Equity-focused theories, models, and frameworks in implementation science: a scoping review and critical appraisal

Implementation science theories, models and frameworks (TMFs) can guide implementation research and practice to address widening inequities in healthcare access, quality, and health outcomes. This scoping review aimed to map and critically appraise implementation science TMFs explicitly created or adapted to advance health equity. We conducted a scoping review using Joanna Briggs Institute guidance. We searched MEDLINE, CINHAL, and five implementation science and equity journals from inception to May 20, 2025. Eligible records were primary descriptions of (i) implementation science TMFs purposely built to advance health equity or (ii) equity-focused adaptations of existing implementation science TMFs. Applications of TMFs in research or practice and non-implementation science TMFs were excluded. Two reviewers independently screened titles/abstracts then full texts in Covidence with consensus adjudication. Data were charted on a standardized form, and each TMF underwent duplicate critical equity appraisal against eight a priori criteria with an equity expert providing methodological input. Findings were summarized narratively and in evidence tables. From 6,012 records, 42 TMFs were included (23 adaptations of existing TMFs, 19 purpose-built), and most (69%) were published after 2020. Geographic provenance was heavily skewed with 67% originating in the United States; none originated in low-income countries. Most included TMFs aimed to orient the implementation process (45%) or assess determinants (23%). Assessment of TMFs according to eight equity criteria showed uneven coverage: 90% explicitly name health inequities; 88% suggest incorporating lay knowledge; 86% promote cultural responsiveness; 64% emphasize two-way learning and relationship building, and 60% consider structural determinants. However, only 45% propose concrete community co-ownership mechanisms; 40% outline strategies to mitigate inequities; and 40% offer processes addressing structural barriers. Seven TMFs (17%) covered all eight equity criteria. Equity-focused TMFs are proliferating, but most originate in high-income countries and few provide concrete guidance for addressing structural determinants of health inequities. Before use, researchers and practitioners should critically appraise candidate TMFs with communities and equity experts, co-adapt them to local contexts, and, where necessary, extend them to strengthen underdeveloped domains such as structural change and community co-ownership. N/A.