Reflections on adapting an Equality Impact Assessment for mental health research

Although usually linked to policy and service delivery, EqIAs are also useful in research. Research decisions shape who takes part, whose experiences are represented and ultimately what evidence is produced. 

By Dr Patrick Nyikavaranda, Co-Lead of Culture, Equality, Diversity & Inclusion – NIHR Policy Research Unit in Mental Health, and Bev Chipp, Lived Experience Researcher

The NIHR Policy Research Unit in Mental Health (MHPRU) conducts research to inform national mental health policy. Within the MHPRU, we made an early commitment to embedding equity into our work. 

However, this initially sat as a broad intention rather than a clearly operationalised approach. The question became: how do we move from principle to practice in a pragmatic way within real-world research? 

A primary consideration was that because we aim for coproduction and tasks are shared, the form needed to be usable by everyone and not just academics.

The journey of adaptation

We began by looking for existing EqIA tools that were already being used in applied health research. In particular, the Equality Impact Assessment Toolkit developed by NIHR ARC East Midlands and the Centre for Ethnic Health Research (CEHR). ARC East Midlands is part of the NIHR infrastructure supporting applied health and care research, while the CEHR has longstanding expertise in inclusion, community engagement and health inequalities.

We obtained permission to adapt the toolkit for use within the MHPRU. We needed an EqIA instrument that was not too onerous to use, short enough to complete without excessive reading and clear enough to be used by everyone involved in our projects. The full toolkit was comprehensive, but for our context we needed a shorter and more navigable form. We therefore focused on adapting the core EqIA form.

This was retyped for a clean format. Iterative versions of the form were trialled in contemporary projects. The adaptation was collaborative. The form was discussed through MHPRU management meetings, project discussions and the Lived Experience Working Group, with colleagues invited to comment as it developed. Feedback from project leads helped refine wording, layout and usability. We looked at how well the research framework and processes fit the form, what might be missing and how each section was understood. 

What changes did we make?

We made several practical changes to make the form easier to use, more accessible and more relevant to mental health policy research. These included: 

• Separating the form from the guidance: detailed instructions were moved into a separate guidance document so the form itself remained uncluttered 
• Clarifying its purpose: we added a short statement explaining that the form is intended to assess impact, risks and mitigations within the research process 
• Improving navigation: we added fields for the research title, project coordinator and dates so completed forms could be identified more easily when downloaded, shared or printed 
• Improving readability: we simplified the layout and formatting to make the document easier to complete 
• Keeping the process iterative: the draft form was shared centrally so colleagues could suggest improvements as it was being tested in projects.

Walking the talk

Without intentional focus on equalities, research risks perpetuating the very disparities it aims to explore. To help us keep this in mind, we added a field for ‘team composition’ and ‘ways of working’. Initially, this was a reflective entry at the end. We then decided to put it at the top to ensure that we had equality, diversity and inclusion, and, notably, power structures, as considerations from the outset. 

The ‘ways of working’ are not only about organisation and delegation within a project but about culture, respect and reciprocity. Acronyms are often Kryptonite to lay members of a group, and so we added a field for ‘abbreviations’ and ‘acronyms’ used in this document.

There are many equality-related factors that could be considered, and not all of them will be relevant to all research projects, as most research is focused on discrete cohorts to enable findings to be applied appropriately. For this reason, we separated the protected characteristics of the Equality Act 2010, for which there are legal obligations and accompanying rights, and other characteristics which fall outside these protections but are arguably no less important to consider. 

These were laid out in a second table and included those that are particularly appropriate to our umbrella of work, as well as more general factors such as socio-economic class, housing insecurity and digital exclusion. This list could be very long, so we tried to be pragmatic and group related factors by the real-life effects on people.

The form also includes a final reflective section called ‘What worked well?’. This was included because EqIA work should not only identify risks or deficits, but also capture learning, positive practice and examples of representation or involvement that can be carried forward. 

What we are learning

Our experience suggests that EqIA tools need to be both rigorous and usable. If a form is too long or complex, it risks becoming something people avoid or complete superficially. If it is too light, it risks becoming tokenistic. The challenge is finding a balance that supports thoughtful reflection without creating unnecessary burden.

For us, the process has reinforced the idea that equity must be considered early, practically and repeatedly. It is not only about participants or final findings, but also about research questions, team composition, recruitment, language, accessibility, dissemination and ways of working.

The adapted MHPRU EqIA remains a live tool. As it is used across projects, we expect to continue learning from it and refining how it works in practice. We are happy to share the template with others and would welcome feedback from anyone interested in using or adapting it within their own research context. 

The current version of the template is available here: MHPRU Projects page.

For further information or enquiries, please contact dop.pru@ucl.ac.uk.