A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities

Implementation Science

Systematic Review

Nicole Rankin¹  Rachel Brown²  Papillon Gustafson³  Yasmin Abdul Aziz³  Sue Crengle³  Michelle Lambert³  Adam Fusheini⁴  Patricia Priest⁴  Peter Carswell⁵  Mihi Ratima⁶  Karen Bartholomew⁷ 

[1] Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;National Hauora Coalition, Auckland, Aotearoa, New Zealand;Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, PO Box 56, Dunedin Campus, 9054, Dunedin, Aotearoa, New Zealand;Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand;Synergia Ltd, Auckland, Aotearoa, New Zealand;Taumata Associates, Hāwera, Aotearoa, New Zealand;Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand;

关键词: Health inequity;    Implementation;    Theories;    Models;    Frameworks;    Ethnic inequities;    Scoping review;   

DOI  :  10.1186/s13012-023-01304-0

 received in 2023-03-06, accepted in 2023-09-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or ‘race’-related health inequities.MethodsA scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated.ResultsDatabase searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a ‘hybrid’ framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation.ConclusionsThis scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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