Brief Orientation

Section

Toolkit Home Brief Orientation Key Language and Concepts Key Literature Community and Partner Engagement Reflectivity in Research Practice Implementation Science Frameworks Measurement and Evaluation Data Collection and Analysis Implementation Trials

Section lead: Kelly Aschbrenner, PhD

Health equity is centered on social justice in health, where everyone has a fair and just opportunity to be as healthy as possible. In the US context, there are numerous historical and ongoing structural drivers and systems that disproportionately create and maintain social and health inequities among population groups, including people from minoritized racial and ethnic groups, people with disabilities, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, and intersex), people with limited English proficiency, and other groups.1,2

In addition, contextual factors like characteristics of the physical and social environment where people live, and harmful aspects of the built environment, can exacerbate health inequalities (e.g., areas of persistent poverty, remote areas, and urban or residential segregation have more harmful exposures and lack access to health-promoting resources, including evidence-based programs). Although well intentioned, broader efforts to implement health interventions and evidence-based practices (EBPs) may disproportionately benefit privileged groups and settings, with reach and benefits limited among groups that experience numerous social and structural impediments to health.3

Implementation science (IS) investigators are well-poised to address health equity. Implementation science involves applying theories, models, frameworks, and methods to rigorously examine strategies to facilitate the uptake of EBPs and the investigation of the contextual determinants (e.g., patient, provider, organizational, community, and policy factors) that influence implementation processes and outcomes.4 IS is team based and investigators represent a broad range of academic disciplines, including medicine, social work, psychology, anthropology, and public health. Additionally, implementation science routinely engages community members and other key partners, including health care professionals, health system administrators, health policy makers, and patients and families.5 Implementation research addresses health equity if it concentrates on explicitly understanding and addressing factors driving inequities and disparities as either a primary or secondary focus of the research.6

Bringing a health equity lens to IS involves identifying barriers to equitable implementation as well as facilitators, assets, or strengths that can be used to promote equity in implementation efforts.7,8 IS-trained investigators have approached this research by integrating health equity into implementation frameworks to identify determinants, guide processes of translating research into practice, and evaluate outcomes of implementation efforts.9-11 Doing this work effectively requires engaging community partners in meaningful ways throughout the implementation and research process to increase relevance and impact and promote sustainability of EBPs.12 Finally, conducting IS research focused on promoting health equity requires ongoing self-reflection on how issues of equity are considered and addressed in one’s own research, research teams, and institutions.13

This toolkit is designed to enable an IS-trained investigator to

  • better understand key health equity terms and use them in planning and carrying out health equity focused implementation research
  • locate additional resources for health equity in IS
  • understand approaches to integrating health equity into implementation frameworks and identify relevant study designs and methods

References

  1. World Health Organization. A conceptual framework for action on the social determinants of health. Geneva, Switzerland: WHO Production Services; 2010.
  2. Gómez CA, Kleinman DV, Pronk N, et al. Addressing health equity and social determinants of health through Healthy People 2030. J Public Health Manag Pract. 2021;27(Suppl 6):S249-S257. doi:10.1097/PHH.0000000000001297
  3. Arcaya MC, Figueroa JF. Emerging trends could exacerbate health inequities in the United States. Health Aff. 2017;36(6):992-998. doi:10.1377/hlthaff.2017.0011
  4. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):53. doi:10.1186/s13012-015-0242-0
  5. Lobb R, Colditz GA. Implementation science and its application to population health. Annu Rev Public Health. 2013;34(1):235-251. doi:10.1146/annurev-publhealth-031912-114444
  6. Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implement Sci. 2021;16(1):28. doi:10.1186/s13012-021-01097-0
  7. Kerkhoff AD, Farrand E, Marquez C, Cattamanchi A, Handley MA. Addressing health disparities through implementation science—A need to integrate an equity lens from the outset. Implement Sci. 2022;17(1):13. doi:10.1186/s13012-022-01189-5
  8. Baumann AA, Cabassa LJ. Reframing implementation science to address inequities in healthcare delivery. BMC Health Serv Res. 2020;20(1):190-190. doi:10.1186/s12913-020-4975-3
  9. Woodward EN, Matthieu MM, Uchendu US, Rogal S, Kirchner JE. The health equity implementation framework: Proposal and preliminary study of hepatitis C virus treatment. Implement Sci. 2019;14(1):26. doi:10.1186/s13012-019-0861-y
  10. Allen M, Wilhelm A, Ortega LE, Pergament S, Bates N, Cunningham, B. Applying a race(ism)-conscious adaptation of the CFIR framework to understand implementation of a school-based equity-oriented intervention. Ethn Dis. 2021;31(Suppl 1):375–388. doi:10.18865/ed.31.S1.375
  11. Glasgow RE, Askew S, Purcell P, et al. Use of RE-AIM to address health inequities: Application in a low-income community health center-based weight loss and hypertension self-management program. Transl Behav Med. 2013;3(2):200-210. doi:10.1007/s13142-013-0201-8
  12. Adsul P, Chambers D, Brandt HM, et al. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun. 2022;3(1):56. doi:10.1186/s43058-022-00311-4
  13. Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. Implement Res Pract. 2021;2. doi:10.1177/26334895211049482