Table 2.

Critical questions to assess and address power in implementation.

EPIS phase	Critical questions
Exploration
Inner Context	Who holds decision-making power/leadership for the initiative? Are individuals who are impacted by the health issue of focus meaningfully involved? Are these individuals meaningfully compensated for their labor?
Outer Context	What factors outside the organization will impact innovation/intervention selection? How does the policy environment influence the identified issue? The intervention/innovation options? How might the built environment, sociopolitical and cultural environments impact innovation/intervention selection? ▪ e.g., Stigma; Racism What role do funders play in the social construction of the issue at hand? Is a multilevel intervention feasible? (Is there a need/role for advocacy and/or structural change in your intervention plan?)
Bridging Factor	What is the perspective of those you are partnering with (academic institutions, IPOs, Trainers and Consultants)? Do they integrate a multi-level approach or perspective? Do they have experience working in partnership with the community? Are their goals aligned with yours and the community’s? What other organizations in the region may be doing similar or intersecting work? How will your organizations’ intervention decisions impact this larger landscape?
Innovation	What is the range of interventions/innovations/actions available to address the selected issue? Have any of them been developed in similar contexts, with similar populations as yours? Do any of them intentionally integrate relevant issues of power related to the selected issue? (e.g., racism, gender-based violence, homophobia, transphobia, unconscious bias)
Preparation
Inner Context	What dynamics exist within your organization that may impact the community's ability to access intervention benefits? Do community trust and feel welcomed by your organization and staff? Is the community supported in your space? Physically through building accessibility? Emotionally and culturally? Linguistically? What training might staff need to support each other and the community for an intervention implementation that successfully benefits marginalized groups and individuals? What mechanisms can be developed to facilitate ongoing support and accountability for staff as implementation proceeds? Do these include mechanisms to collect and integrate community feedback?
Outer Context	How will your organization address structural barriers external to your organization that may impede access to your intervention and/or obstruct community members from actualizing full intended health benefits of intervention? Are you developing structures to collect the information necessary to identify emerging inequities in access and outcomes and their potential influencing factors?
Bridging Factors	Have you assessed your network of referrals for alignment with the community's values, priorities and preferences? Are there opportunities to develop networks to explore system-wide change?
Innovation Factors	Does your intervention of choice require adaptation? Does your adaptation plan meaningfully integrate community knowledge?
Implementation
Inner Context	Do you have a plan to support staff in working with marginalized groups and addressing power? Do you have mechanisms to collect and integrate ongoing feedback from community members participating in the intervention? Have you established a culture of trust and transparency to receive uncensored feedback from the community and staff without fear of reprisal?
Outer Context	What evolving dynamics at the organizational, neighborhood, regional and national level may impact ongoing implementation? What new barriers may emerge? What policy windows may expand possibilities? Do you have necessary information network channels to access this information as it emerges?
Bridging Factor	Do you continually reassess your partnerships, their utility and what additional partners may be needed?
Innovation	How might your organization's experience with implementing the intervention impact ongoing intervention development? What is your organization and community learning from the implementation process that may enhance health equity potential of the intervention if shared with the broader field?
Sustainment
Inner Context	What lessons has your organization learned about pursuing health equity through intervention implementation that may have implications for structure and culture of the larger organization?
Outer Context	What are the larger sociopolitical factors impacting the sustainability of the intervention? What funding sources may support your ongoing, dynamic engagement with intervention implementation? Have new potentialities for multilevel interventions emerged since project inception?
Bridging Factor	What can your role be in the region regarding health equity? Can you become a bridging factor for other organizations seeking more equitable intervention outcomes?
Innovation	Do you keep vigilant in measuring health equity outcomes? Do you have a plan to assess the need for de-implementation and an ethical de-implementation plan? Are you prepared to grow with the developing intervention evidence?