Table 3 Delphi open-ended responses

Round 1 Suggestions

Theme

Quote

Combine Equity with other Domains

"Not to drop equity—it should be somewhere -, but equity and reach (from implementation outcomes have considerable overlap). This could be a single implementation outcome domain."

Combine Bundled Strategies with Other Domains

“Nearly all implementation interventions are complex health interventions and hence bundled or multi-component. Any considerations related to bundled strategies should be generalized and applied to all strategies ….”

Clarify Overall Evidence of Effectiveness

"Overall evidence of effectiveness is generally understood as average effect size estimates, which are largely meaningless and unhelpful when studying complex health interventions.… strong, high-quality designs for complex health interventions require application of the core function/form framework, allowances for adaptation and tailoring and assessment of fidelity to function (not form).. Research answering the simple (simplistic) question "is intervention X effective" offers little value in implementation science, insofar as the dominant answer is 'sometimes' or 'it depends'."

Merge Medium Levels (promising/ emerging)

“I struggle a little with the distinction between Promising Strategies and Emerging Strategies. I suspect the distinction might be between the number of studies? but the conclusion seems to be the same regardless.”

Round 2 Open-ended Responses on Equity Domain Changes

Hard no on equity

"I still don't see why this isn't considered as an implementation outcome. It seems like a normative decision to separate the domain…This just seems like an unnecessary complexity."

Soft no on equity with suggested changes

"I agree with keeping it separate but think there are two separate domains: (1) the actual reach to specific populations. This can be covered elsewhere and (2) the intentionality of the strategy to reach a specific marginalized population (including involving marginalized individuals/population representatives in strategy development and research design). I think this is very reasonable to have as a separate domain. I would give examples of target populations, but not define them or leave it to the CDC to define. Some of the most marginalized populations may be identified through community engaged research and implementation science

Might consider using a more well-established definition of health equity research–for example, something from CDC or NIH. Also seems like the partner engagement would be more under engagement (broadly speaker) not explicitly called out under health equity…."