Equitable implementation: Weaving equity into selecting change strategies

By Dr. Sobia Khan - Director of Implementation, The Center for Implementation

Equity is top of mind for many in the fields of implementation science and practice. Recently, people have been asking us how we would suggest they go beyond performative acts that address equity and the surface level and what are some concrete ways to weave equity into the fabric of what they do. To us, equity is a process and an outcome — it’s about what we do in our actions and relationships and how we aim to change systems and mental models that can help us achieve those equitable outcomes we seek — and, ultimately, to go beyond equity to seek justice.

Ever since we launched TCI in 2018, our mission has been to accelerate the application of implementation science to improve outcomes. Driven by this mission, our goal is to see hundreds of thousands of people around the world actively applying implementation science to design, implement, spread, and scale their change initiatives. To achieve this goal, we are dedicated to providing accessible resources and tools that makes implementation easier for changemakers globally. ?

Selecting and operationalizing change strategies with equity in mind

Let’s deep dive into how we can weave equity into one implementation step — selecting change strategies — to illustrate what we mean. The purpose of selecting change strategies is to support people to do something different to their behavior, practice, etc. so that the ‘thing’ you are implementing can be implemented well. From an outcomes perspective, we want to measure whether people engage in the change strategies equitably in order to achieve equity in the intended outcomes. So how do we achieve this outcome?

This all comes down to process. In order to ensure that people are equitably engaging in the change strategies, they have to be designed with equity in mind. Therefore, they have to be selected and operationalized in such a way that different people who have different needs and challenges will still be able to engage in them. Are the barriers and facilitators different for different groups? Are strategies selected and designed to address these different barriers and facilitators? Think about considerations related to people’s work schedules, their accessibility needs, cultural competency, and the nature of the communities in which they live and work — these and many other factors can impact whether change strategies are designed in such a way that meets people’s needs.

Strengthening engagement as part of equitable implementation planning

But going even deeper than that, the whole process of selecting and designing strategies should be equitable. In equitable implementation, the people who are affected most by implementation would have a say in what strategies are optimal for them; which are most feasible, acceptable, and safe; and which would most likely address their needs.

This means we would have to embed inclusiveness and co-design throughout the whole process of selecting and designing change strategies, and not just in ways that tick off boxes to say, “We consulted with different groups,” but in ways that the people most impacted by the change would want to be meaningfully involved. Throughout the whole process, from assessing barriers and facilitators to aligning these with options for change strategies to designing and enacting strategies, we can be inclusive in our approaches in ways that promote fairness and mitigate power dynamics. People who are affected the most by change know best about how they might experience change strategies and, therefore, should be driving decisions on which ones would be most suitable for them and which would help them access and use the strategies more equitably.

Dismantling hierarchies and dominant cultures to achieve equity and justice

Equity is difficult for many because it means that we have to dismantle hierarchies and dominant cultures that we are so used to in spaces that we work and live in. For example, determining who gets to make decisions in implementation if they are not considered a traditional ‘expert’ is difficult for many because they have been taught that a person who studies the theories of change in a community is more of an expert than the person who experiences change within a community.

But these changes to our systems and mental models need to occur in order to change processes of implementation and ultimately to achieve different kinds of outcomes – more equitable outcomes. What we’ve done before is obviously not working for everyone, and therefore we have to forge a new path forward to create the equity and justice that we are all striving to seek.

Have you decided on a solution to implement but are having difficulty selecting change strategies because of the complexity of your solution and system? Our course?Embracing Complexity?is now open for enrollment until July 18!

Note: An earlier version of this article originally appeared in the October 2022 issue of our?Implementation in Action?bulletin.?Subscribe here to receive our next issue.