Translational framework for implementation evaluation and research: a critical approach to patient-centred equity design

Background: The field of implementation research has recently seen much interest in equity, with a strong emphasis on recognising and responding to disparities in care. Recent studies highlight the role of macro-level processes that translate meso-level institutional behaviours to micro-level healthcare practices, and that are generative of health and care inequities. They emphasise challenges patient-centredness and underscore the need for justice-oriented intervention design to address disparities and promote equitable care. Aim: To develop a patient-centred and justice-informed approach to the design of complex healthcare interventions and innovations in service delivery. Method: Patient-centred Equity Design was developed in five stages. Sociological, public health, and implementation science theories explaining the generation of modifiable inequities were identified, and relevant explanatory constructs were extracted from them and organised into a determinant framework. Framework elements were then translated into (a) process models characterizing causal mechanisms of systemic inequities; (b) generative principles to guide equity- and patient-centred interventions and services; and (c) critical design questions to appraise the ways that inequities are embedded in healthcare interventions and services. Results: Development work led to a determinant framework linking macro-level processes to meso- and micro-level healthcare inequities, and these were visualized in process models. The framework informed principles for the promotion of equitable, patient-centred interventions: fostering civility and dependability, ensuring clarity and continuity, and reducing workload and complexity. Four critical questions address relational inequalities, participation barriers, role expectations, and restitution for inequities. These were translated into proposed content for a simple appraisal tool to support the equitable design and evaluation of healthcare interventions and services. Conclusion: Patient-centred Equity Design integrates sociology, social justice, and implementation science to create equity-focused healthcare interventions. It offers a determinant framework, process models, generative principles, and critical questions to guide design. While not a validated tool, it enhances intervention development and service delivery, with potential for future Medical Research Council Framework integration. Patient- centred Equity Design provides actionable generative design principles to centre patient and caregiver experiences within intervention development, emphasizing restitution for inequities.