versus a potential drain on resources.…”

“…Using a harm reduction lens emphasizes that problematic substance use is better understood as a complex, relapsing, long‐term condition (Pauly et al, ) and shifts the culture of health care from one where resources may be rationed on the basis of deservedness to one where everyone is seen as deserving of care. A growing body of research demonstrates that in practice, harm reduction approaches build trust, avoid stigmatization and judgements, (Smye et al, ) and improve health overall (Pauly et al, ).…”