Our Research
Purpose
In Aotearoa New Zealand there are persisting inequities in the health of Māori and Pacific peoples when compared with people of other ethnic groups. Systemic factors, such as the slow implementation and uptake of interventions known to improve health, contribute to this. Māori and Pacific peoples are less likely to receive such interventions than other groups within the population.
This project aimed to create and test tools that will support the health system to deliver equitable health outcomes by ensuring that the implementation of interventions is designed and undertaken in such a way that equitable outcomes are achieved.
Funding
This research with funded by the National Science Challenges (Healthier Lives). The research began in 2021, and concluded in 2024.
The Research Approach
The research was undertaken in two stages:
In Stage 1 (July 2020 – April 2021), factors relating to the implementation of health interventions, which either facilitate or impede equitable health outcomes, were identified through literature reviews and stakeholder interviews. Tools to guide the implementation of equity-enhancing health interventions – an equity-focused implementation science framework and an equity readiness assessment tool – were created through a co-design process with community members and end-users.
In Stage 2 (May 2021 – June 2024), the tools developed in Stage 1 were trialled, evaluated and refined during the implementation of a lung cancer screening intervention at Waitematā, Auckland, Counties Manukau and Northland districts of Te Whatu Ora. Resource materials were then produced to support the use of the tools.
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Researchers across four collaborating organisations
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In-depth interviews across forty organisations
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Papers full-text reviewed for the scoping review
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People involved in the process of testing and refining the framework
How we developed the FrEEIA tools
The Framework for Effective and Equitable Implementation in Aotearoa (FrEEIA) provides for guidance to facilitate equitable implementation of health and social service interventions. It supports organisations and individuals to reflect on factors influencing implementation and to then develop strategies to remove any barriers to implementation, particularly those that might result in inequitable implementation.
There are two components to the FrEEIA tool kit. One is the framework itself. More detail about this can be found in our publication (CLICK HERE) and on the FrEEIA Framework page in this website. The other component is the FrEEIA Readiness Assessment Tool. To improve equitable implementation the intent is BOTH are used. The Framework guides users through the implementation process, with the FrEEIA Readiness Assessment Tool providing valuable information on where your organisation/service current is on key enablers for equitable implementation.
We followed a robust approach in developing the the readiness assessment tool: The stages included:
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Interviews with key stakeholders to explore barriers and facilitators impacting the implementation of interventions to improve health equity. Qualitative data obtained though these interviews ultimately identified fifteen themes clustered within four domains.
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A review of existing equity readiness assessment tools. This review identified six equity readiness assessment tools and six change readiness tools, which were mapped against domains that the tools collectively measure.
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A researcher workshop to develop key domains for the FrEEIA Readiness Assessment Tool. This workshop identified fourteen domains of measurement for the FrEEIA Readiness Assessment Tool, based on material obtained through interviews and the review of existing tools.
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A review of the evidence in the use and design of self-assessment tools. This review identified a number of best practice design principles aimed at getting people using the tool and increasing the likelihood of follow-on actions. It also elicited recommendations for the use of the tool – these are included in the next section of these guidelines ‘Using the FrEEIA Readiness Assessment Tool’.
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The development of the FrEEIA Readiness Assessment Tool, based on ‘The Readiness Thinking Tool®’ (Wandersman Center). The first draft of the FrEEIA Readiness Assessment Tool included items within each of the 14 domains identified during the researcher workshop. This was tested with a range of stakeholders and an iterative process of further drafts resulted in a ‘final’ version for field testing.
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Field testing of the FrEEIA Readiness Assessment Tool. The FrEEIA Readiness Assessment Tool was tested with a selection of teams involved in lung cancer screening research and other equity focussed interventions. Feedback was collected though a survey, interviews and observations. This was used to inform changes to the FrEEIA Readiness Assessment Tool and the development of the Facilitator Guide.
FrEEIA Publications and Presentations
Click on the title below to view
