Implementation science has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality is a concept introduced by Black feminist scholars that can advance equity considerations. Intersectionality emphasizes that human experience is shaped by a combination of social categories (e.g., ethnicity, gender), embedded in systemic power structures. Using an intersectional approach offers a way to improve the applicability of implementation interventions, however, intersectionality is critiqued for being difficult to apply. The objective of this study was to develop and conduct usability testing of tools to support implementation intervention developers in applying intersectionality in three key phases of implementation: identifying the gap; assessing barriers to knowledge use, and selecting, tailoring, and implementing interventions.
We used an integrated knowledge translation approach throughout the project. We assembled a development committee to develop draft tools for each of the three key implementation phases. The development committee included scholars trained in intersectionality and adult education, implementation researchers and practitioners, and health research funders. We used a mixed methods approach to revise and test the usability of each draft tool, which included semi-structured qualitative interviews with implementation intervention developers using the think-aloud method and completion of the System Usability Scale (SUS). We calculated an average summary score for each draft tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the actionable feedback to revise tools. The final tools were formatted by a graphic designer and underwent a final review.
Nine people working in Canada joined the development committee. They drafted a primer on intersectionality and one tool for each of the three key implementation phases that included recommendations, activities, reflection prompts, and resources. Thirty-one people with experience developing implementation interventions from three countries participated in usability testing. Average SUS scores of the draft tools ranged between 60 and 78/ 100. Most participants reported an intention to use the tools. They wanted tools to be shorter, contain more visualizations, and use less jargon. They identified that the “select, tailor, and implement interventions” tool included an overwhelming volume of content. The development committee significantly revised this tool to focus on “selecting and tailoring interventions”, shortened and clarified all tools, and added two one-page summary documents. The final toolkit includes six documents.
We developed and evaluated practical tools for to help embed intersectionality into implementation interventions. Future work should develop guidance for enhancing social justice in intersectionality-enhanced implementation, and exploring how to meaningfully center Indigenous considerations in an intersectional approach.