A Qualitative Exploration of Barriers and Enablers to Health Equity Competencies in Clinical Practice: Application of the Health Equity Implementation Framework.

Abstract

Health equity is essential to high-quality care, yet implementation in clinical settings remains challenging. The New York State AIDS Institute developed Health Equity Competencies to guide equity-focused care. This study examined barriers and enablers to implement these competencies using the Health Equity Implementation Framework (HEIF). We conducted semi-structured interviews and focus groups with 33 participants, including physicians (39%), residents (24%), administrators (24%), medical students (18%), social workers (6%), and patients (12%). Thematic analysis, guided by the HEIF, organized findings across 5 domains: innovation, clinical encounters, patient/provider factors, inner and outer context, and societal influence. Enablers included provider commitment, culturally responsive care, and community outreach. Barriers included limited institutional policies, insufficient bias training, inadequate resources for addressing social needs, and fragmented engagement. The most critical challenges emerged in the outer context (eg, structural barriers to care) and inner context (eg, organizational gaps). Aligning provider efforts with institutional support is essential. Structured training, equity-oriented policies, and sustained community partnerships are key to operationalizing equity in clinical practice.