Equity Intervention Research Articles

Study of the Impact of Private Equity Involvement on Corporate IPO Decisions

At present, private equity investment has become a relatively popular option for financing enterprises of unlisted companies. This paper conducts a case study on the changes in profitability, development, and technological innovation ability of NAIXUE before and after its listing. Tiantu invests in this famous listed catering company to explore the issue of how private equity intervention affects the decision-making of enterprises to go public. The single-case study found that personal equity intervention can help enterprises accelerate the speed of financing, improve their soft power, profitability, and competitiveness, and accelerate the listing process. They proposed a profitable way for private equity firms to continue to hold shares after listing. Under its unique operation mode and management ability, private equity supports enterprises in management, technology, resources, and other aspects. Resource integration helps solve the difficulties in developing enterprises before going public so that they can concentrate on technological innovation.

Role and Impact of Private Equity in Mergers and Acquisitions of Publicly Listed Companies

This article discusses the role and impact of private equity funds in the mergers and acquisitions of listed companies. It introduces the historical development of private equity funds, the domestic and international M&A background, as well as the research purpose and significance. The section exploring the role of private equity in the mergers and acquisitions of listed companies discusses the methods of private equity intervention and financial support, along with the relationships and decision-making processes involving other investors. Additionally, the article discusses the impact of M&A funds on market activity and evaluates market price fluctuations. The article delves into the discussion and prevention of risks, covering positive effects and collaborative advantages, regulatory challenges in new models, negative effects and risks, as well as challenges and cooling trends in the models. Future regulatory efforts should focus on strengthening the scrutiny and disclosure of related-party transactions, consolidated financial statements, and announcement disclosures.

Design and pilot test of an implicit bias mitigation curriculum for clinicians.

Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity." To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys. Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum. Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.

Inequalities ed equity in health

The relationship between inequalities and health has been widely studied. Several theories have been proposed to define the role of the factors that act on the health levels, their strength and the determination profile. This review recalls the main theories and interpretation proposed by different fields of knowledge and highlights that there is not a single way to generate inequalities in health. Deprivation, disadvantage drift, empowerment, structure and social capital, status syndrome, and embodiment are some of the concepts recalled and explored. Some theories consolidate each other, and some remain more isolated. To increase the knowledge on the mechanisms to define the disease distributions among individuals in the population can help to define new and greater equity intervention policies.

Feasibility of the Poverty-Targeted Pediatric Cancer Resource Equity (PediCARE) intervention.

10009 Background: Children with cancer living in poverty are more likely to relapse and die, even when treated uniformly on clinical trials. No evidence-based interventions targeting poverty as a risk factor for disparate outcomes exist in pediatric oncology. We previously developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention—a centrally-delivered, household material hardship (HMH)-targeted intervention that provides transportation and groceries to low-income pediatric oncology families. We report feasibility of administering PediCARE as a randomized intervention across 2-centers. Methods: We conducted a pilot randomized controlled trial (RCT) of PediCARE versus usual care at Dana-Farber Cancer Institute (DFCI) and University of Alabama Birmingham (UAB) between May 2019 and August 2021 (NCT03638453). Eligible participants included children age < 18 years with de novo cancer diagnosed in the prior 2-months, who were planned to receive at least 4-cycles of chemotherapy and lived in a household that screened positive for HMH (food, housing, utility or transportation insecurity). Participants were randomized 1:1 by site to receive PediCARE or usual care for 6-months. Parent/guardians completed a household survey at baseline and at completion of the 6-month intervention. The primary outcome was feasibility defined a priori as a recruitment and consent to randomization rate of > = 75% and < 20% attrition per arm—endpoints intended to justify the feasibility of a subsequent efficacy RCT. Secondary outcomes included proportion of recipients who successfully received the intervention and intervention acceptability. Results: A total of N = 40/40 eligible families (n = 12 UAB; n = 28 DFCI) were approached and offered an opportunity to participate (100% consent rate). Among participants, there was 0% attrition in either arm following randomization and the 6-month intervention period; 100% of parent/guardians completed both baseline and 6-month surveys. Among those randomized to PediCARE, 100% (n = 20) successfully received grocery and transportation resources; 100% reported that it was "easier to buy food for my family," 85% reported it was easier to get to and from the hospital, and 95% reported they would be “very likely to recommend the intervention to other families”. Conclusions: Stark disparities exist in pediatric oncology. Advancement in health equity science must include establishment of a robust, evidence-based portfolio of scalable health equity interventions for evaluation in the Children’s Oncology Group (COG) drug trial setting. Findings from this pilot RCT support feasibility and utility of a poverty-targeted intervention from the clinical oncology setting—as evidenced by 100% of parent/guardians consenting to randomization with 0% attrition across 2-centers. Immediate next steps include randomized efficacy evaluation in a COG trial-embedded study. Clinical trial information: NCT03638453 .

A Protocol to Assess Contextual Factors During Program Impact Evaluation: A Case Study of a STEM Gender Equity Intervention in Higher Education

Program evaluations that lack experimental design often fail to produce evidence of impact because there is no available control group. Theory-based evaluations can generate evidence of a program's causal effects if evaluators collect evidence along the theorized causal chain and identify possible competing causes. However, few methods are available for assessing competing causes in the program environment. Effect Modifier Assessment (EMA) is a method previously used in smaller-scale studies to assess possible competing causes of observed changes following an intervention. In our case study of a university gender equity intervention, EMA generated useful evidence of competing causes to augment program evaluation. Top-down administrative culture, poor experiences with hiring and promotion, and workload were identified as impeding forces that might have reduced program benefits. The EMA addresses a methodological gap in theory-based evaluation and might be useful in a variety of program settings.

Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial

BackgroundHealthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities. Methods/designHWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted.DiscussionAs a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities.Trial registrationISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760

Utilizing the Modified OMP Model for Health Equity in a Family Medicine Residency Clinic

Background Racial and ethnically diverse communities have higher mortality rates from chronic diseases. One approach to address health disparities and systemic racism in health care is through alterations in primary care workforce development via the One-Minute Preceptor (OMP) Teaching Method. The University of North Carolina at Chapel Hill created a modified OMP Model for Health Equity to address racial health disparities while teaching. This quality improvement (QI) project focuses on faculty confidence in discussing racial health disparities with learners using the modified OMP Model. Methods The QI project used a Plan-Do-Study-Act (PDSA) framework. Faculty participated in the Awareness, Reflection/Empowerment, and Action (AREA) survey, to assess level of engagement in addressing health disparities. Family Medicine (FM) residents completed a survey on current precepting practices of ethno-racial health disparities. Faculty were introduced to the modified OMP, followed by a two-month intervention period. Post-intervention surveys assessed the impact and identified faculty development opportunities. The intervention took place within a Family Medicine Residency Program, specifically during outpatient continuity clinics and the inpatient Family Medicine Hospital Service. Results Faculty engagement increased in areas of awareness and action and decreased in reflection/empowerment. Residents reported higher satisfaction with Ethno-Racial health disparities clinical teaching after the intervention. Qualitative data suggests discussions are not occurring as often as residents desire and depend on different factors; race/ethnicity of the patient, clinical situation, social determinants of health impacting care, time, and preceptor. Discussion The modified OMP for Health Equity intervention can be used to increase awareness and promote self-reflection and change. Conclusion The PDSA cycle framework for an intervention can improve faculty engagement addressing Ethnic-Racial health disparities.

Utilizing the Modified OMP Model for Health Equity in a Family Medicine Residency Clinic

Background Racial and ethnically diverse communities have higher mortality rates from chronic diseases. One approach to address health disparities and systemic racism in health care is through alterations in primary care workforce development via the One-Minute Preceptor (OMP) Teaching Method. The University of North Carolina at Chapel Hill created a modified OMP Model for Health Equity to address racial health disparities while teaching. This quality improvement (QI) project focuses on faculty confidence in discussing racial health disparities with learners using the modified OMP Model. Methods The QI project used a Plan-Do-Study-Act (PDSA) framework. Faculty participated in the Awareness, Reflection/Empowerment, and Action (AREA) survey, to assess level of engagement in addressing health disparities. Family Medicine (FM) residents completed a survey on current precepting practices of ethno-racial health disparities. Faculty were introduced to the modified OMP, followed by a two-month intervention period. Post-intervention surveys assessed the impact and identified faculty development opportunities. The intervention took place within a Family Medicine Residency Program, specifically during outpatient continuity clinics and the inpatient Family Medicine Hospital Service. Results Faculty engagement increased in areas of awareness and action and decreased in reflection/empowerment. Residents reported higher satisfaction with Ethno-Racial health disparities clinical teaching after the intervention. Qualitative data suggests discussions are not occurring as often as residents desire and depend on different factors; race/ethnicity of the patient, clinical situation, social determinants of health impacting care, time, and preceptor. Discussion The modified OMP for Health Equity intervention can be used to increase awareness and promote self-reflection and change. Conclusion The PDSA cycle framework for an intervention can improve faculty engagement addressing Ethnic-Racial health disparities.

Examining ACCURE's Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care.

There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.

Mechanisms to enhance racial equity in health care: Developing a model to facilitate translation of the ACCURE intervention

BackgroundAs medical and public health professional organizations call on researchers and policy makers to address structural racism in health care, guidance on evidence-based interventions to enhance health care equity is needed. The most promising organizational change interventions to reduce racial health disparities use multilevel approaches and are tailored to specific settings. This study examines the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, which changed systems of care at two U.S. cancer centers and eliminated the Black-White racial disparity in treatment completion among patients with early-stage breast and lung cancer. PurposeWe aimed to document key characteristics of ACCURE to facilitate translation of the intervention in other care settings. MethodsWe conducted semi-structured interviews with participants who were involved in the design and implementation of ACCURE and analyzed their responses to identify the intervention's mechanisms of change and key components. ResultsStudy participants (n ​= ​18) described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key components. Intervention components were designed to enhance either institutional transparency (e.g., a data system that facilitated real-time reporting of quality metrics disaggregated by patient race) or accountability of the care system to community values and patient needs for minimally biased, tailored communication and support (e.g., nurse navigators with training in antiracism and proactive care protocols). ConclusionsThe antiracism principles transparency and accountability may be effective change mechanisms in equity-focused health services interventions. The model presented in this study can guide future research aiming to adapt ACCURE and evaluate the intervention's implementation and effectiveness in new settings and patient populations.

Evaluation of a three-part equity intervention for women of color with breast cancer.

TPS1129 Background: Women of color (WOC) with breast cancer miss and fail key points in care due to racial disparities in cancer services. Conscious and unconscious bias means that these women are not treated in a timely way or as rigorously. They are offered fewer options, and the patient navigation and education needed for them to self-advocate is ignored. Black women in particular have the highest breast cancer death rates. Care delivery differs even independent of such variables as literacy, income, and education. Separately and incrementally, findings to date have shown the potential oof patient navigation, equity assessment, and mobile support to reverse these disparities. In pilot investigations –– partnering with academic cancer centers –– The Chrysalis Initiative (a nonprofit patient advocacy and research organization) has validated the potential of combining these approaches in a three-part intervention. Based on preliminary work, it is hypothesized patients will: experience significantly greater adherence to the recommended continuum of care, without disruption or barriers; more often seek second opinions and additional supportive resources, and engage in clinical trials; demonstrate less co-morbidities, through more preventive measures and healthful lifestyle; suffer fewer interactions perceived to be influenced by racism; undergo less financial distress, with guidance on managing and planning costs; feel more confident and more optimistic in their outlook; and achieve better clinical results and lower costs. Methods: To determine and document the full impact, both quantitatively and qualitatively, of the experimental three-part intervention, the trial is: delivering navigation/coaching services to the study population, using counselors who are predominantly WOC who have experienced the challenges of breast cancer care. Surveys and interviews pre- and post-intervention will add to impact measures; providing the experimental group with the BC Navi App on both iOS and Android devices . Developed in partnership with InTouch, the app supports engagement and tracking. It provides a dashboard for care evaluation to supplement EMR data; conducting an equity assessment of breast cancer services of partnering clinical programs through use of focus groups with staff, patients, and community; procedural checks; and data collection from center EHR systems. The review audits 40 domains of care based on NCCI, NCI, ASCO, ACR, and other standards. The assessment team works closely and collaboratively with each cancer center’s clinical and administrative staff to reveal disparities and find consensus on ways to close gaps. This trial in progress is randomizing 200 subjects to the coaching/mobile app intervention arm and 100 to benefits of the equity assessment only, with comparison to nonWOC with breast cancer. The trial aims to disseminate the three-part intervention in easily reproducible form.

CHARM 2: A Gender Synchronized Family Planning Intervention for Couples in Rural India, a Cluster Randomized Trial [A05

INTRODUCTION: Gender synchronized family planning interventions are posited to be an important means of engaging men while supporting women’s reproductive agency and increasing modern contraceptive use, particularly in contexts where traditional gender norms prevail. The Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention counsels men, women, and couples on gender equity and family planning. METHODS: This is an institutional review board (IRB)-approved cluster randomized controlled trial evaluating the effect of the CHARM2 intervention on contraceptive use, communication and agency, pregnancy, and quality of care among married couples across 20 clusters in rural Maharashtra, India. RESULTS: We enrolled 1,201 couples. Full-couple retention at 18 months was 90.5%. Contraceptive use was higher among intervention participants at 9 but not 18 months (adjusted ratio of odds ratio [AROR] 1.5, 95% CI 1.03-2.3 and AROR 0.8, 95% CI 0.4-1.4). Communication (9-month AROR 1.9, 95% CI 1.0-3.6; 18-month AROR 2.7, 95% CI 1.5-4.8) and agency (9-month AROR 5.1, 95% CI 1.2-22.4; 18-month AROR 8.1, 95% CI 1.4-48.2) improved at both times. Intervention participants had significantly higher mean Interpersonal Quality of Family Planning scale scores at both times (9-month intervention 3.2 vs control 2.3, P<.001; 18-month intervention 3.2 vs control 2.8, P<.001). There was no significant difference in pregnancy between groups over the 18-month period (AOR 0.8, 95% CI 0.7-1.1) However, unintended pregnancy was marginally less likely among intervention participants (47% vs 19%) (P=.07). CONCLUSION: Broad implementation of the CHARM2 intervention has the potential to improve contraceptive use, communication, agency, and quality of care and to possibly decrease unplanned pregnancies in rural India.

Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems.

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.

Equity-focused PBIS approach reduces racial inequities in school discipline: A randomized controlled trial.

We assessed the effects of a whole-school equity intervention implemented within a school-wide positive behavioral interventions and supports (PBIS) framework on racial inequities in school discipline in eight elementary schools with inequitable referrals for Black students. The intervention involved assessing patterns of racial disparities in school discipline decisions and providing professional development on adapting school-wide behavior systems to improve cultural responsiveness through concrete strategies targeting the patterns. After consent and matching on existing levels of racial inequities, half of the schools were randomly assigned to receive the intervention. Analyses showed that schools receiving the intervention had significant decreases in racial disparities in school discipline and rates of office discipline referrals (ODRs) for Black students, while control schools had minimal change. Results are discussed in terms of improving equity in school discipline within multitiered systems of support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Student Teaching Equity Project: Exploring Teacher Candidates’ Knowledge, Skills, and Beliefs

A quasi-experimental mixed-methods study was conducted to evaluate the effectiveness of an equity intervention on teacher candidates’ abilities to articulate equity-based beliefs, and demonstrate and apply equity-based skills and knowledge. Three pre/post instruments were utilized. Treatment participants ( N = 35) were exposed to curricular modifications made to the traditional curriculum, including a workshop, panel event, online learning modules, and reflective postconferences. Quantitative findings showed a statistically significant treatment effect for treatment participants compared with candidates in the control group ( N = 83). Qualitative analyses showed that treatment participants articulated more equity-based language when describing their beliefs and intentions for their future classroom communities. Implications for practice and research are provided.

PediCARE: Development of a poverty-targeted intervention for pediatric cancer.

Poverty is associated with inferior psychosocial outcomes, higher rates of relapse, and decreased overall survival in children with cancer. Despite this, there are few evidence-based, poverty-targeted interventions and none specific to pediatric oncology. To address this gap, we developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention, a household material hardship (HMH) targeted intervention providing transportation and groceries to pediatric oncology families. This was a single-arm pilot study conducted at a single, large, tertiary pediatric cancer center. Newly diagnosed patients with HMH-exposure were directly assigned to receive PediCARE for a total of three months. Quantitative and qualitative approaches were used to evaluate its acceptability and to rapidly refine the intervention. Nine families (100% of those approached) consented to enrollment with no attrition over the three-month study period. Families were highly satisfied with the intervention and recommended participation to others. All of the families utilized the grocery delivery component of PediCARE, and seven utilized the transportation component. Qualitative participant feedback was used to rapidly refine the intervention including logistics of intervention delivery, and dose of intervention components. PediCARE, a poverty-targeted intervention, was highly acceptable to pediatric oncology families. The intervention was refined in real-time utilizing quantitative and qualitative feedback. Next steps include intervention evaluation in a randomized, controlled feasibility study.

The Readiness, Resilience and Recovery Tool: An Emerging Approach to Enhance Readiness Amidst Disruption.

Disruptions of varying severity often occur in the course of an organization’s work to implement new programs or projects. These disruptions may slow their progress or even derail the work altogether. Resilient organizations must be prepared to respond in a thoughtful and timely way to disruptions. Readiness, Resilience and Recovery is an adaptable readiness assessment tool that organizations can use to proceed with their work with insight about their readiness status and how their readiness has been impacted by a disruption. The resulting information can then be used to guide the development of solutions for recovery and build the organization’s overall capacity for resilience. Based on our early experience, the Readiness, Resilience and Recovery approach is emerging as a tool that can be useful when organizations face significant disruptions. We have found it to be adaptable to different types of projects, at various points in the implementation cycle, and with multiple types of disruptions. To demonstrate its use, this illustrative paper provides five examples from different projects and settings: Substance Abuse Treatment Services, Multi-Site Sexual Assault Prevention Initiative, Serve and Connect (a Police-Community Relationships Initiative), Carolina Family Engagement Center (family engagement in schools), and Action for Equity (an equity intervention). Practical uses of the tool and conceptualizing it within important implementation science concepts are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43477-021-00011-6.

A gender synchronized family planning intervention for married couples in rural India: study protocol for the CHARM2 cluster randomized controlled trial evaluation

BackgroundPrior research from India demonstrates a need for family planning counseling that engages both women and men, offers complete family planning method mix, and focuses on gender equity and reduces marital sexual violence (MSV) to promote modern contraceptive use. Effectiveness of the three-session (two male-only sessions and one couple session) Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention, which used male health providers to engage and counsel husbands on gender equity and family planning (GE + FP), was demonstrated by increased pill and condom use and a reduction in MSV. However, the intervention had limited reach to women and was therefore unable to expand access to highly effective long acting reversible contraceptives such as the intrauterine device (IUD). We developed a second iteration of the intervention, CHARM2, which retains the three sessions from the original CHARM but adds female provider- delivered counseling to women and offers a broader array of contraceptives including IUDs. This protocol describes the evaluation of CHARM2 in rural Maharashtra.MethodsA two-arm cluster randomized controlled trial will evaluate CHARM2, a gender synchronized GE + FP intervention. Eligible married couples (n = 1200) will be enrolled across 20 clusters in rural Maharashtra, India. Health providers will be gender-matched to deliver two GE + FP sessions to the married couples in parallel, and then a final session will be delivered to the couple together. We will conduct surveys on demographics as well as GE and FP indicators at baseline, 9-month, and 18-month follow-ups with both men and women, and pregnancy tests at each time point from women. In-depth interviews will be conducted with a subsample of couples (n = 50) and providers (n = 20). We will conduct several implementation and monitoring activities for purposes of assuring fidelity to intervention design and quality of implementation, including recruitment and tracking logs, provider evaluation forms, session observation forms, and participant satisfaction surveys.DiscussionWe will complete the recruitment of participants and collection of baseline data by July 2019. Findings from this work will offer important insight for the expansion of the national family planning program and improving quality of care for India and family planning interventions globally.Trial registrationClinicalTrial.gov, NCT03514914.

The "Waze" of Inequity Reduction Frameworks for Organizations: a Scoping Review.

Different conceptual frameworks guide how an organization can change its policies and practices to make care and outcomes more equitable for patients, and how the organization itself can become more equitable. Nonetheless, healthcare organizations often struggle with implementing these frameworks. To assess what guidance frameworks for health equity provide for organizations implementing interventions to make care and outcomes more equitable. Fourteen inequity frameworks from scoping literature review 2000-2017 that provided models for improving disparities in quality of care or outcomes were assessed. We analyzed how frameworks addressed key implementation factors: (1) outer and inner organizational contexts; (2) process of translating and implementing equity interventions throughout organizations; (3) organizational and patient outcomes; and (4) sustainability of change over time. We conducted member check interviews with framework authors to verify our assessments. Frameworks stressed assessing the organization's outer context, such as population served, for tailoring change strategies. Inner context, such as existing organizational culture or readiness for change, was often not addressed. Most frameworks did not provide guidance on translation of equity across multiple organizational departments and levels. Recommended evaluation metrics focused mainly on patient outcomes, leaving organizational measures unassessed. Sustainability was not addressed by most frameworks. Existing equity intervention frameworks often lack specific guidance for implementing organizational change. Future frameworks should assess inner organizational context to guide translation of programs across different organizational departments and levels and provide specific guidelines on institutionalization and sustainability of interventions.