Equity considerations when making decisions to scale-up health interventions: a review and analysis of scalability assessment resources.

backgroundScale-up of effective interventions is needed to achieve population health outcomes. Before scaling-up, many assess the potential scalability of interventions using a scalability assessment resource. Given the critical importance of reducing health inequities, understanding how equity is considered in these resources merits investigation. We sought to determine if scalability resources consider equity and, if so, how equity is applied.

methodsA structured search of the literature identified 28 scalability resources. A deductive content analysis was undertaken by two independent coders to identify key aspects of equity concepts within the resources.

resultsOf the resources identified, only half explicitly mentioned equity or equity-related terms; none provided a clear definition of equity. Of the half that mention equity, only three included an equity-specific step while only two included equity as a guiding principle. Three-quarters highlighted a range of disadvantaged groups for consideration, with race/ethnicity and socio-economic status being most frequently mentioned.

conclusionThis highlights an important gap in current scalability assessment resources and provides an opportunity to improve the systematic consideration of equity. Without more concerted effort to consider equity in scalability assessments, it may result in disadvantaged and marginalized groups being exposed to increasing inequity even when interventions are scaled-up.