Top

International Journal for Equity in Health

Published in:

Open Access 01-12-2019 | Research

Conceptual framework of equity-focused implementation research for health programs (EquIR)

Authors: J. Eslava-Schmalbach, N. Garzón-Orjuela, V. Elias, L. Reveiz, N. Tran, E. V. Langlois

Published in: International Journal for Equity in Health | Issue 1/2019

Abstract

Background

Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions.

Objective

To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems.

Methods

A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them.

Results

A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the “health in all policies” proposal affecting universal health and the potential impact of the public health and public policies.

Conclusion

EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53 Available from: https://doi.org/10.1186/s13012-015-0242-0; https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0242-0.

Vogel JP, Moore JE, Timmings C, Khan S, Khan DN, Defar A, et al. Barriers, facilitators and priorities for implementation of WHO maternal and perinatal health guidelines in four lower-income countries: a great network research activity. PLoS One. 2016;11:1–18.

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3:1–12. https://doi.org/10.1186/s40359-015-0089-9.CrossRef

Kirchner JE, Ritchie MJ, Pitcock JA, Parker LE, Curran GM, Fortney JC. Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health. J Gen Intern Med. 2014;29:904–12 Available from: http://link.springer.com/10.1007/s11606-014-3027-2.CrossRef

Khan F, Owolabi M, Amatya B, Hamzat T, Ogunniyi A, Oshinowo H, et al. Challenges and barriers for implementation of the World Health Organization global disability Action plan in low- and middle- income countries. J Rehabil Med. 2018;50:367–76 Available from: https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2276.CrossRef

Wensing M. Implementation science in healthcare: Introduction and perspective. Z Evid Fortbild Qual Gesundhwes. 2015;109:97–102 Available from: https://linkinghub.elsevier.com/retrieve/pii/S1865921715000495.CrossRef

Handley MA, Gorukanti A, Cattamanchi A. Strategies for implementing implementation science: a methodological overview. Emerg Med J. 2016;33:660–4.CrossRef

Waters E, Hall BJ, Armstrong R, Doyle J, Pettman TL, de Silva-Sanigorski A. Essential components of public health evidence reviews: capturing intervention complexity, implementation, economics and equity. J Public Health (Bangkok). 2011;33:462–5 Available from: https://academic.oup.com/jpubhealth/article/33/3/462/1562240.CrossRef

Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action. 2015;8:27106 Available from: https://doi.org/10.3402/gha.v8.27106.CrossRef

10.

Lee JT, Huang Z, Basu S, Millett C. The inverse equity hypothesis: does it apply to coverage of cancer screening in middle-income countries? J Epidemiol Community Health. 2015;69:149–55 Available from: http://jech.bmj.com/lookup/doi/10.1136/jech-2014-204355.CrossRef

11.

Victora CG, Joseph G, Silva ICM, Maia FS, Vaughan JP, Barros FC, et al. The inverse equity hypothesis: analyses of institutional deliveries in 286 National Surveys. Am J Public Health. 2018;108:464–71 Available from: http://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304277.CrossRef

12.

Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000;356:1093–8 Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673600027410.CrossRef

13.

Alliance for Health Policy and Systems Research. Implementation Research in Three Priority Areas [Internet]. World Heal. Organ. 2017 [cited 2017 Sep 9]. Available from: http://www.who.int/alliance-hpsr/projects/ir3/en/

14.

Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347:f6753 Available from: http://www.bmj.com/content/bmj/347/bmj.f6753.full.pdf.CrossRef

15.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50 Available from: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50.

16.

Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50:217–26 Available from: https://insights.ovid.com/pubmed?pmid=22310560.CrossRef

17.

Weiss CH. Why do we fail to deliver evidence-based practice in critical care medicine? Curr Opin Crit Care. 2017;23:400–5 Available from: http://insights.ovid.com/crossref?an=00075198-201710000-00009.CrossRef

18.

Chopra M, Sharkey A, Dalmiya N, Anthony D, Binkin N. Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition. Lancet. 2012;380:1331–40 Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673612614238.CrossRef

19.

Meyers DC, Durlak JA, Wandersman A. The quality implementation Framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50:462–80 Available from: http://doi.wiley.com/10.1007/s10464-012-9522-x.CrossRef

20.

Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. https://doi.org/10.1186/1748-5908-3-1.CrossRefPubMedPubMedCentral

21.

Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Heal Promot Pr. 2014;15:29s–39s Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415354/pdf/nihms599389.pdf.CrossRef

22.

Peters DH, Tran NT, Adam T. Implementation Research in Health: A Practical Guide: WHO; 2013. p. 69. Available from: http://who.int/alliance-hpsr/alliancehpsr_irpguide.pdf. Accessed 15 June 2017.

23.

Braveman PA. Monitoring equity in health and healthcare: a conceptual Framework. J Heal Popul Nutr. 2003;21:181–92 Available from: http://www.jstor.org/stable/23499216.

24.

Tran N, Langlois EV, Reveiz L, Varallyay I, Elias V, Mancuso A, et al. Embedding research to improve program implementation in Latin America and the Caribbean. Rev Panam Salud Publica. 2017;41:e75.PubMed

25.

Whitehead M. The concepts and principles of equity and health. WHO Reg. Off. Eur. Discuss. Pap. 2000. https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN.CrossRef

26.

Eslava-Schmalbach J, Elias V, Reveiz L. G-ON. Incorporating health equity into implementation research: review of conceptual models. Rev Panam Salud Publica. 2017;41:e126.

27.

Panamerican Health Organization/World Health Organization. Manual para el Monitoreo de las Desigualdades en Salud, con especial énfasis en países de ingresos medianos y bajos. Washington, D.C.: Panamerican Health Organization/World Health Organization. 2016. Available from: https://www.paho.org/hq/dmdocuments/2016/manual-moni-desig-sociales-salud-2016.pdf.

28.

Mann G, Squire SB, Bissell K, Eliseev P, Du Toit E, Hesseling A, et al. Beyond accuracy: creating a comprehensive evidence base for TB diagnostic tools [State of the art]. Int J Tuberc Lung Dis. 2010;14:1518–24 Available from: http://www.ingentaconnect.com/content/iuatld/ijtld/2010/00000014/00000012/art00007.PubMed

29.

Mann GH, Thomson R, Jin C, Phiri M, Vater MC, Sinanovic E, et al. The role of health economics research in implementation research for health systems strengthening. Int J Tuberc Lung Dis. 2011;15:715–21.CrossRef

30.

Rudan I. Setting health research priorities using the CHNRI method: IV. Key conceptual advances. J Glob Heal. 2016;6:10501 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938380/.CrossRef

31.

Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S–28S Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366039/.CrossRef

32.

Percival NA, McCalman J, Armit C, O’Donoghue L, Bainbridge R, Rowley K, et al. Implementing health promotion tools in Australian indigenous primary health care. Heal Promot Int; 2016. Available from: http://heapro.oxfordjournals.org/content/early/2016/07/25/heapro.daw049. Accessed 10 July 2017.

33.

Zamora G, Flores-Urrutia MC, Mayen AL, Mayén AL. Large-scale fortification of condiments and seasonings as a public health strategy: equity considerations for implementation. Ann N Y Acad Sci; 2016. Available from: https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.13183. Accessed 17 July 2017.

34.

Bowen S, Botting I, Roy J. Promoting action on equity issues: a knowledgeto-action handbook. Edmonton: School of Public Health, University of Alberta; 2011. Available from: http://nccdh.ca/resources/entry/promoting-action-on-equity-issues.

35.

Rudolph L, Caplan J, Ben-Moshe K, Dillon L, Framework H, Action C, et al. Health in All Policies: A guide for state and local governments [Internet]. Washington, DC and Oakland: CA Am. Public Heal. Assoc. Public Heal. Inst; 2013. Available from: https://www.apha.org/~/media/files/pdf/factsheets/health_inall_policies_guide_169pages.ashx.

36.

Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–104 Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673605711466.CrossRef

37.

O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67:56–64.CrossRef

38.

Oliver S, Kavanagh J, Caird J, Lorenc T, Oliver K, Harden A, et al. Health promotion, inequalities and young people’s health: a systematic review of research. EPPI-Centre; 2008 [cited 2018 Jul 12]; Available from: http://researchonline.lshtm.ac.uk/2603/#.W0afkAkyAVw.mendeley

39.

Embrett MG, Randall GE. Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med. 2014;108:147–55 Available from: http://linkinghub.elsevier.com/retrieve/pii/S0277953614001658.CrossRef

40.

Kruk ME, Freedman LP. Assessing health system performance in developing countries: A review of the literature. Health Policy (New York). 2008;85:263–76 Available from: http://linkinghub.elsevier.com/retrieve/pii/S016885100700200X.CrossRef

41.

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7:23568 Available from: https://www.tandfonline.com/doi/full/10.3402/gha.v7.23568.CrossRef

42.

Bosch-Capblanch X, Zuske MK, Auer C. Research on subgroups is not research on equity attributes: Evidence from an overview of systematic reviews on vaccination. Int J Equity Heal. 2017;16:95.CrossRef

43.

Eslava-Schmalbach JH, Welch VA, Tugwell P, Amaya AC, Gaitan H, Mosquera P, et al. Incorporating equity issues into the development of Colombian clinical practice guidelines: suggestions for the GRADE approach. Rev Salud Publica. 2016;18:72–81.CrossRef

44.

Welch VA, Akl EA, Guyatt G, Pottie K, Eslava-Schmalbach J, Ansari MT, et al. GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol. 2017;90:59–67.CrossRef

45.

Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, et al. GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol; 2017. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0895435617304705. Accessed 17 July 2017.

46.

Welch VA, Akl EA, Pottie K, Ansari MT, Briel M, Christensen R, et al. GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol. 2017;90:76–83.CrossRef

47.

Pottie K, Welch V, Morton R, Akl EA, Eslava-Schmalbach JH, Katikireddi V, et al. GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process. J Clin Epidemiol. 2017;90:84–91.CrossRef

48.

Morgan RL, Kelley L, Guyatt GH, Johnson A, Lavis JN. Decision-making frameworks and considerations for informing coverage decisions for healthcare interventions: a critical interpretive synthesis. J Clin Epidemiol. 2018;94:143–50.CrossRef

49.

Guthmann J-P, Pelat C, Célant N, Parent du Chatelet I, Duport N, Rochereau T, et al. Socioeconomic inequalities to accessing vaccination against human papillomavirus in France: Results of the Health, Health Care and Insurance Survey, 2012. Rev Epidemiol Sante Publique. 2017;65:109–17 Available from: http://linkinghub.elsevier.com/retrieve/pii/S0398762017301037.CrossRef

50.

World Health Organization. Innov8 approach for reviewing national health programmes to leave no one behind: technical handbook [Internet]. 2016. Available from: http://www.who.int/life-course/partners/innov8/innov8-technical-handbook/en/. Accessed 17 July 2017.

Title: Conceptual framework of equity-focused implementation research for health programs (EquIR)
Authors: J. Eslava-Schmalbach
N. Garzón-Orjuela
V. Elias
L. Reveiz
N. Tran
E. V. Langlois
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-019-0984-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Conceptual framework of equity-focused implementation research for health programs (EquIR)

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

The effect of China’s new cooperative medical scheme on health expenditures among the rural elderly

Confidentiality agreements: a challenge in market regulation

“Let’s talk about money”: how do poor older people finance their healthcare in rural Ghana? A qualitative study

Inequality of health stock and the relation to national wealth

Swedish Healthcare Direct managers’ views on gender (in)equity: applying a conceptual model

Overseeing health care facilities in Shanghai, China: regulatory regime, activities and challenges of the governmental regulatory system