Building Health Equity into Implementation Strategies and Mechanisms

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PROJECT SUMMARY Cancer is one of the leading causes of death in the United States. Despite the successes of cancer control efforts, historically marginalized populations continue to experience a disproportionate burden of cancer morbidity and mortality. Implementation science has the potential to advance health equity by improving the adoption, implementation, and sustainment of evidence-based practices delivered to disadvantaged groups. However, the integration of health equity into implementation science methods is still in the early stages, and several limitations in the field must be overcome to enhance equitable implementation. This supplement builds on the parent award’s efforts to improve the specification of implementation strategies and to elucidate potential causal mechanisms through which strategies elicit desired outcomes. This supplement enhances the parent award’s impact by bringing a health equity lens to the study of implementation strategies and their causal mechanisms. This supplement has two aims: 1) Develop and refine a resource guide for integrating health equity into the selection, tailoring, and specification of implementation strategies; and 2) generate visual representations of causal mechanisms of equity-focused implementation strategies. The first aim will integrate health equity literature and existing guidance for selecting implementation strategies, tailoring them to address context-specific determinants (barriers and facilitators), and specifying strategy components so that they may be tested and replicated. Input from experts in health equity and implementation research will inform the resource guide development. Stakeholder feedback sessions applying user-centered design methods will generate preliminary mixed-methods data on the resource guide’s usability and recommendations for its refinement. The investigative team will apply the resource guide to specify a subset of implementation strategies for health equity impact. Aim 2 draws upon the causal diagramming methods from the parent award to illustrate plausible strategy-mechanism linkages of four health-equity focused implementation strategies and articulate moderators, preconditions, and outcomes associated with those linkages. The health equity-focused implementation strategy specification and the causal pathways of their proposed mechanisms will be compared to “standard” versions of the same strategies to highlight key similarities and differences. The products from this supplement will be added to the parent award web repository and disseminated to implementation scientists and practitioners so they may apply these in equity-focused implementation research and practice. The proposed supplement is innovative in that it is among the first efforts to articulate specific guidance for applying a health equity lens to implementation strategies. It is significant for its potential to advance equitable implementation of evidence-based practices in cancer control and other health fields.