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Stakeholders from all organizational levels should be included in implementation planning and special attention should be giving to ensure that equity focused stakeholders are involved. This may include front-line staff, managers, department leads as well as clients, patients, or community members. Meaningful involvement of partners representing vulnerable populations should be emphasized. These partners are likely to experience both internal and external barriers to participation in the implementations process, as such there should be flexibility in the ways they can engage. In this stage a plan should be developed to establish how the stakeholders and other partners will be involved throughout the implementation project. At this stage, roles should be clearly established and agreed upon at the outset of the project, including a plan for involvement at each stage - not just the beginning and end!<\/p>\n\n

Ask Yourself:<\/strong><\/p>\n\n

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Who are the stakeholders related to health problems among vulnerable populations in my setting?<\/li>\n\t
Have I developed community partnerships and relationships with vulnerable groups in my setting that might encourage them to participate in the implementation process?<\/li>\n\t
What are stakeholder and partner preferences for how they are involved during different stages of the implementation process?<\/li>\n\t
Have I considered ways to ensure that stakeholders and partners are adequately compensated for their time and contributions?<\/li>\n\t
Are stakeholder priorities aligned with or at odds with implementation? How might I address this?<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"e51bac60-c2ba-4aef-899d-264673be1a61","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"1. Identify stakeholders and establish roles for partners."},{"content":{"params":{"text":"
When possible interventions should be created with stakeholders and community groups, co-creation with these partners will help ensure that interventions are closely aligned with community needs, available resources, and local context, while reducing the need for later adaptation. When identifying an appropriate intervention consider the strength of the evidence for effectiveness, including strength of the evidence for implementation in diverse populations and settings. Interventions with demonstrated effectiveness are reducing health disparities should be prioritized and low-value interventions should be terminated. It may be necessary to conduct pre-implementation research regarding certain interventions - external validity of some interventions regarding vulnerable populations may be unclear due to their lack of inclusion in clinical studies. At this stage, trusted messengers for vulnerable populations should also be identified and involved in building trust and support around an intervention. <\/p>\n\n
Ask Yourself:<\/strong><\/p>\n\n
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Is the health problem I want to address a priority to people in this community?<\/li>\n\t
Does the intervention I've considered have evidence to support strong potential to improve health outcomes in my setting? (Consider the specific vulnerable groups you are working with).<\/li>\n\t
Are there existing interventions that cause little to no benefit to this community?<\/li>\n\t
Who are my trusted messengers for vulnerable populations? Have we built these relationships?<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"c38caf09-66ac-4f8e-930c-73a88f334c21","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"2. Consider equity when determining the interventions that should be implemented or terminated."},{"content":{"params":{"text":"
Address the gap between the performance and outcome. The performance gap is the difference between current uptake and ideal uptake of a program, while the outcome gap is the difference between current and expected outcomes. Assessing these gaps among vulnerable populations will help determine how much potential there is to reduce health disparities through improved access to or uptake of an intervention. This stage should occur concurrently with stage two, gaps should be discussed with stakeholders and partners to inform selection of an intervention.<\/p>\n\n
Ask Yourself:<\/strong><\/p>\n\n
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Do performance and outcome gaps differ across populations and settings?<\/li>\n\t
What do the gaps tell me about potential to reduce health disparities related to quality outcomes (effectiveness, efficiency, patient-centeredness, safety, timeliness)?<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"7ab4c5dd-2248-476e-9dfe-c27b2e708f0b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"3. Evaluate the performance gap of the intervention within vulnerable populations."},{"content":{"params":{"text":"
Vulnerable populations experience unique barriers to care at the individual, community, and health systems levels. These barriers differ across settings and require you to do formative research involving those with relevant lived experiences, as well as stakeholders and partners. The purpose of the formative research is to identify the context-specific barriers to accessing or receiving an intervention that are the most important to target in the implementation project. This process should include assessing how historical and structural racism and power dynamics have and may continue to influence the implementation context. Multi-level implementation strategies to address identified barriers should be designed with stakeholders and partners. Implementation strategies that are shown to be effective at reducing inequities in health should be prioritized in the design process and modified to suit the needs of the vulnerable populations in your setting. Strategies should also be person- and community-centered in order to minimize barriers to access. At this stage, stakeholders should be involved in defining indicators for evaluation to ensure that outcomes being assessed are meaningful to the vulnerable populations in your setting. <\/p>\n\n
Ask Yourself:<\/strong><\/p>\n\n
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Have you discussed the social determinants of health among vulnerable populations in your setting\/context (including historical and structural racism and power dynamics) with stakeholders to understand their importance and potential impact on the health problem, intervention and implementation strategies being considered?<\/li>\n\t
What implementation strategies may overcome key barriers\u2014including social determinants of health\u2014and optimize reach among vulnerable populations in your setting? <\/li>\n\t
What evaluation measures will allow you to ensure that your implementation strategies are improving (not worsening) health disparities among vulnerable populations in your setting\/context? Are theses measures meaningful to stakeholders and partners? <\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"06a6abd5-1a0f-451e-af62-8d684561392a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"4. Prioritize barriers faced by vulnerable populations \u2014 including structural racism and power dynamics."}],"hTag":"h2"}

Pre-Implementation Planning for Health Equity

Lidia Mateus