When choosing from among several potential interventions to address a priority health problem, the strength of evidence for effectiveness must be considered, including whether this evidence is similarly robust across populations and settings. Ideally, interventions should be co-created with community groups and other stakeholders to ensure that they are maximally aligned with community needs, available resources, and local context, rather than later being adapted for local relevance. Include equity-related considerations when deciding which intervention(s) to implement and de-implement. Further, this stage should include developing a plan that outlines and establishes an agreement for how partners, including stakeholders representing vulnerable populations, will be involved at all stages of the implementation and/or research process, and not only at the outset or at the end of a project, and how they will be compensated. In particular, forging community partnerships can give voice to vulnerable populations, facilitate cross-sector collaborations and encourage synergies between communities and researchers, programmers, and/or policymakers. Preferences for how and when to participate in the implementation process should be elicited, and where possible, flexibility and choices for multiple involvement opportunities should be provided. There should be strong attention to the meaningful involvement of individuals from and representing vulnerable populations (communities disproportionately affected by health inequities, including racial/ethnic minorities, socioeconomically disadvantaged communities, sexual and gender minorities, and indigenous peoples, among others ), acknowledging that such persons may be unable or unwilling to participate in all stages of the implementation process and should not be excluded on this basis. Applying the central principles of research models for co-creation (i.e., community-based participatory research and integrated knowledge translation ), stakeholders across all levels and sectors with a strong interest in the priority health problem being addressed should be involved in implementation planning this requires thinking broadly and giving the stakeholder engagement process adequate time.
Identify important stakeholders related to equity and establish roles for partners throughout the entire implementation process. Herein, we propose four pre-implementation planning steps and associated guiding questions (Table 1) that have been adapted from the early phases of the Knowledge-to-Action Framework that we believe can elevate health equity throughout all processes represented by implementation science activities and complement the recommendations outlined by Brownson and colleagues.
In this paper, we seek to highlight not only the need to better incorporate equity into implementation science methods and frameworks, but also to have an equity focus from the outset of all implementation activities. We support their concrete recommendations and those recently put forth by others to better incorporate an equity lens into implementation science. In their article, Brownson and colleagues identify three key challenges to advancing health equity through implementation science-(1) limitations of the current evidence base, (2) underdeveloped measures and methods, and (3) inadequate attention to context-and outline ten important action steps to address them.
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