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

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

doi:10.1186/s12939-019-0984-4

Abstract

BackgroundImplementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions.ObjectiveTo develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems.MethodsA 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.ResultsA 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.ConclusionEquIR 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.

Highlights

Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions
Implementation Research (IR) covers the systematic use of the scientific method for the Implementation Science (IS) and can be defined as research that “identifies common implementation problems and main determinants which hinder effective access to interventions; develops and tests practical solutions to these problems that are either specific to particular health systems and environments, or that address a problem common to several countries in a region; and determines the best way of introducing these practical solutions into the health system and facilitates their full scale implementation, evaluation and modification as required” [13]
Why is IR research different in general? Even when IR uses the available tools of the scientific method, its objective of study is the implementation of health policies, programs or interventions, which makes it different from classical research that focuses on finding the effect of such policies, programs or interventions, without considering all the aspects that affect this effect during implementation [14]

Summary

Introduction

Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. Even when IR uses the available tools of the scientific method, its objective of study is the implementation of health policies, programs or interventions, which makes it different from classical research that focuses on finding the effect of such policies, programs or interventions, without considering all the aspects that affect this effect during implementation [14]. With this method, IR evaluates the effect of such policies, programs or interventions in the community after implementation, finding scientific evidence on the real impact of implementation, based on short, medium or long-term indicators [13, 14]. IR offers the possibility of evaluating this effect during implementation, and in the case of this proposal, equity-focused IR offers the possibility of intervening and evaluating the effect on equity with the IR [11, 18]

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Discussion

Conclusion