Table 1 Four steps and associated guiding questions to explore prior to implementation of interventions that can improve health equity throughout early phases of implementation science activities

Identify important stakeholders related to equity and establish roles for partners throughout the implementation process

• Who are the key stakeholders for health problems among vulnerable populations in your setting/context?

• What are stakeholders’, including vulnerable persons and community members, preferences for how to be involved throughout different phases of the implementation process?

• Can choices be provided for different approaches to and opportunities for involvement across different implementation phases?

• Have ways to ensure that stakeholders are appropriately compensated for their time been considered?

• What are the priorities of stakeholders that align with or are at odds with implementation, and how can they be leveraged/addressed?

• Has a plan been outlined with and agreed to by community members and other stakeholders about engagement processes across the implementation stages, including dissemination strategies?

Include equity-related considerations when deciding which intervention(s) to implement and/or de-implement

• Is the health problem you are interested in targeting a priority to vulnerable populations in your setting/context?

• Does the intervention(s) being considered have strong potential to improve that health problem for vulnerable populations in your setting/context?

• Is there an existing intervention related to that health problem that provides low-value to vulnerable populations in your setting/context that should be de-implemented?

• Who are trusted messengers and sources for vulnerable populations in your setting/context?

Evaluate the performance gap related to the intervention or program of interest in vulnerable populations

• What is the performance gap for an intervention in vulnerable populations in your setting/context?

• What is the outcome gap for an intervention in vulnerable populations in your setting/context?

• Do the performance and outcome gaps differ across populations and settings?

Identify and prioritize barriers faced by vulnerable populations—including structural racism and power dynamics

• Have the individual-, health systems-, and community-level barriers that explain the performance gap among vulnerable populations in your setting/context been explored?

• Have the social determinants of health among vulnerable populations in your setting/context (including historical and structural racism and power dynamics) been discussed with stakeholders to understand their importance and potential impact on the health problem, intervention and implementation strategies being considered?

• What implementation strategies may overcome key barriers—including social determinants of health—and optimize reach among vulnerable populations in your setting/context?

• Are outcomes that are important and meaningful to stakeholders, including vulnerable populations, known, and included in the evaluation plan?

• What evaluation measures will allow you to ensure that your implementation strategies are improving (not worsening) health disparities among vulnerable populations in your setting/context?