Table 2 Retrospective Application (assessment of ongoing or completed ESI implementation or IR studies)
From: How to leverage implementation research for equity in global health
Key Question* | How to apply | Example of relevant methods |
|---|---|---|
Six key questions: | ||
Implementation context | ||
1. Who is benefiting most from the ESI and implementation strategies (beneficiaries) or carrying most of the burden of the health problem? | a. Review burden of disease and project data. Consider disaggregating magnitude and/or severity of a health problem and benefits of ESI and implementation strategies by relevant equity variables (e.g., ‘PROGRESS’—place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, and disability status). b. Examine the quantity and quality of the ESI and implementation strategies received by different relevant social groups. c. Explore the programmatic experiences (including any implementation problems) of members of different relevant social groups with the ESI and implementation strategies. Highlight the experiences of socially disadvantaged groups relative to the advantaged groups. d. Track and review data on implementation processes. Highlight any differences in the implementation procedure for socially disadvantaged groups compared to the advantaged groups – and whether these differences contribute to any negative experiences with the ESI and implementation strategies reported by the socially disadvantaged groups. | • Secondary data analysis of available quantitative data (including population-based survey, surveillance, administrative, burden of disease data, and health management information system records) • Qualitative methods (including interviews, direct observations, and focus group discussions) • Process documentation • Document review |
2. What is the power differential between implementers and beneficiaries of the ESI and strategies – who is accountable (‘voice and teeth’) to who? Similarly, what is the power differential between researchers and research subjects in IR – who is accountable (‘voice and teeth’) to who? | a. Interrogate processes for decision-making and priority setting, resource administration, and accountability within the project, and compare the influence of key actors in these processes e.g. implementers vs. beneficiaries, socially disadvantaged vs. socially advantaged beneficiaries, researchers vs. research subjects. b. Examine whether beneficiaries or research subjects know and can implement mechanisms for holding implementers or researchers accountable, e.g. boycotting services or withdrawing participation (‘exit’), influencing resource administration. | • Qualitative methods (including interviews, direct observations, and focus group discussions) |
3. Whose ethics, values, and knowledge of evidence and how this is produced (epistemology) guided the description of the health problem and/or decision, selection, and implementation of the ESI? | a. Interrogate whether any participatory approaches were employed in the process for decision-making and priority setting on health problems, selection of the ESI and any implementation strategies, resource administration, and accountability within the project, and compare the influence of key actors in these participatory processes e.g. implementers vs. beneficiaries, socially disadvantaged vs. socially advantaged beneficiaries, researchers vs. research subjects. b. Examine whether local and indigenous knowledge and custom were sought and considered in the decision-making on health problems and causes, ESI/implementation strategies and their supporting evidence. c. Clarify how the local and indigenous knowledge and custom were employed in the implementation. Explore specific leadership, administrative and/or advisory roles of community duty-bearers and members of socially disadvantaged groups in the project implementation. | • Qualitative methods (including interviews, direct observations, and focus group discussions) |
Implementation strategies | ||
4. Were any structural and/or systemic determinants of health addressed in implementation? How? | a. Examine whether any specific implementation strategies were employed to address social injustices and human rights violations within the inner context of implementation (e.g., establishing and enforcing anti-discriminatory policies). [49] b. Examine whether any specific implementation strategies were employed to address pertinent social determinants of health (e.g. provision of subsidized or free access to good quality health services). [72] c. Examine whether any specific implementation strategies were employed to address negative historical antecedents, structural and systemic determinants of health (e.g. training and deploying tools for addressing unconscious bias and discrimination within health systems). [73] | • Process documentation • Document review |
Implementation outcomes | ||
5. Was any evaluation of the implementation project completed? Whose outcomes (implementation and health outcomes) served as the basis for the evaluation or are being monitored (for ongoing implementation)? | a. Examine whether an evaluation was completed for the project, and if any specific implementation outcomes (e.g. acceptability, uptake) were defined from the perspective of socially disadvantaged groups as part of the evaluation. | • Process documentation • Document review |
IR design | ||
6. Was a pragmatic research design used to generate evidence for the implementation to include impact of the design features on implementation outcomes and overall health outcomes for all populations and socially disadvantaged groups? | a. Examine the specific IR design that was used to generate evidence for implementation. b. Explore if any differential impact of the ESI and/or implementation strategies were examined on implementation and health outcomes for socially disadvantaged vs. advantaged groups. | • Process documentation • Document review |