Table 3.

Statements sorted into the five cluster areas

Cluster 1: Last Mile Populations – The Who 13. understanding the barriers to equitable health from the perspective of people in the last mile. 17. the diversity of disability & engagement needs. 20. a focus on populations who have not always benefited from research or interventions before. 52. finding and advocating for those without a political or social voice. 54. children, women, the elderly and others in specific life stages relevant to the research. 55. people with disabilities, including invisible disabilities. 56. looking at specific hard to reach groups due to equity-related concerns. 58. indigenous people and any minority group in the context–religious, sexual, migrant, refugees, and others. 59. most vulnerable populations that current efforts have not yet reached. 60. those who have traditionally been left out of ‘mainstream’ research. 61. populations who face multiple vulnerabilities that marginalize them further. Cluster 2: Research Methods/Approaches – The How 21. being culturally and contextually sensitive. 26. generated, conducted and interpreted by those with full understanding of cultural, social, fiscal context. 27. empowerment of participants and communities. 28. community engagement throughout research: conceptualization, design, implementation, dissemination. 29. universal design for engagement principles. 30. participatory methods that can be conducted remotely. 31. equity centered research questions, methods, and sampling strategies. 32. methods that might have to be adapted or designed specifically. 34. priorities that have been identified by last mile populations themselves. 35. reflexive thinking and practice throughout the research process. 36. multi-stakeholder buy-in from the beginning to extent possible. 37. attention to power dynamics in research. 38. a way to return research results to the affected population. 39. a focus on how research can be translated to action or improvements for last mile populations. 40. translation of research to build capacity and knowledge. 41. being thoughtful about integrative and end-of-grant knowledge translation. 42. community activism. 43. advocacy so that people in the last mile are not ‘left behind’ in development or health gains. 44. intentionally promoting health equity. 46. a focus on human rights. 47. being thoughtful around all ethical considerations. 48. social justice as an underlying value. 49. recognizing and valuing community members as experts in their own lives. 50. participatory approaches to meaningfully reach individuals and groups often overlooked or left out of traditional research. 51. telling stories and showing data that are often neglected. 53. raising voices of the unheard. 64. using methods that privilege the voices of minority populations.

Cluster 3: Health System – The Why Factors – The Why 12. defining and measuring obstacles to desired health outcomes. 15. access to research, services and information gathering to inform data & services. 22. the centralization of public workers and services. 25. mapping of transportation options, cost, frequency, and hazards. 33. addresses issues that encompass the entirety of the patient cascade from prevention to symptoms to restored health. 45. equity or fairness. 57. involving local pharmacies, healers, midwifes, birth-attendants. at personal, social and system levels. 6. consider structural determinants of health. 8. looking upstream for factors that have led to the group being ‘last mile.’ 10. social marginalization. 11. overcoming obstacles that have limited inclusion of last mile groups traditionally. 14. understanding stigmatization in the context. 16. understanding the community and whether one group is making another vulnerable or under-acknowledged. 18. the influence of governmental structures and policies at the local level. Cluster 4: Broader Environmental Factors – The Why 2. the effect of climate change on the area and people. 3. conflicts and how they affect the population. 7. displacement and its effects. 9. how geographic isolation affects the population. 62. the security situation for vulnerable groups. Cluster 5: Structural/Systemic Determinants – The Why 1. economic barriers 19. attention to reasons why the population is considered a ‘last mile’ population. 23. understanding the systemic biases and processes that contribute to individuals or groups being ‘last mile.’ 24. examining the systems of power that have led to marginalization. 4. consideration of social determinants of health. 5. examining the determinants of health and how to improve these factors. 63. identifying the circumstances that have positioned people on the margins of healthcare systems.

Cluster 1: Last Mile Populations – The Who.

Cluster 2: Research Methods and Approaches – The How.

Cluster 3: Health System Factors – The Why.

Cluster 4: Broader Environmental Factors – The Why.

Cluster 5: Structural/Systemic Factors – The Why.