The FrEEIA readiness assessment tool: an evidence-informed pro-equity readiness assessment tool adapted in Aotearoa New Zealand for the implementation of health interventions.

Introduction: Equitable implementation is an important dimension of effective implementation. In Aotearoa New Zealand, many health interventions with the potential to lessen health inequities for Māori fail to do so because of implementation challenges. Equity readiness can ensure organisations are both willing and able to implement or scale up health interventions in a way that doesn't result in further health disparities. Methods: An equity readiness assessment tool, designed to be used by healthcare organisations in conjunction with an equity focussed process framwork (FrEEIA: Framework for Effective and Equitable Implementation in Aotearoa), was developed through a seven stage, mixed methods, iterative process. This tool frames equity readiness as a collective, multi-level construct. Initial stages of its development included interviews with interest holders to explore barriers and facilitators impacting the implementation of interventions to improve health equity, a reveiw of existing equity assessment and change readiness tools, and a researcher workshop to develop key domains. This was followed by the actual development/adaptation of a suitable tool with advice from interest holders who had utilised similar tools, testing and the development of additional resources that would aid its use. Results and discussion: The final version of the FrEEIA Readiness Assessment Tool is an adapted version of The Readiness Thinking Tool®, comprising 31 statements in three sections (individual readiness, intervention-specific readiness, and organisational readiness) which users rate individually and then discuss as a team, before formulating an action plan to improve equity readiness. Pilot testing highlighted the particular benefit of the tool in increasing awareness of the different dimensions of equity readiness, with the identification of strategies to address barriers to readiness more challenging due primarily to timing, team make up, and facilitation challenges. A range of supporting resources -a User Guide, Facilitator's Guide and Action Plan template- were developed to facilitate action plan development.The FrEEIA Readiness Assessment Tool is now available for use and adaptation through an interactive online interface, a format which was found to carry distinct advantages for tailoring feedback. The research team will continue to make refinements as this tool gets rolled out in a wider variety of service settings.