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

Abstract

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-026-00910-5.

Contributions to the literature.

• This scoping review explores the methods used to design, adapt, and apply health equity-focused implementation science TMFs. Researchers and practitioners used evidence synthesis, consensus and community engagement when designing or adapting TMFs.

• TMFs should be tailored to communities' ways of knowing and doing (e.g., Indigenous consensus methods), and consider the specific health equity factors relevant to their lived experiences.

• Future research should measure health equity outcomes to understand the impacts of these frameworks and interventions on the determinants of health.

Background

Health inequities are the unjust and avoidable differences in health between groups of people, based on social determinants such as race, age, gender, income, and access to healthcare [1–4]. Commonly reported health inequities include poorer health outcomes of women, people living with low socioeconomic status, and Indigenous communities [5, 6]. Inequities can be derived from environmental and structural factors, such as governance, policy, laws, and the distribution of resources that favour certain populations over others [7]. These inequities are also costly, with racial, ethnic and educational inequities contributing to an estimated $421 billion USD in health care costs, loss of productivity, and years of life lost [8].

Implementation science (IS), the study of how evidence is integrated into practice, is well-positioned to improve health equity in healthcare systems [9]. Firstly, IS uses theories, models, and frameworks (TMFs) to examine the processes, barriers, and facilitators for implementing interventions.For example, the Consolidated Framework for Implementation Research (CFIR) contains five domains: the intervention, individual, inner setting, outer setting and process. Frameworks such as these allow researchers to understand the factors which generate and perpetuate inequities in healthcare, including system-level factors. Examining system-level factors is important to shift the focus from individual responsibility to root-level causes, targeting the underlying structures and power dynamics of inequities [10]. Second, IS emphasizes tailoring interventions to meet the needs of communities. IS could be used to design and adapt healthcare interventions for communities that experience historical and systemic racism within the healthcare system. Lastly, IS can be used to generate metrics for quantifying and monitoring disparities. Health service acceptability, feasibility, and appropriateness can serve as measurable indicators of the impact of the implementation of evidence-based interventions on health disparities [11]. Recent recommendations to improve health equity outcomes using IS include incorporating health equity in the TMFs applied to study these interventions and engaging people with lived experience and practitioners early in the implementation process [12].

There is increasing attention to the need for and benefits of including the expertise of those with lived experience, who have historically been left out of scientific practice. Implementation scientists have begun integrating participatory approaches in their research [13, 14]. However, the depth of application of these approaches, such as integrated knowledge translation (iKT), in practice varies [15]. Engagement of communities experiencing health inequities is recognized as essential to support bidirectional knowledge sharing. Ultimately, this engagement can build community trust in and control over the design, implementation, and sustainment of relevant evidence-based interventions, and drive transformation within the healthcare system to address harmful practices and policies [13].

Interest in mobilizing IS to advance health equity in healthcare systems has grown in recent years. Consequently, health equity-focused IS TMFs have increased [16]. TMFs inform the determinants, processes, and lenses through which interventions are studied and evaluated [12]. Commonly used TMFs include the CFIR and the Theoretical Domains Framework (TDF) [17]. A recent scoping review by Gustafson et al. [16, 18] identified 15 equity-focused IS TMFs published from 2011 to 2022. The equity focus of TMFs was considered explicit if TMFs included health equity in a stated aim or within a construct of the model. For example, a study by Woodward et al. [19] utilized the Integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework to create the Health Equity Implementation Framework (HEIF), a model that considers equity characteristics at the micro (e.g., patient/provider factors), meso (e.g., inner and outer context) and macro levels (e.g., societal influence). Health equity was considered in the domains of the HEIF model. Other studies adapted existing frameworks (e.g., Reach, Effectiveness, Adoption, Implementation, and Maintenance: RE-AIM) to incorporate health equity into the intervention design, implementation and evaluation. For example, Glasgow et al. [20] explored the additional barriers to the Be Fit Be Well weight loss intervention for at risk populations. The researchers considered equity components such as access to the Internet and transportation when designing the intervention. Equity-focused frameworks have been used to study a variety of determinants and health topics, such as developing a framework for tobacco cessation amongst Indigenous pregnant women in Australia [21] and examining barriers and facilitators of hepatitis C virus treatment in Black veterans [22].

There are calls for IS to pay closer attention to how health equity is integrated into research. Shelton et al. argue that it is essential for IS research to demonstrate how equity is foundational in the research question, the structuring of methods, and the TMFs used [23]. TMFs developed without equity considerations could further perpetuate inequities in healthcare systems, leading to systems that benefit certain populations over others. Koh et al. argue that to reduce disparities, researchers must collaborate with partners, track progress by monitoring equity outcomes, and engage early and often throughout the research process [24]. Methods such as participatory action research or community-based research incorporate community voice into the research process and are recognized for their focus on social action [25–27]. Although the number of health equity-focused TMFs has increased, what remains unknown are the methods used to design or adapt TMFs to incorporate health equity [28]. Understanding how TMFs are designed, adapted, and applied could shed light on how power dynamics in IS research-health system-community partnerships are addressed throughout the research process.

This scoping review explores the methods used to design, adapt and apply health equity-focused IS TMFs. Exploring how health equity is incorporated into IS TMFs could inform future adaptations and refinements of other TMFs within healthcare systems. It could also help us understand how to apply a health equity lens in our implementation practice in real-world settings, addressing healthcare system gaps in practice [29]. This review maps the IS literature describing how researchers and practitioners designed TMFs to incorporate health equity. This review also explores different aspects of health equity (e.g., race, ethnicity, gender) incorporated into TMFs.

Methods

This scoping review followed the Arksey & O’Malley [30] and Levac, Colquhoun & O’Brien [31] scoping review methodology. The framework includes five stages: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarizing and reporting the results. Step 6 (incorporating consultation with key partners) will be reported in future work.

• Step 1: Identifying the research question

In light of the growing interest in using equity-focused IS TMFs we developed the following question: How are equity-focused IS TMFs designed, adapted and applied to incorporate health equity within the healthcare system context? Equity was defined in line with the World Health Organization as “unjust or unfair differences in health status based on social, economic, demographic or geographical dimensions of inequality (e.g. sex, gender, ethnicity, disability or sexual orientation)” [32].

• Step 2: Identifying relevant studies

Studies were identified through 1) electronic databases; 2) reference lists; and 3) existing networks. First, we updated the search strategy of the scoping review by Gustafson et al., [16], exploring equity-focused IS TMFs and information specialist LB reran Gustafson et al.'s search to retrieve articles published between April 1, 2022, and November 13, 2024. The search was executed in MEDLINE All (Ovid) and CINAHL with Full Text (EBSCO). The full search strategy in both databases is reported in Supplemental File 1. Second, one author (LJK) searched the reference lists of articles included in the scoping review. Third, we identified articles through websites, newsletters and discussions with existing IS networks (e.g. KT Canada and the Center for Implementation Science).

• Step 3: Study selection

Studies were eligible for inclusion if they: a) described an equity-focused IS TMF that explicitly incorporated health equity or applied an IS TMF that explicitly incorporated health equity; b) were published in a peer-reviewed journal; c) were written in English; d) were situated within a healthcare system context. Commentaries and discussion papers that did not describe an equity-focused TMF were excluded. Articles describing equity frameworks adopted by governments, case studies, and expert opinion pieces were deemed not eligible. We considered that the TMF was explicit if equity was mentioned in the TMF either as a stated aim or within the TMF as a construct [16].

Two reviewers from the authorship team (LJK, MG, ADP, and AH) were paired and independently screened each title and abstract and full text according to a screening tool. The team met regularly to discuss adjustments to the inclusion and exclusion criteria. When consensus could not be reached, a third researcher (GM) was consulted. All screening and extraction took place in Covidence. A list of sources excluded following full-text review with primary reasons for exclusion can be found in Supplemental File 2.

• Step 4: Charting the data

LJK developed the data extraction form (Supplemental File 3). Authors LJK, MG, ADP and AH pilot-tested and refined the extraction tool. Two authors extracted data including author, year of study, country of study, the definition of health equity or inequity and the source of the definition, theory, name of the TMF, intervention being tested, type of TMF (process, determinant, evaluation, hybrid) [17], methods/process for adapting the TMF, health equity considerations, and any noted strengths or limitations of the proposed TMF. A TMF was considered hybrid if it included elements of more than one type of TMF (process, determinant or evaluation) [16, 17].

• Step 5: Collating, summarizing and reporting the results.

We categorized TMFs based on the type of operationalization, including novel, adapted or applied. By operationalization we mean how the model was developed or used. Novel operationalization meant that the authors produced a new equity-focused TMF. Adapted operationalization meant equity was added to a TMF (e.g. added as a determinant). Applied operationalization meant the TMF was utilized for data collection or analysis.

Our findings are reported using narrative synthesis. Narrative syntheses use words and text to summarize and explain findings [33, 34]. We use a narrative synthesis to explore the patterns between the methods used throughout the studies to understand how TMFs are designed, adapted, and applied. Our results report on the equity-focused TMFs, group processes, contexts, and health equity considerations.

Results

Since the Gustafson et al. review, the updated search for this paper resulted in 654 new articles, 48 of which were removed as duplicates. 606 articles were screened for title and abstract. 84 were assessed for full-text review. 44 articles were excluded. Reasons for exclusion included: wrong intervention (not an equity-focused TMF), wrong outcomes (equity is discussed but there are no IS-related outcomes), wrong population (e.g., schools), and wrong study design (e.g., protocol). A total of 40 articles were extracted (28 from the updated search, 11 from the previous scoping review, and 1 from citation searching). See Fig. 1 for the PRISMA diagram.

Fig. 1.

PRISMA diagram

We organized articles according to the categories of TMFs described by Nilsen [17] and the way in which the TMF was operationalized in the study. Figure 2 shows a breakdown of the distribution of articles according to type of operationalization and type of TMF. Table 1 shows cross-tabulation with counts of operationalization by type of TMF. Each TMF was counted once.

Fig. 2.

Breakdown of the distribution of articles

Table 1.

Summary of TMF type and their operationalization

Type of TMF	Type of Operationalization										TOTAL
	Applied		Adapted		Novel		Applied and Adapted		Novel and Applied
	%	n	%	n	%	n	%	n	%	n
Determinant	55.5	5	33.3	3	8.3	1	80.0	4	20.0	1	14
Evaluation	0	0	11.1	1	0	0	20.0	1	20.0	1	3
Process	44.4	4	44.4	4	75.0	9	0	0	40.0	2	19
Theory	0	0	0	0	8.3	1	0	0	0	0	1
Hybrid – Determinant and Evaluation	0	0	11.1	1	0	0	0	0	20.0	1	2
Hybrid – Process and Evaluation	0	0	0	0	8.3	1	0	0	0	0	1
TOTAL	100	9	100	9	100	12	100	5	100	5	40

Operationalization of TMFs

Of the 40 articles, ​​12 (30.0%) presented a novel TMF [19, 35–45]; 9 (22.5%) articles applied an existing equity-focused TMF [46–54]; 9 (22.5%) adapted an existing TMF [55–63]; 5 (12.5%) articles adapted and applied a TMF [64–68]; and 5 (12.5%) articles presented and applied a novel TMF [69–73].

In the case of articles presenting novel equity-focused TMFs, several (n = 6; 15.0%) reported using ecological models, particularly the socio-ecological model (SEM) to guide TMF development [37, 39, 41, 44, 45, 70]. CFIR was the most frequently adapted TMF (n = 5; 12.5%) [54, 61, 65–67]. The CFIR was commonly adapted to incorporate the HEIF domains of clinical encounter, culturally relevant factors and societal context. (n = 3; 7.5%) [65–67]. Other commonly adapted TMFs include the Exploration, Preparation, Implementation, Sustainment (EPIS) (n = 2; 5.0%) [59, 60], the Equity-focused Implementation Research (EquIR) (n = 2; 5.0%) [62, 63], and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) (n = 2; 5.0%) [58, 64]. The HEIF was the most frequently applied TMF (n = 4; 10.0%) [48, 50–53], followed by the EquIR (n = 2; 5.0%) [47, 49].

Type of TMFs

When articles were categorized according to type of TMF, this resulted in 19 (47.5%) process models, 14 (35.0%) determinant frameworks, 3 (7.5%) hybrid TMFs, 3 (7.5%) evaluation frameworks, and 1 (2.5%) theory. The HEIF (n = 8; 20.0%) [48, 50, 51, 53, 63, 65–67] and CFIR (n = 9; 22.5%) [41, 42, 44, 56, 61, 63, 65–67] were the most frequently applied determinant frameworks. The EquIR framework was the most frequently applied process framework (n = 4; 10.0%) [47, 49, 62, 63]. The characteristics of each article are detailed in Table 2.

Table 2.

Study characteristics, including type of TMFs, type of operationalization, TMFs used, and equity considerations

Author(s), Year	Country of study	Type of Operation-alization	Name of novel or adapted TMFs	Purpose of article	TMFs used	Equity considerations
Aschbrenner et al. [46]	United States	Applied		To examine how health equity was operationalized and addressed at Federally Qualified Health Centers in an implementation science partnership network	The Framework for Advancing Health Equity	• Organization level change • Medically underserved populations
*Baumann & Cabassa [55]	United States	Adapted	Adaptation of Procter et al. Implementation Model	To develop an equity lens that helps integrate the fields of implementation science and research to address inequities in healthcare delivery	Proctor et al. (2010) Implementation Model	• Historically underserved communities • Implementation outcomes
Bowen et al., [67]	United States	Applied Adapted	Integration of HEIF Domains into Expanded CFIR	To assess community-based organizations' preferences for breast and ovarian cancer risk screening tools and the barriers/facilitators for implementation	Expanded CFIR from Senier et al.,(2019), HEIF	• Latinx populations • Gender • Same as Woodward et al
Dickson et al., [66]	United States	Applied Adapted	Adaptation of CFIR with HEIF	To apply Implementation Mapping to inform the selection and testing of implementation strategies to improve implementation of two behavioral health programs in a Care Coordination Program at a partnered Federally Qualified Health Centers	CFIR, HEIF	• Hispanic and Latinx communities • Same as Woodward et al
Etherington et al., [57]	Canada	Adapted	Adaptation of TDF Using an Intersectionality Lens	To develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers	TDF, Intersectionality	• Intersectionality • Power
Hoskins et al., [48]	United States	Applied		To provide equity-oriented recommendations to launch a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy	HEIF	• Medical complexity • Race and ethnicity • Sex • Same as Woodward et al
*Maar et al., [72]	Canada and Tanzania	Novel Applied	Intervention and Research Readiness Engagement and Assessment of Community Health Care (I-RREACH) Tool	To develop a tool to guide dialogue between researchers and communities on key aspects of researcher, community, system functionality and readiness for complex interventions in low-resource environments	Practice-based Knowledge, Community Readiness Assessment	• Low to middle-income countries or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Indigenous people
Norman et al., [50]	United States	Applied		To describe provider and community member experiences with health care access and telehealth, identifying barriers and facilitators using a health equity lens	HEIF	• Access to health services for low-income and historically marginalized communities • Same as Woodward et al
Ramadurai & Shea [51]	United States	Applied		To propose a 360-degree learner assessment to ensure successful implementation of the HEIF in medical education	HEIF	• Healthcare provider education level • Same as Woodward et al • Socio-political forces
Singh et al., [65]	United States	Applied Adapted	Adaptation of CFIR with HEIF	To examine providers’ barriers and facilitators to providing LGBTQ + affirming care and LGBTQ + veterans’ barriers and facilitators to receiving LGBTQ + affirming care	CFIR, HEIF	• LGBTQ + populations • Same as Woodward et al
Wolfe et al., [68]	United States	Applied Adapted	Adaptation of the National Institute of Health’s Sexual and Gender Minority Health Disparities Research Framework	To provide a qualitative summary of barriers and facilitators to gender-affirming hormone therapy at the individual (e.g., knowledge, coping mechanisms), interpersonal (e.g., interactions with other individuals or groups), and structural (e.g., gender norms, policies) levels	National Institute of Health’s Sexual and Gender Minority Health Disparities Research Framework (version of SEM)	• Transgender and gender diverse populations • Multiple levels of influence • Policies
*Woodward et al., [19]	United States	Novel	HEIF	To complete a consensus process to clarify steps to incorporate a health equity lens into an implementation determinant framework	Integrated Promoting Action on Research Implementation in Health Services (i-PARiHS)	• Cultural relevance • Bias and unequal power at the patient-provider interaction • Societal context (economics, physical structures, sociopolitical forces)
Zhao et al., [53]	Philippines	Applied		To investigate factors influencing equitable COVID-19 vaccine delivery and to provide recommendations to enhance equitable vaccine delivery in low and middle-income countries to prepare for future health emergencies	HEIF	• Low to middle income countries • Same as Woodward et al
Zullig et al., [61]	United States	Adapted	National Institute on Minority Health and Health Disparities Research Framework	To understand how social determinants of telehealth—particularly race and ethnicity, poverty, and rurality—affect the use of telehealth	Health Disparities Research Framework (version of SEM), CFIR	• Race and ethnicity • Poverty • Rurality • Multiple levels and domains of influence
Evaluation
Hirchak et al., [64]	Australia, United States, Canada	Applied Adapted	RE-AIM	To inform future substance use disorder evidence-based implementation research among Indigenous communities	RE-AIM from D’Lima et al., (2022) and RE-AIM from Shelton et al., (2020)	• Indigenous populations • Substance use disorder
*Oetzel et al., [73]	New Zealand	Novel Applied	He Pikinga Waiora Implementation Framework	To present an implementation framework for interventions to prevent and treat chronic conditions for Māori and other Indigenous communities	Kuapapa Māori	• Structures and systems level • Socio-political • Indigenous populations
*Shelton et al.,[58]	United States	Adapted	An Extension of RE-AIM to Enhance Sustainability	To propose a reconsideration of RE-AIM to integrate recent conceptualizations of sustainability with a focus on addressing dynamic context and promoting health equity	RE-AIM	• Influence of cost and resources on health equity and impact on sustainability
Process
*Alcaraz et al. [35]	United States	Novel	ConNECT Framework	To present a framework for behavioral medicine science that provides actionable strategies for framing, measuring, and addressing health inequities		• Increasing cultural, literacy, and linguistic diversity • Between- and within-group heterogeneity
Bucknor et al., [36]	United States	Novel	Framework for Developing Health Equity Initiatives in Radiology	To provide a framework for developing a health equity initiative in radiology and the barriers/facilitators to developing equity initiatives		• Access to health services
*Eslava-Schmalbach et al., [69]	Latin American Countries (Argentina, Bolivia, Brazil, Chile, Colombia, Peru, Dominican Republic)	Novel Applied	EquIR	To develop and propose an equity-based framework for implementation research of health programs, policies and systems	National Framework for Health Sector Monitoring, Evaluation, Analysis. Impact Evaluation Framework. Framework for Strengthening Health Systems. Promoting Action on Research Implementation in Health Services. Child Health and Nutrition Research Initiative. Conceptual Model for Racial and Ethnic Disparities in Healthcare. Implementing Health Promoting in Australian Indigenous Primary Healthcare. Large-Scale Fortification of Condiments and Seasoning as a Public Health Strategy. Equity-Focused Knowledge Translation Toolkit	• Population health status and aspects of health equity before, during and after the implementation • Health in all policies • Applied in case of Bolivian health program for families in remote rural areas
Gaitan-Rossi et al., [47]	Mexico, United States	Applied		To examine how the Ventanillas de Saludin in two Mexican Consulates in the United States adapted their outreach services to better serve Mexicans in the US during the COVID-19 pandemic	EquIR	• Hispanic and Latino populations • Immigrant populations
Groom et al., [62]	United States	Adapted	Digital Health EquIR Conceptual Model	To expand an implementation model with recommendations on the equitable implementation of new digital health technologies	EquIR	• Digital determinants of health • Population health level
Gustafson et al., [63]	New Zealand	Adapted	Adaptation of EquIR to Support the Equitable Implementation of Health Interventions, Programmes and Services in Aotearoa NZ	To develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions	EquIR, He PikingaWaiora Implementation HEIF, CFIR, RE-AIM, Equity-Focused Adaptation of Proctor et al.’s Implementation Framework	• Indigenous populations • Anti-racism
LaFave et al., [71]	United States	Novel Applied	Whole System Framework Prevention	To describe two Healthy Start programs and a larger framework for other community-based initiatives addressing maternal and infant morbidity and mortality and potentially other wicked problems	Life Course Theory, Prevention Thinking and Systems Thinking	• Race and ethnicity • Gender • Multiple system and prevention levels • Systems thinking • Policy
Lanzi et al., [37]	United States	Novel	Disability-Inclusive Healthcare-to-Well-Being Translational Science Framework	To present a framework and detailed strategic plan to address health disparities and health equity for people living with disabilities	SEM	• People with disabilities
*Napoles & Stewart, [39]	United States	Novel	Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health Disparities	To describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities	SEM, Behavioural Theory	• Disparity populations in community settings
Nkimbeng et al., [49]	United States	Applied		To detail critical challenges that can affect gerontology researcher–community partnerships and relationships from the perspective of researchers	EquIR	• Race and ethnicity • Older adults
Novak Lauscher et al., [54]	Canada	Applied		This study aims to describe the rapid implementation process and identify facilitators and barriers to successful implementation of Rural Urgent Doctor in-aid pathway real-time virtual support in Dawson Creek District Hospital emergency department	Quadruple Aim, Social Accountability Framework	• Rural, Remote, and Indigenous Communities
*Percival et al., [45]	Australia	Novel	Indigenous Health Promotion Tool Implementation Model	To theorize the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services	Health Promotion Continuous Quality Improvement; Family Wellbeing Program; Ecological Coding Procedure, Community Health Action Pack	• Indigenous populations • Primary healthcare services • Organizational governance and resourcing
Petrovskis et al., [41]	United States	Novel	Data for Addressing Social Determinants of Health (DASH) Model	To develop a preliminary model that identifies the factors that contribute to data‐driven decision‐making related to the social determinants of health in United States local health departments and describe relationships between them	CFIR and SEM	• Data-driven decision-making in local health departments • Population health level
Sibley et al., [42]	Canada	Novel	Tool for Applying Intersectionality in Knowledge Translation	To develop and conduct usability testing of tools to support integrating intersectionality in knowledge translation	Knowledge-to-Action, Intersectionality Theory, Iowa Model of Evidence-Based Practice, CFIR, TDF/Behaviour Change Wheel	• Intersectionality • Older adults
Stanton et al., [59]	United States	Adapted	Adaptation of EPIS Framework to Advance Mental Health and HIV Health Equity	To propose a typology of power generated through implementation processes and apply this power typology to expand on the EPIS framework	EPIS	• HIV and mental health • Types of power
Stanton et al., [52]	United States	Applied		To examine implementation strategies of the SUSTAIN COMPASS Coordinating Center’s person- centered care capacity- building interventions	EPIS	• People living with HIV • Power dynamics • Funding
Stockton et al., [43]	Australia	Novel	Collaborative Adaptation of Service Models for Child and Family Health in Diverse Settings (CASCADES) Framework	To develop a framework for the adaptation of community-based child and family health service models for diverse settings		• Intended for various geographic and socio-economic contexts, including rural settings
Thompson et al., [60]	United States	Adapted	Adaptation of EPIS Framework for Transgender Health Equity	Two compare two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care	EPIS	• Black and Latina transgender women
*Yousefi Norraie et al., [44]	United States	Novel	Equity-Dissemination and Implementation Science Framework (EQ-DI)	To develop a proposed framework that highlights the interaction opportunities between D&I and health equity	SEM, RE-AIM, CFIR	• Multiple levels of influence
Theory
Mmari et al. [38]	United States, Democratic Republic of Congo, Kenya, Malawi, Indonesia	Novel	Theory of Change for Interventions in Global Early Adolescent Study	To create a set of criteria to assess facilitators and barriers to implementation among gender transformative interventions that target very young adolescents across different cultural settings		• Gender • Adolescence • Power imbalances
Hybrid – Determinant and Evaluation
Damschroder et al. [56]	United States	Adapted	Updated CFIR	To gain feedback from experienced CFIR users to inform updates to the framework	CFIR	• Social and structural determinants of equity in implementation (inner and outer setting) • Power
*Henderson et al. [70]	United States	Novel Applied	Mi-MAMO Breast Cancer Screening and Navigation Practical, Robust Implementation and Sustainability Model (PRISM) and SEM Framework	To implement an integrated framework for a breast cancer screening and navigation program for women from under resourced communities	PRISM, SEM, RE-AIM	• Gender • Under resourced communities • Multiple levels of influence • Systems • Funding • Policies
Hybrid – Process and Evaluation
Hayvon [40]	Canada	Novel	Three Component Framework Integrating Snell-Rood plus Five Social Justice Focused Theories	To conduct an environmental synthesis of social justice and EDI theories, models and frameworks	Snell-Rood; John Rawls’ Theory of Justice; Amartya Sen’s Capabilities Approach; Iris Marion Young’s Theories of Justice; Paulo Freire’s Critical Consciousness; Critical Race Theory	• Focus on minimizing potential harms arising from actions intending to reduce inequalities • Simultaneous marginalizations

^*Indicates article was included in Gustafson et al., (2023)

Abbreviations: CFIR Consolidated Framework for Implementation Research, EPIS Exploration, Preparation, Implementation, Sustainment, EquIR Equity-based Framework for Implementation Research, HEIF Health Equity Implementation Framework, RE-AIM Reach, Effectiveness, Adoption, Implementation, and Maintenance, SEM Socio-ecological Model, TDF Theoretical Domains Framework

Methods for designing, adapting or applying equity-focused TMFs

The majority of articles (n = 34, 85.0%) described methods for designing, adapting, or applying equity-focused TMFs. Methods included evidence synthesis, consensus methods, community engagement, and qualitative analysis. The six articles (15.0%) that did not describe methods presented an adapted [55, 58, 61] or novel [35, 44, 70] TMF. The articles that did not describe methods studied IS in behavioural medicine [35], community health programs [70], telehealth [61], academic medical research centres [44], sustainability [58], and healthcare delivery [55]. See Table 3 for an overview of the reported methods.

Table 3.

Methods for designing, adapting, and applying equity-focused TMFs

	Method	Authors	Description
Evidence synthesis (n=10; 25%)	Environmental scan (n=1; 2.5%)	Hayvon (2024)
	Integrative review (n=3; 7.5%)	*Stockton et al., (2024) *Damschroder et al., (2022) Groom et al., (2024)
	Literature review (n=2; 7.5%)	*Napoles et al., (2018) Petrovskis et al., (2023)
	Scoping review (n=3; 7.5%)	*Gustafson et al., (2024) *Percival et al., (2018) Hirchak et al., (2023)
	Systematic review (n=1; 2.5%)	*Eslava-Schmalbach et al., (2019)
Consensus (n=8; 20%)	Unspecified (n=5; 12.5%)	Mmari et al., (2023)	The working group participated in a one-day workshop to develop a theory based on a series of implemented interventions. A draft version of a theory was developed and shared with working group members. Theory was revised and provided continuous feedback until a finalized version received consensus across the group.
		Woodward et al., (2021)	Authors used a consensus process informed by Moullin et al. Expanded five steps from Moullin with steps on how to incorporate health equity domains and determinants. Steps vetted with the authorship team through oral discussions, reviewing written documents and refining steps.
		*Damschroder et al., (2022)	Surveyed authors of articles included in the literature review. Authors were asked to complete three surveys (author’s use of CFIR, rate the CFIR based on sensibility criteria and asked open-ended feedback about the domains and constructs). The team independently reviewed all feedback items to add their notes and recommendations, and then met approximately 3h a week from September 2020 to February 2022 to discuss and reach consensus on CFIR updates. Included details about positionality.
		*Gustafson et al., (2024)	In a single-day meeting members of the research team with expertise in health equity, Indigenous health, and health systems reviewed TMFs identified in the literature. Members discussed appropriateness of TMF for the study and reached consensus.
		Etherington et al., (2020)	The TDF was selected as a framework to adapt based on consensus-building activity with Framework Committee. Committee along with subgroup of experts considered 14 domains of TDF and iteratively developed recommendations for incorporating intersectionality considerations. An iterative approach was used to build final consensus. 12 rounds of revision.
	Modified Delphi (n=1; 2.5%)	*Stockton et al., (2024)	Integrative review and participatory action research studies were conducted and summarized. Expert panel (including Australian and international professionals and parents from rural and remote communities) used the WHO building blocks for strengthening health service systems to guide adaptation of model (2 rounds of consensus).
	Indigenous (n=1; 2.5%)	Maar et al., (2015)	Community-based participatory research and Indigenous consensus methodology (3 cycles). Cycle 1) Workshop meeting with Indigenous communities, health and clinical researchers (held workshop in Canada and Tanzania). The workshop included a discussion and feedback on factors impacting implementation. Provided feedback on the framework and domains. Cycle 2) Create a revised theoretical framework Cycle 3) Final member check on the framework, including key issues, domains, questions.
	Nominal group theory (n=1; 2.5%)	Sibley et al., (2022)	Draft tool development - Invited a diverse group of community members, clinicians, KT practitioners and researchers to participate in a Nominal Group technique exercise. 12 meetings over 1 year. Usability testing - Prioritized certain KTA cycles: identifying problem, assessing barriers to knowledge use, selecting/tailoring and implementing interventions. Used a structured consensus process (think aloud method, interviews) to identify one TMF corresponding to each prioritized KTA phase. 31 participants. Tool refinement - They developed intersectionality-enhanced versions of each selected TMF through an iterative process of co-creation and consensus-building. The committee met 4 times (between 2017 and 2019) to address the feedback, resulting in a final suite of 6 documents.
Community engagement (n=6; 15%)	Unspecified (n=2; 5.0%)	Stanton et al., (2022)	Involved directors and staff from an equity focused organization working on HIV service capacity building for mental health, trauma informed care and harm reduction. Framework was informed by 3 years of partnering with other HIV organizations to develop implementation coaching field notes, grant reporting, and evaluation documents, training feedback, partner evaluation interviews, and existing implementation literature. The expanded framework was developed through analyzing these documents. Types of power were developed through iterative analysis.
		Lanzi et al., (2024)	Stakeholders selected and separated into two expert panels to create recommendations. Strategic plan from recommendations was developed by a consulting firm. The firm also held interviews with 9 key stakeholders to develop strategic plan. Thematic analysis was conducted on interview transcripts and information was integrated into final draft of plan
	Advisory/Working Group (n=3;7.5%)	Thompson et al., (2022)	Used contextual factors and processes of engagement identified in cases to extend and adapt EPIS into an intersectional framework. The exploration, planning, design, and implementation of interventions to improve transgender health equity required input, guidance, and participation from trans communities (e.g. town hall; world cafe). The steering committee was composed of members of the transgender communities. Author team included trans and/or people of colour.
		*Gustafson et al., (2024)	Presented first iteration of the framework to Māori Advisory Group and Consumer Advisory Group. Advisory members were invited to contribute to the design of the tools during regular joint advisory group meetings. Governed by a Terms of Reference.
		*Eslava-Schmalbach et al., (2019)	Conducted a stakeholder analysis with "implementers" - decision makers and researchers - and asked questions to determine the inclusion of equity issues in implementation research. Implementers and mentors (who helped with work) met to select options to improve the program, policy and planning of implementation research. Implementers and health equity experts built a framework.
	Workshop (n=1; 2.5%)	*Percival et al., (2018)	Researchers, practitioners, policy makers and community members attended collaborative workshop and selected health promotion tools from a scoping review. Selected tools were analyzed (qualitatively) using the constant comparison method. The author met face-to-face to construct the final model.
Qualitative analysis (n=13; 32.5%)		Aschbrenner et al., (2024) Bowen et al., (2023) Dickson et al., (2022) Gaitan-Rossi et al., (2023) Hoskins et al., (2022) Novak Lauscher et al., (2023) Norman et al., (2024) Oetzel et al., (2017) Ramadurai & Shea (2024) Singh et al., (2024) Stanton et al., (2023) Wolfe et al., (2023) Zhao et al., (2024)
Other (n=4;10.0 %)		Bucknor et al., (2023)	Used the experience of three academic radiology departments as they engaged in health equity-focused work. Includes key principles and observations.
		Nkimbeng et al., (2022)	Hosted a series of three focused discussions with researchers to understand their experiences and reviewed literature. Presents identified challenges and solutions.
		Lafave et al., (2024)	Applied the framework through training, service mapping, data visualization and strategic planning.
		*Napoles et al., (2018)	Builds on authors prior methodological framework and training resource for adapting behavioral interventions to address health disparities. Relied on experience from community-based trials of behavioural interventions with communities experiencing disparities.
Not described (n=6; 15.0%)		Henderson et al., (2020) Zullig et al., (2024) Shelton et al., (2020) Alcaraz et al., (2017) Yousefi Norraie et al., (2020) Baumann & Cabassa (2022)

Grouped by 1) evidence synthesis 2) consensus and 3) community engagement, 4) other and 5) analysis (for applied frameworks)

An asterisk (*) indicates that more than one method was used by the authors

All percentages as calculated using 40 (total studies included) as a denominator

Evidence synthesis

Evidence synthesis uses systematic methods to bring together findings from pre-existing research evidence [74]. Authors used evidence synthesis (n = 10; 25.0%), including an environmental scan [40], integrative review [43, 56, 62], literature review [39, 41], scoping review [45, 63, 64] and systematic review [69]. Reviews included peer-reviewed literature, with one article additionally including grey literature [45]. Evidence searches retrieved literature about equity and existing frameworks (e.g., feedback on the CFIR model or a review of social justice frameworks) and health topics (e.g., health promotion tools, digital health implementation). Five articles (12.5%) used evidence synthesis as a starting place to inform subsequent methods [43, 45, 56, 63, 69].

Consensus methods

Consensus methods include any systematic process undertaken where a group of experts are given the best available evidence to generate and reach a level of agreement on solutions [75]. Authors used consensus methods (n = 8; 20.0%) to adapt or design TMFs. These methods included modified Delphi [43], Indigenous consensus methods [72], nominal group theory [42] and unspecified (19,38,56,57,63,). Consensus was achieved through oral discussions, reviewing written documents or evidence, interviews, think-aloud methods, co-creation, and continuous refinement. The experts involved in these consensus processes included academics, healthcare professionals [43], people with lived experience, community members, knowledge translation practitioners and researchers [19, 42, 56]. Alternatively, the Indigenous consensus method relied on the cultural values and lived experiences of participants, namely community members and local communities of practice. This method prioritizes the voices of those impacted by interventions [72]. The Indigenous consensus process is considered completed when the nexus between community, academic and practice-based knowledge manifests. Articles reported meeting frequencies, including a one-day meeting [38, 63], multiple meetings [43, 56] or two [43], three [72], four [42] or twelve rounds of consensus [42, 57]. For example, Damschroder et al., reported meeting for multiple hours each week from September 2020 to February 2022 [56]. Other authors did not report the frequency of their meetings [19].

Community engagement

Community engagement involves collaboration with people who are affected by similar situations or a shared purpose to address health-related issues. There are different levels of community involvement which evolve along a continuum from outreach to shared leadership [76]. Community engagement methods (n = 6; 15.0%) varied and included panels involving those with lived experience [37], partnerships with organizations [59], world cafes and townhalls [60], working and advisory groups [60, 63, 69], and collaborative workshops [45]. Participants included community members with lived experience, researchers, staff from equity-focused fields, policy makers and practitioners. There was an emphasis on community expertise and people who had lived experience with specific health inequities. Articles also included details about the different member composition. For example, the article by Thompson et al., differentiated the author team, steering committee, and community members and discussed the diversity within each [60]. Community engagement methods (e.g., advisory groups) were combined with other methods (e.g. literature reviews). There was also an emphasis on context and understanding the settings and communities where the interventions were being implemented.

Qualitative analysis

Many studies (n = 13; 32.5%) applied the TMFs by coding, mapping or theming qualitative data [46–48, 50, 51, 53, 54, 59, 65–68, 73]. For example, Wolfe et al. adapted the National Institute of Health’s Sexual and Gender Minority Health Disparities Research Framework [68]. The authors used content analysis to code a series of semi-structured interviews with patients and healthcare providers regarding barriers and facilitators to gender-affirming hormone therapy. The equity-focused framework was applied to organize themes across individual, interpersonal, and structural levels [68].

Some studies described using a combination of evidence synthesis, consensus, community engagement, and qualitative analysis methods, or other methods. Four studies (10%) used other methods [36, 39, 49, 71], three of which relied on researcher experience conducting health equity-focused work [36, 39, 49]. Some studies combined multiple methods. For example, Stockton et al. developed a framework for the adaptation of community-based child and family health service models for rural settings [43]. The framework development was informed by an integrative review of existing rural health services literature. These findings were integrated with the results of a participatory action research study to understand the local context, a modified Delphi study to identify considerations for adapting service models, and a second participatory action research study to evaluate and refine the framework in a different rural location. In the case of Gustafson et al., following a scoping review to identify existing equity-focused TMFs, the research team hosted a single-day meeting to select an appropriate TMF for adaptation for their study. The authors presented the first draft of the adapted framework to the project’s Māori and Consumer Advisory Groups. Practitioner, researcher, and consumer members provided feedback to shape the revised framework [63]. The collaboration with the advisory groups was governed by a terms of reference.

Evaluation

In health research, evaluation is defined as the systematic collection of information about the activities, characteristics, or outcomes of interventions to determine the value, improve effectiveness, or inform decision-making [77]. Evaluation of TMFs was reported in 6 articles (15.0%) with all being novel equity-focused TMFs [41–43, 69, 72, 73]. Evaluation methods included quantitative analysis [41], workshops [43], semi-structured interviews [42, 69], focus groups [72, 73] and reviewing secondary data [73]. Evaluations were limited to perspectives from certain contexts [41–43], privileged identities in the group [42], experts and decision-makers [69], or a small sample size [43, 73]. For example, Sibley et al. (2022) recognized that their project involved a committee that primarily identified as white and female with perspectives from high-income countries, such as Canada [42].

Context

Our findings showed the application of TMFs in various healthcare system contexts. Articles originated primarily from the United States (U.S.) (n = 26; 65.0%) as well as Canada (n = 4; 10.0%), New Zealand (n = 2; 5.0%), Australia (n = 2; 5.0%), and the Philippines (n = 1; 2.5%). Five (12.5%) articles originated from multiple countries. TMFs were tested in mostly high-income countries, but three (n = 3; 7.5%) were studied in low to middle-income countries [53, 69, 72]. Authors used the TMFs to explore equity within digital health [35, 50, 54, 61, 62], gender affirming care [60, 65, 68], health policies [68–71], data-driven decision-making [41], radiology [36], gerontology [49], community-based organizations [67, 71], primary health care [45, 48], and behavioural and mental health [35, 59, 64, 66]. Some TMFs bridged healthcare and community-based services, building on the idea that IS needs to connect systems and build partnerships outside of healthcare, as the literature recommends [28].

Equity considerations

Various definitions of equity were referenced. Articles considered social factors including, race, ethnicity, gender, culture, age, Indigeneity, income, living rural/remote, gender identity, ability, language. Many (n = 23; 57.5%) articles were tailored to one or more specific equity-deserving populations, including Indigenous communities (n = 6; 15.0%) [45, 54, 63, 64, 72, 73], Hispanic/Latinx and other racial and ethnic minority populations (n = 8; 20.0%) [47–49, 60, 61, 66, 67, 71], LGBTQ +, women and gender diverse populations (n = 7; 18.0%) [38, 60, 65, 67, 68, 70, 71], people with disabilities (n = 1; 2.5%) [37], people living with HIV (n = 2; 5.0%) [52, 59], children and youth (n = 3; 7.5%) [38, 43, 48], and older adults (n = 2; 5.0%) [42, 49]. Nearly half (n = 17; 0.42.5%) of the articles included in this review considered structural determinants of health, such as organizational priorities [46], power [19, 38, 52, 56, 57, 59], governance [41, 45], policies (,68–71), sociopolitical contexts [19, 51, 73], anti-racism [63], systems thinking [70, 71, 73] and funding [58, 70]. Additionally, two articles (5.0%) addressed intersectionality [42, 57].

Discussion

This scoping review explored the methods for designing, adapting, and applying health equity-focused IS TMFs. Authors used a combination of evidence synthesis, consensus, and community engagement methods when designing or adapting TMFs. When applying TMFs, authors used qualitative methods for data collection (e.g., interviews and focus groups) and analysis (e.g., theming, mapping, and coding). Equity considerations included social (e.g., race, ethnicity, gender) and structural (e.g., policies and power) determinants of health. There was a shift away from consensus methods relying on academic expertise and an emphasis on lived experience or community expertise. The majority of articles did not report evaluation methods.

The increase in the number of TMFs since Gustafson et al.’s 2023 review reflects calls to incorporate equity into IS [9, 23]. Many of the studies included in this review focused on who was at the table, engaging members of equity-deserving communities in the earliest stages of the TMF design (engaging early) and throughout the TMF design (engaging often). This addresses recommendations from implementation scientists to consider equity in the earliest stages of implementation (e.g., pre-implementation) [78], where equity is considered before the TMF is conceptualized.

Studies used consensus processes or community engagement methods. For consensus processes, authors used modified forms of consensus, including modified Delphi and Indigenous consensus methods. For example, Maar et al. [72] used an Indigenous consensus method in combination with community-based participatory research to build an assessment tool for improving implementation readiness in communities. Other authors acknowledge that frameworks could be adapted to Indigenous populations (e.g., RE-AIM framework) [64]. This is reflected in other studies exploring consensus methods using Indigenous knowledge outside of IS [79]. This shift towards Indigenous consensus methods could be in response to the critiques of consensus processes for focusing on expert, or academic, knowledge rather than community knowledge or lived experience [80]. There appears to be a shift from creating TMFs for communities to creating TMFs with communities. Our findings suggest that the methods to design and adapt TMFs should be tailored to communities’ ways of knowing and doing and consider the equity factors relevant to their lived experiences.

At times, scholars combined consensus and community engagement methods (hybrid) (e.g., participatory action research, community-based research). This is also being done in other disciplines. For example, Brush et al., [81] used a case study to explore a community-based participatory research (CBPR) enhanced Delphi method, using quantitative and qualitative data without prioritizing one over the other. They described this as co-learning, leaving space for diverse opinions, environments of curiosity and developing deeper levels of understanding. Brush et al. also note the importance of having a heterogeneous group, diverse in race, ethnicity and geography, rather than based on research interest [81]. Wallerstein and Duran [26] highlight that CBPR could address many of the challenges facing intervention and implementation sciences, including the potential for translational research to develop, implement and disseminate interventions with greater effectiveness, sustainability, and cultural and contextual centeredness. However, there remains a need to better understand the theoretical underpinnings of CBPR and the processes of power-sharing and flattening knowledge hierarchies to improve health equity [25]. Additionally, academics and funding institutions need to be mindful about the time and resources required to complete these types of consensus and engagement processes [82].

The articles that applied TMFs (e.g., EquIR and HEIF) provided valuable information about the strengths and limitations of equity-focused TMFs. For example, Ramadurai et al. [51] applied the HEIF to a learning assessment in medical education. They acknowledged that the framework could be restructured and might not be relevant to teaching in clinical environments. The application of equity-focused TMFs mirrors the recommendations of Wensing et al., [29] to test, refine, and integrate TMFs to understand how and in what contexts they work best.

Over half of the articles considered social and structural determinants of health. A cross-sectional study by Baumann et al. explored the attitudes and perceptions of researchers who incorporate health equity into their work and found that most reported focusing on individual-level factors rather than structural factors [55]. However, many TMFs in our review focused on the structural determinants of health, namely power. This was also reflected in the community engagement methods, namely participatory action research, which challenges where the power lies and with whom. It is essential for researchers to acknowledge that some team members may hold more privileged positions or resources, which can influence their ability to address power effectively. Therefore, it is crucial to engage in transparent discussions about power from the outset of these relationships [83]. This mirrors calls for the incorporation of intersectionality into IS; however, authors warn against tokenism [84].

IS can continue to draw from other disciplines such as health economics, public health and digital health, to advance the application of health equity. For example, Groom et al. used the Digital Health EquIR Conceptual Model to influence the implementation of equitable digital health technologies [62]. Additionally, Hirchak et al. adapted the RE-AIM framework to inform substance use disorder implementation research among Indigenous communities [64]. Drawing on disciplines like public health could help dismantle inequities at population levels and build relationships with communities that have been systemically left out of the healthcare system.

Implications

This work sheds light on the methods used to design, adapt and apply equity-focused TMFs. These findings are particularly relevant to researchers and practitioners interested in embedding health equity into their work. These findings can be used for reflection and planning, including who sits at the table (e.g. power dynamics), equity components (e.g. social, structural), and context (e.g. community, healthcare). This paper emphasizes the importance of considering health equity from the outset of projects to engage early and frequently with partners. There is a need to evaluate the impacts of these TMFs and interventions on addressing health inequities for equity-deserving populations.

Strengths and limitations

This scoping review provided an overview of the methods used to design, adapt and apply equity-focused IS TMFs. It addresses a noteworthy opportunity for IS to advance health equity and improve health outcomes for those who have been socially and structurally left out of healthcare systems. This review provides scholars with a starting place as they consider the methods they will use to design, adapt, and apply TMFs [28, 85]. Our reporting conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) [86]. As this scoping review was an updated search of a previous scoping review, the limitations reported by Gustafson et al. could be carried forward in our study [16]. Given the scoping nature, we did not complete a systematic search or quality assessment of the literature. Our search was limited to academic papers published in English in peer-reviewed journals. We excluded grey literature due to variability of reporting formats and limited IS focus. We may have missed literature reporting on TMFs generated from communities, organizations, or non-English speaking countries. The TMFs included in this review had a strong U.S. skew, therefore, the transferability of the findings may be limited across contexts, such as in low to middle-income countries. This scoping review did not include studies where interventions were tailored to equity-deserving communities without the operationalization of a TMF, which may have contributed to our analysis. This review did not include the optional Step 6 of Arksey and O’Malley’s methods, which involves consulting with the community. Future work is needed to consult with experts and develop recommendations to guide future research and practice with equity-focused TMFs.

Conclusion

This scoping review explored the methods for designing, adapting and applying equity-focused IS TMFs. Authors used evidence synthesis, consensus, community engagement, qualitative analysis, and multiple methods. The articles stressed the importance of including community members with lived experiences in the design of the TMFs. Methods must be tailored to communities’ ways of knowing. TMFs can continue to incorporate the structural determinants of health (e.g. power, policies) and consider monitoring the equity factors relevant to their lived experiences. Future research must continue to evaluate these TMFs to determine their impacts on improving health equity and inform future applications in implementation practice in the healthcare system.

Author’s contributions

CC and LJK conceptualized the paper. LJK, LB, SC, AH, AD, MG, and GM contributed to the data collection. GM contributed to the data analysis and original draft of the paper. All authors reviewed the manuscript.

Funding

This review was supported by the Margaret Inglis Development Fund at the School of Nursing, Dalhousie University. LJK is supported by a CIHR Health System Impact Fellowship Postdoctoral Award. MG is support by a CIHR Canadian Graduate Scholarship – Doctoral Award.

Data availability

This review includes published secondary data.

Declarations

Ethics approval and consent to participate

This paper did not require ethics approval.

Consent for publication

Not applicable. This paper does not include individual’s data.

Competing interests

The authors have no competing interests to declare.