Abstract
BackgroundResearchers could benefit from methodological advancements to advance uptake of new treatments while also reducing healthcare disparities. A comprehensive determinants framework for healthcare disparity implementation challenges is essential to accurately understand an implementation problem and select implementation strategies.MethodsWe integrated and modified two conceptual frameworks—one from implementation science and one from healthcare disparities research to develop the Health Equity Implementation Framework. We applied the Health Equity Implementation Framework to a historical healthcare disparity challenge—hepatitis C virus (HCV) and its treatment among Black patients seeking care in the US Department of Veterans Affairs (VA). A specific implementation assessment at the patient level was needed to understand any barriers to increasing uptake of HCV treatment, independent of cost. We conducted a preliminary study to assess how feasible it was for researchers to use the Health Equity Implementation Framework. We applied the framework to design the qualitative interview guide and interpret results. Using quantitative data to screen potential participants, this preliminary study consisted of semi-structured interviews with a purposively selected sample of Black, rural-dwelling, older adult VA patients (N = 12), living with HCV, from VA medical clinics in the Southern part of the USA.ResultsThe Health Equity Implementation Framework was feasible for implementation researchers. Barriers and facilitators were identified at all levels including the patient, provider (recipients), patient-provider interaction (clinical encounter), characteristics of treatment (innovation), and healthcare system (inner and outer context). Some barriers reflected general implementation issues (e.g., poor care coordination after testing positive for HCV). Other barriers were related to healthcare disparities and likely unique to racial minority patients (e.g., testimonials from Black peers about racial discrimination at VA). We identified several facilitators, including patient enthusiasm to obtain treatment because of its high cure rates, and VA clinics that offset HCV stigma by protecting patient confidentiality.ConclusionThe Health Equity Implementation Framework showcases one way to modify an implementation framework to better assess health equity determinants as well. Researchers may be able to optimize the scientific yield of research inquiries by identifying and addressing factors that promote or impede implementation of novel treatments in addition to eliminating healthcare disparities.
Highlights
Researchers could benefit from methodological advancements to advance uptake of new treatments while reducing healthcare disparities
What occurs in the clinical encounter determines, in part, whether an innovation is delivered, and we argue that this is especially important for healthcare disparities because of unique patient and provider factors in the healthcare of vulnerable groups
Application of health equity implementation framework we describe an application of this framework to a healthcare disparity implementation challenge— hepatitis C virus (HCV) treatment among Black patients seeking care in the US Department of Veterans Affairs (VA)
Summary
Researchers could benefit from methodological advancements to advance uptake of new treatments while reducing healthcare disparities. The group suffering from the disparity is considered vulnerable by proxy of a defining feature (e.g., low income, race, gender) that has led to societal discrimination and stress [17]. As examples of these disparities, a US national report found that poor and low-income households have worse care than high-income households [20]. Implementation researchers could benefit from further methodological advancements to integrate implementation science methods and health disparities methods with the goal to advance health equity for all. Health equity includes fair access to opportunities for optimal health and well-being
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