Advancing Health Justice through Equity-Focused Implementation: Strategies to Examine Power and Create More Equitable Processes

Implementation Science (IS) has begun to examine how the field can more intentionally promote health equity through, for example, centering communities experiencing health inequity in IS research and strengthening the science of adaptation. In social work, scholars have argued the importance of integrating IS into social work research to ultimately bridge the gap between research and practice, leading to more equitable, accessible research. However, lacking is a practical conceptual framework to analyze how power is generated and distributed through practical implementation processes and how this power can dismantle and/or reproduce health inequity through intervention implementation. The co-presenters have developed an equity-based framework using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al. 2011). In their framework, authors identify three technologies of power working through implementation; 1) discursive power is enacted through defining health related problem to be targeted by intervention implementation, as well as through health narratives that emerge through implementation; 2) epistemic power influences whose knowledge is valued in decision-making and is recreated through knowledge generation; and 3) material power is created through resource distribution and patterns of access to health resources and acquisition of health benefits provided by the intervention. Decisions across all phases and related to all factors of EPIS influence how these forms of power work through intervention implementation and ultimately affect health equity outcomes.

Despite the availability of such frameworks, they remain challenging to apply in real world contexts. In this workshop, therefore, the co-presenters will first discuss the current state of research on IS and equity. They will then use their own work implementing a large, multi-state HIV capacity building initiative as a case study in application of equity-centered implementation to advance health justice through identifying specific technologies of power which work through implementation. Finally, co-presenters will facilitate attendees’ analysis of power in their own implementation projects using a set of guiding critical questions to spur reflection and generate action strategies. Participants will leave with concrete skills and strategies to leverage the tools of implementation science to promote health equity across varied contexts.