Decision tree for improving the impact of equity-focused public health service delivery and research

An equity focus in public health service delivery and research is needed to address persistent health inequities. This requires not only redistribution of health resources and services to prioritised populations, but also attention to the process through which initiatives are selected, designed and implemented, and how these engage with and address the social determinants of health. Applying this in practice can be challenging, and there is limited practical guidance for public health organisations.

We adapted a decision tree to support equity-focused public health service delivery and research, aimed at practitioners and researchers working to support the co-design and implementation of effective and socio-culturally responsive health initiatives for a known priority population within a defined public health focus area (e.g., tobacco cessation, physical activity, cancer screening). This tool was informed by the literature and iterative development with an interdisciplinary team of public health professionals, implementation scientists, and health equity academics.

The Equity-Focused Decision Tree consists of structured decision points and actions across three steps, underpinned by co-creation principles and ongoing local community engagement. Step 1 - Identify or co-design and evaluate an initiative: users integrate empirical and qualitative evidence to a) determine whether any existing initiative is both effective and suitable for the priority population; and b) where none exist, a new initiative is co-designed and evaluated. Step 2 - Assess evidence-practice gaps: users determine whether the initiative is being routinely implemented. Step 3 - Identify implementation strategies: users identify or co-design evidence- and community-informed implementation strategies that are responsive to the community's needs, values, and context.

This decision tree provides a practical tool to guide public health organisations in applying an equity focus across the process of service delivery and research. It has the potential to advance equity by improving health outcomes for the priority population, and by contributing towards addressing the social determinants of health that underpin persistent health inequities.