A more practical guide to incorporating health equity domains in implementation determinant frameworks.
A more practical guide to incorporating health equity domains in implementation determinant frameworks.
复制标题
将健康平等领域纳入实施确定框架中的更实用的指南。
DOI：
10.1186/s43058-021-00146-5
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发表时间：
2021-06-05
影响因子：
--
通讯作者：
Kirchner JE
中科院分区：
文献类型：
--
作者：
Woodward EN;Singh RS;Ndebele-Ngwenya P;Melgar Castillo A;Dickson KS;Kirchner JE
由于医疗创新的实施存在显著差异，研究人员和从业人员必须有意义地使用实施决定因素框架，以了解为什么在医疗保健的获取，接收，使用，质量或结果方面存在差异。我们之前的工作记录和试点的第一个出版的适应现有的实施决定因素框架与卫生公平领域，以创建卫生公平实施框架。我们建议将这三个健康公平领域整合到现有的实施决定因素框架中：（1）接受者的文化相关因素，（2）临床就诊或患者-提供者互动，以及（3）社会背景（包括但不限于健康的社会决定因素）。该框架是为医疗保健和临床实践环境开发的。一些执行小组已开始在其评价中使用卫生公平执行框架，并要求提供更多指导。我们与作者团队完成了一个共识过程，以澄清将健康公平透镜纳入实施决定因素框架的步骤。我们描述了将卫生公平领域纳入实施决定因素框架的实施研究和实践的步骤。对于每一步，我们都编写了示例或实用工具，以帮助实施研究人员和实践者应用这些步骤。对于每一个领域，我们编制的定义与支持文献，展示了一个说明性的例子，并建议样本的定量和定性措施。在实施决定因素框架内确定卫生公平领域，可以通过评估和理想地同时解决实施和公平障碍，优化科学产出和实施工作的公平性。提供的这些实用指导和工具可协助执行问题研究人员和从业人员具体捕捉和了解执行差距的障碍和促进因素。在线版本包含补充材料，可通过10.1186/s43058-021-00146-5获得。
Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance. We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework. We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures. Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities. The online version contains supplementary material available at 10.1186/s43058-021-00146-5.
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