An implementation mapping approach to equitable program delivery: building readiness in community organizations

Community-based, not-for-profit organizations have potential to advance health equity through delivery of health-promoting interventions to underserved populations. However, structural barriers (e.g., limited resources) and contextual nuances often inhibit organizations' ability to adopt, implement, and sustain evidence-based interventions (EBIs). Implementation support systems ('support systems') can address these challenges by providing tailored support to enhance organizational readiness - an essential precursor for high-quality equitable implementation. In this paper, we used a case study approach to identify implementation strategies ('strategies') that a support system uses to build readiness in community organizations to adopt, implement, and sustain a health-promoting EBI for diverse groups of older adults (Choose to Move; CTM).

We used a novel application of implementation mapping to name, define, and operationalize strategies used by the support system. We operationalized each strategy across eight dimensions: actor, action, action target, dose, theoretical justification, mechanism of action, temporality, and implementation outcomes addressed. We aligned strategies to a readiness framework (R=MC²; motivation, innovation-specific capacity, general capacity) and devised an equitable implementation roadmap to build organizational readiness.

We identified 17 strategies enacted by the support system to enhance organizational readiness, particularly motivation and innovation-specific capacity, across a five-stage implementation roadmap: 1. engagement, 2. readiness assessment, 3. feedback and prioritization, 4. preparation, and 5. support during delivery. The 17 strategies aimed to improve adoption, reach, fidelity, and sustainment of CTM.

Our results highlight the critical role of support systems to achieve equitable implementation of EBIs in community organizations. When support systems use tailored strategies to build readiness, they contribute to equitable access to health-promoting EBIs which in turn can prevent widening health inequities. The equitable implementation roadmap offers a practical guide for others working in community health promotion. Future studies that evaluate the selection and effectiveness of strategies that build readiness to achieve equitable implementation and improve health outcomes in diverse groups are needed.