Optimizing Interventions for Equitability: Some Initial Ideas

Abstract

Interventions (including behavioral, biobehavioral, biomedical, and social-structural interventions) hold tremendous potential not only to improve public health overall but also to reduce health disparities and promote health equity. In this study, we introduce one way in which interventions can be optimized for health equity in a principled fashion using the multiphase optimization strategy (MOST). Specifically, we define intervention equitability as the extent to which the health benefits provided by an intervention are distributed evenly versus concentrated among those who are already advantaged, and we suggest that, if intervention equitability is acknowledged to be a priority, then equitability should be a key criterion that is balanced with other criteria (effectiveness overall, as well as affordability, scalability, and/or efficiency) in intervention optimization. Using a hypothetical case study and simulated data, we show how MOST can be applied to achieve a strategic balance that incorporates equitability. We also show how the composition of an optimized intervention can differ when equitability is considered versus when it is not. We conclude with a vision for next steps to build on this initial foray into optimizing interventions for equitability.

Applying an Equity Lens to Evidence-Based Preventive Interventions: A Systematic Review of Subgroup Findings from Experimental Evaluations

“…Although reports showing no subgroup effects have historically been viewed as important for broadly improving outcomes, there is growing acceptance that no "silver bullet" exists (Schindler, 2024). Interventions that are effective overall but not equitable (e.g., bene ts are concentrated among those who are already advantaged) could have a diminished public health impact and possibly even exacerbate health disparities (Strayhorn et al, 2024). Understanding when and why an EBPI may bene t some youth and not others is critical for identifying and responding to inequities; tests for moderation could thus inform some approaches for achieving net population impacts.…”

“…Because of the pervasive nature of health disparities, we argue that issues of equity are always relevant in prevention research, regardless of topic area (e.g., educational attainment, substance misuse, delinquency, etc.). Examining effectiveness without investigating the potential to mitigate health disparities can disguise inequities (Strayhorn et al, 2024). Researchers may inadvertently perpetuate the assumption that ndings apply to all when they do not explicitly test this assumption (Gaias et al, 2020;Murry et al, 2024).…”

“…A high-quality RCT preregistered with ClinicalTrials.gov (#NCT00051727) showed reduced substance use and improved emotional well-being and academic performance in teens following the transition to middle school (Gonzales et al, 2012(Gonzales et al, , 2018. Meanwhile, Strayhorn et al (2024) offer guidance for incorporating equitability with other intervention design criteria (i.e., effectiveness overall, as well as affordability, scalability, and/or e ciency).…”

“…However, the term "preventive" underscores their proactive nature; EBPIs intervene before problems occur or escalate to reduce the burden of disease and dysfunction on individuals, families, communities, and societies (Boyd et al, 2023;Fishbein & Sloboda, 2023). Strayhorn et al (2024) de ne equitability of an intervention as the extent to which the health bene ts provided by an intervention are distributed evenly, such that all participants have a fair and just opportunity to achieve the desired outcome of the intervention. Building upon previous research that called for clear reporting and better representation of racial and ethnic minoritized populations to reduce disparities and improve the utility of preventive interventions (Buckley et al, 2023), we explore the prevalence of EBPIs that equitably bene ted minoritized youth.…”