This is the second of a series of blog posts that chronicle the implementation of core components of a health equity workplan that was created by NACCHO (National Association of County & City Health Officials) and a Colorado-based consulting firm called HEART (Health Equity and Action Research Tools & Training for Transformation). The core components of a health equity workplan are listed in Figure 1 below.
In Michigan, The Michigan Overdose Data to Action (MODA) program is endeavoring to use these core components to evaluate our quick response teams (QRTs). Accordingly, MODA is integrating these components into its QRT evaluation profiles. Over the course of FY22 and FY23, MODA will implement one core component per quarter. (Note: We had initially intended to introduce two components per quarter, but it has become evident that this would overwhelm our contractors.) The program has already implemented the Root Cause Analysis and Equity Review component. During the second quarter of FY22, the program will be implementing the Plan for Adaptation component. Last month’s blog post introduced the Root Cause Analysis and Equity Review component. This month’s blog post introduces the Plan for Adaptations component.
Implementation Science
Implementation is the act of creating change with strategic intention. Implementation science is the study of how to implement well. In my December blog post, I mentioned that the overdose epidemic, like many public health issues, is a complex (AKA wicked) social problem. I also mentioned that such wicked social problems stem from values that are fluid, and from purposes that are unstable and pluralistic, and require a multidisciplinary approach to make sense of them.
Accordingly, wicked social problems like the overdose epidemic require interventions that are implemented well. This is especially true when you consider that public health issues are driven by social determinants of health and are rooted in structural health inequities such as racism, sexism, and classism. It should not be surprising, then, that the NACCHO prioritizes key areas of implementation science in its health equity workplan.
There are three key areas of implementation science represented in the core components of the health equity workplan:
- Being proactive about adaptations (represented by the Plan for Adaptations component, discussed in this blog post)
- Selecting change strategies that actually target barriers to change (represented by the Barriers & Facilitators Assessment component, to be discussed in a later blog post)
- Sustainability planning (represented by the Plan for Sustainability component, to be discussed in a later blog post)
Plan for Adaptations
Adaptation involves changes to an activity during implementation so that it better fits the needs of a particular population and context. These changes may be additions, deletions, and/or substitutions to the activity. During a root cause analysis and/or an equity review (discussed in last month’s blog post), it may become evident that the activity needs to be adapted to address the root cause of the problem more effectively, or to address the health inequities acting as barriers to the full implementation of the activity.
Planning for adaptations can be done using a tool called the Map2Adapt tool1. (See Figure 3 below.) This tool can be used to proactively plan for adaptations rather than resort to reactive adaptations. Using this tool, planning for adaptations can be broken down into a two-phase process: (1) exploring fit and (2) designing adaptations. For the MODA program, we will be using this tool to reinforce the fidelity element of the QRT evaluation profile.
To explore fit means to consider proposed adaptations and determine whether they can be successfully integrated into the activity. This involves looking at all the components of the original activity (a logic model is useful for this step), creating adaptation objectives, and involving stakeholders to determine whether those objectives fit with the original objectives of the activity.
To design adaptations means to determine exactly how to meet those adaptation objectives while maintaining fidelity to the original activity. This includes articulating the proposed changes, selecting adaptation strategies, and determining potential impact. This second phase of the process is likely to alter the activity’s logic model, especially the sub-activities on the left side of the logic model and the short-term outcomes on the right side of the logic model.
Key to the successful integration of adaptations is using the results of the Root Cause Analysis and Equity Review to develop proposed adaptations that are more likely to effectively address root causes and health inequities. Using the components of the health equity workplan in this manner is a good example of developmental evaluation, which is an evaluation approach that can assist social innovators develop social change initiatives in complex or uncertain environments.
I’ll be helping our MODA QRT contractors during the next set of quarterly meetings to use the Map2Adapt tool plan. I’ll let you know how it goes. In the meantime, I encourage you to jump in the conversation with any questions or comments you have about evaluating OD2A-funded activities through a health equity lens.
1) Moore, J.E., Bustos, T., & Khan, S. (2021). Map2Adapt: A practical roadmap to guide decision-making and planning for adaptations. The Center for Implementation. https://thecenterforimplementation.com/map2adapt
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