This toolkit provides guidance on evidence-informed decision making to address health equity issues. Drawing on the results of a Knowledge to Action research project, funded by the Canadian Institutes of Health Research, this resource provides a framework and worksheets that can be used to develop an equity-focused knowledge translation strategy.
The World Health Organization (WHO) defines health equity as "the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically" (WHO 2007, p. 7). As such, health inequities are health differences that are unfair and socially produced. For more equity resources, see NCCDH's Resource Library.
This toolkit provides case examples and worksheets to guide the user in addressing health inequities. There are four major sections:
- Section 1: Knowledge Translation 101 (an overview of knowledge translation)
- Section 2: Getting ready (practical guidance to frame a knowledge translation strategy)
- Section 3: Starting in the right place (a six-step process to plan an equity-focused knowledge translation strategy based on organizational readiness)
- Section 4: Developing a comprehensive strategy (concrete examples of strategies for using evidence to address health inequities)
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Steps for Using Method/Tool
The following steps, which may be used in an iterative manner, provide guidance for using evidence to address health inequities. These steps are outlined in Section Two of the toolkit, with Knowledge Translation phases 1-6 detailed in Section Three.
Step 1: Build a coalition of partners
- Identify stakeholder groups who will be involved.
- Determine the format for working group meetings.
- Select individuals who best represent the persectives of your stakeholder groups, including organizational champions to support your knowledge translation strategy.
Step 2: Determine the current challenge
- Planning your equity-focused knowledge translation strategy is delineated in a six-step process:
Phase 1: Understand and frame the issue
- Determine what is known about the issue.
- Determine barriers to use of evidence.
- Worksheet 2: Framing the Problem
Phase 2: Get an issue on the agenda
- Determine the nature and extent of the problem and its impact in order to get the issue on the policy/planning agenda.
- Worksheet 3: Getting an Issue on the Agenda
Phase 3: Inform a response
- When the issue is already on the agenda, develop a policy/program response to your issue.
- Inerpret evidence in context.
- Identify the specific dimensions of the issue around which decisions will be made.
- Develop a business case for your solution.
- Worksheet 4: Informing the Response
Phase 4: Inform implementation
- Assess evidence to inform how your proposed solution will address the issue through an implementation strategy.
- Monitor and evaluate implementation of your initiative.
- Worksheet 5: Informing Implementation
Phase 5: Change practice
- Engage program managers and staff to gain their support to change practice.
- Assess barriers and motivators to change.
- Ensure the new practice is more efficient and satisfying than the previous practice.
- Worksheet 6: Changing Practice
Phase 6: Maintain support
- Keep the issue on the policy/program agenda.
- Support continual learning and development.
- Identify principles or characteristics associated with success to support transferring initiatives to other contexts (transferability vs. replicability).
- Worksheet 7: Maintaining Support
Step 3: Clarify your intended audience
- Differentiate between stakeholders (interested and affected parties) and knowledge users.
- Understand that intended users will be different at different stages of your KT stage.
- Worksheet 1: Interested and Affected Parties vs. Knowledge Users
After these steps are used to create the plan and set up the intervention, Section Four, "Go," provides concrete examples of strategies to use to put the plan into action and tips for documenting and communicating the implementation process.
Who is involved
Numerous individuals will be involved throughout the planning and implementation of an equity-focused knowledge translation strategy. On pg. 24, examples of different roles involved are provided for two different equity initiatives, a Language Access Initiative and a Language and Ethnicity Indicators Initiative. Worksheet One also helps the user to clarify who is affected by the issue at hand and who is in a position to use the knowledge to create change.
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Method of Development
This toolkit seeks to provide practical guidance to those working to address health inequities. It is based on the results of a research project funded by a Canadian Institutes of Health Research (CIHR) Knowledge-to-Action grant. The research project assessed effective strategies to implement evidence into health care planning and decision making within the Winnipeg Regional Health Authority to address health inequities on five diversity issues. The strategies presented in this toolkit are based on the evaluation of effective strategies for five different projects, though many of the examples presented are from a language access initiative. The five projects are:
- providing trained health interpreter services
- integrating language and ethnicity indicators into an electronic hospital information system
- adopting an organization diversity framework
- developing a coordinated health response for newly arrived immigrants and refugees
- developing a community health assessment report to inform planning for ethno-cultural communities.
School of Public Health, Department of Public Health Sciences
University of Alberta
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Phone: (780) 248-1566
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These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.