Methods to design, adapt and apply equity-focused implementation science theories, models and frameworks in healthcare systems: a scoping review

BACKGROUND: Implementation science has a key role to play in reducing health inequities within healthcare systems. In recent years, the number of health equity-focused implementation science theories, models, and frameworks (TMFs) has increased. However, the methods used to design and adapt TMFs are not well understood. Exploring these methods will help us understand how health equity is considered in implementation science TMFs and inform future adaptations and applications in real-world, healthcare system contexts. The purpose of this review is to explore the methods used to design, adapt, and apply health equity-focused implementation science TMFs. METHODS: This scoping review followed Arksey & O'Malley (2006) and Levac, Colquhoun & O'Brien's (2010) revised scoping review methodology. We updated the search of a recent scoping review published by Gustafson et al. in 2023. We searched CINAHL and MEDLINE for articles published from April 2022 to November 13, 2024. Eligibility included articles which described or applied an implementation science TMF that explicitly incorporated health equity. Two independent reviewers screened the titles, abstracts and full texts of the included articles. Two independent reviewers extracted data. We used a narrative synthesis to report our findings. RESULTS: This review identified 40 articles, 11 from the review by Gustafson et al. and 29 papers from our updated search. 34 articles provided a detailed description of the methods they used; 6 articles did not. Methods included evidence synthesis (e.g., scoping review, integrative review) consensus (e.g., modified Delphi, Indigenous consensus, nominal group technique), community engagement (e.g., partnerships, workshops), and qualitative analysis. Articles also reported using multiple methods. Equity considerations included social (e.g. race, ethnicity, gender) and structural determinants of health (e.g. power, policies). Articles reported novel (n = 12), applied (n = 9), adapted (n = 9), adapted and applied (n = 5), and novel and applied (n = 5) equity-focused TMFs. CONCLUSIONS: This scoping review explored the methods for developing and using equity-focused implementation science TMFs. There was a focus on who is invited to the table and tensions between expert (consensus) and experiential (community engagement) knowledge. Our findings suggest that the methods to design and adapt TMFs should be tailored to communities' ways of knowing and doing, and consider the health equity factors relevant to their lived experiences. These results can inform future equity-focused TMFs to reduce health inequities.