Table 2 Recommendations to advance health equity within implementation science
From: Implementation science should give higher priority to health equity
Domain | Recommendation | Core elements | Actorsa |
|---|---|---|---|
Evidence base | |||
1. Link social determinants with health outcomes | • Build literature linking social determinants with health outcomes of importance to key stakeholders (e.g., funders) • Build the literature on implementation processes in low-resource settings • Identify opportunities to address social risk in primary care • Describe the role of social determinants as moderators of behavior change • Apply equity-relevant guidelines and evidence frameworks | • Funders • Researchers | |
2. Build equity into all policies | • Incorporate health and equity consideration in policy decisions across sectors (Equity in All Policies) • Analyze barriers to change with an equity focus • Frame and communicate policy information in new ways (e.g., framing for audience segments, use of narratives) | • Advocates • State and local practitioners • Policy makers | |
Methods and measures | |||
3. Use equity-relevant metrics | • Expand macro-level metrics to focus on upstream indicators to measure progress toward equity in communities • Identify new metrics in studies to address context and historical disadvantage • Apply existing taxonomies (e.g., outcomes developed by Proctor et al.) in an equity context | • Funders • Researchers • State and local practitioners | |
4. Study what is already happening | • Describe how end users experience implementation • Work with practitioners and policy makers to conduct natural experiments • Enhance the role of equity in tailored implementation | • Funders • Researchers • Program evaluators | |
5. Integrate equity into models | • Identify the focus of existing models regarding equity and related gaps, social determinants, and stakeholder engagement • Identify methods for fully integrating equity into existing models • Use interactive webtools to increase the focus on equity | • Researchers • Program evaluators | |
6. Design and tailor implementation strategies | • Apply lessons from previous studies of implementation and scale-up • Enhance the explicit focus on equity among implementation strategies • Test novel strategies at multiple levels • Enhance the role of adaptive designs in development of equity-relevant implementation strategies | • Researchers • Program evaluators | |
Context | |||
7. Connect systems and sectors outside of health | • Establish the premise that justice across societal sectors is essential • Conduct more disease-agnostic interventions • Apply models and methods from systems science | • Advocates • Funders • Researchers • State and local practitioners • Health system leaders | |
8. Engage organizations, internally and externally | • Internally, assess climate and culture with an equity focus • Evaluate existing programs and policies regarding their equity impacts • Externally, bring on new equity partners, share power and decision-making, and break down funding silos | • Researchers • State and local practitioners • Program evaluators | |
Cross-cutting issues | |||
9. Build capacity for equity | • For the “who” of capacity building, increase engagement of persons in trainings from under-represented minority backgrounds • Re-shape the “how” of trainings with an equity lens on the audience, competencies, engagement, and evaluation • Add new settings to expand the “where” of capacity building | • Funders • Researchers | |
10. Focus on equity in dissemination efforts | • Provide incentives for researchers to engage with end users in ways to improve dissemination • Engage with equity-focused partners early and often in the research process • Develop new dissemination products that resonate with key stakeholders | • Advocates • Funders • State and local practitioners • Researchers |