112 - Using an Equity Framework for Program Development and Evaluation: The Added Complexities of Incorporating Intersectionality and Aging

Abstract Information: In this session, we will discuss the role of equity frameworks in guiding organization development and evaluation planning. Members of our team will briefly share our experience developing a new center with a health equity mission. We hope to facilitate a discussion regarding the role of equity frameworks in evaluation and how to choose or adapt an equity framework that supports the organization's mission and facilitates equitable data collection, assessment, planning, and decision-making. We will also discuss specific challenges to using an intersectional approach, and how intersectionality can both be a tool for engaging partners but may also add social complexity to the problem situation. The Oregon Health Authority (OHA) recently funded a new center committed to supporting Oregonians' behavioral health as they age. As the evaluation team of the Oregon Center of Excellence in Behavioral Health and Aging (OCEBHA), we sought to develop our program theory and evaluation design using an equity framework based on direction from OHA and our mission to serve aging Oregonians and their families equitably. We adapted the Bay Area Health Inequities Initiative (BARHII) framework, which the OHA regularly uses to engage community partners. Then, we applied this framework to our evaluation plan. During this process, we ran into multiple challenges. First, we needed to adapt and add to the BARHII framework, a widely used framework for promoting health equity in public health, as it does not include age or aging as a factor informing inequities, living conditions, risk behaviors, or disease/injury. Using the lens of intersectionality and theories of lifecourse and weathering, we found the existing framework did not allow for the complexity of compounding life experiences or factors such as the higher prevalence of multigenerational households among lower-income and racially minoritized populations. To account for this, we added an arrow indicating the compounding lifecourse effect to the inequity, risk behavior, and disease/injury domains of the framework. We also added factors from the National Institute on Aging Health Disparities framework to the applicable domains. Second, using an intersectional approach can imply a need to disaggregate population data, a task outside of our scope of work. Instead of attempting to look at outcomes for each sector or the population broken down by various demographic combinations, we recognized the implications of intersectionality and sought to create measures that correspond with meeting the needs of the older adults and their families experiencing the most marginalization. Furthermore, this informed our recruitment of intersectoral collaborators and advisory board members. Finally, we faced challenges in effectively communicating the resulting framework due to its complexity. To navigate this, we broke the framework down by domains with corresponding graphics and guiding questions for planning and decision-making.