Using Health Equity Impact Assessments to Modify Evidence Based Strategies within Local Health Departments in North Carolina

Full Description: Background :
Health equity has been at the forefront of recent discourse within MCH. Health Equity Impact Assessments (HEIAs) evaluate the impact of programs or policies on the health of a population. The North Carolina (NC) HEIA was developed by #impactEQUITYNC (a collaboration between NC Child, the NC Division of Public Health Women’s and Children’s Health Section, the NC Office of Minority Health and Health Disparities, and the Rockingham County Division of Health Services). The HEIA is comprised of the following steps, all conducted by a group of stakeholders: 1) describe the program/policy; 2) analyze and interpret data; 3) identify modifications; and 4) develop a monitoring plan.  The purpose of this presentation is to describe the impact of HEIAs on implementation processes- more specifically the operationalization of modifications and the engagement of community members, particularly within underserved populations.

Project :
In 2016, NC Department of Public Health launched Improving Community Outcomes for Maternal and Child Health (ICO4MCH) to 1) improve birth outcomes, 2) reduce infant mortality, and 3) improve health of children ages 0-5 years. ICO4MCH funded five local health department (LHD) collaboratives serving 14 counties to implement three evidence-based strategies (EBS) each. ICO4MCH LHDs conducted a HEIA for each EBS to modify strategies and lead to more equitable health outcomes. Between July 2017 and June 2020, ICO4MCH LHDs implemented 15 HEIAs on topics including breastfeeding and positive parenting. The Evaluation Team completed a content analysis of the HEIA modifications using HEIA tools and evaluation data, identifying themes within the modifications and lessons learned in implementing those modifications.    

Findings and Lessons Learned : 
The most common themes among the modifications to the EBS were 1) increasing community level partnerships and engagement, 2) altering messaging mediums and language to target intended audiences, and 3) equity-based education of staff, providers, and key stakeholders. Several ideas emerged from the HEIA including a peer support model to promote equity in tobacco prevention, the engagement of men and the LGBTQ + population in reproductive life planning, and partnerships with faith-based leaders and school leadership for a positive parenting program. The HEIAs gave new clarity around underserved populations needs, as well as where and how best to reach them. Lessons learned and innovations from this process have been valuable to purveyors and implementers of the EBS, guiding future equity work in LHDs. 

Significance and

Conclusion:
The HEIA serves as a useful tool to reflect on past practices and provides a structured and systematic way to center health equity work- providing tangible ways to utilize data and engage communities. Ensuring the work we do is rooted in equitable practices and engagement is critical in shaping the future of more holistic and impactful work in MCH.

Abbreviated Description: In 2016, NC Department of Public Health launched Improving Community Outcomes for Maternal and Child Health (ICO4MCH). ICO4MCH funded local health department (LHDs) collaboratives to implement specific evidence-based strategies (EBS). These LHDs were tasked with conducting Health Equity Impact Assessments (HEIAs) to modify the process of EBS implementation. This presentation explores the impact of the HEIAs on the implementation processes of LHDs-specifically the operationalization of modifications and the engagement of community members, particularly within underserved populations. Key themes and lessons learned help to elucidate how HEIAs serve as a structured, systematic, and tangible way to center health equity, reflect on past processes, and inform improvements in future work.