scholarly journals Implementation science should give higher priority to health equity

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ross C. Brownson ◽  
Shiriki K. Kumanyika ◽  
Matthew W. Kreuter ◽  
Debra Haire-Joshu
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Social Determinants ◽  
Implementation Strategies ◽  
Evidence Base ◽  
Central Feature ◽  
Health Differences ◽  
Health Related Research ◽  
Health Related ◽  
The Usa

Abstract Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

scholarly journals Embracing policy implementation science to ensure translation of evidence to cancer control policy

2021 ◽  
Vol 11 (11) ◽  
pp. 1972-1979
Author(s):  
Karen M Emmons ◽  
David Chambers ◽  
Ali Abazeed
Keyword(s):  
Policy Implementation ◽  
Implementation Science ◽  
Scientific Discovery ◽  
Scientific Evidence ◽  
Cancer Control ◽  
Control Policy ◽  
Evidence Base ◽  
Future Research ◽  
Health Related ◽  
The Usa

Abstract Although health-related policies are abundant, efforts to understand how to ensure that these policies serve as an effective vehicle for translating scientific evidence are relatively sparse. This paper explores how policy-focused implementation science (IS) may contribute to understanding the translation of scientific evidence to health-related policy in governmental and nongovernmental sectors. Expanding the focus of implementation science in cancer control could systematically address policy to both increase the use of scientific evidence in general and to address health equity. In this Commentary, we look to relevant work outside of IS that could be informative, most notably from the field of political science. We propose several ideas for future research that could help move the field of policy implementation science in cancer control in the USA forward. Although most efforts to increase uptake of the scientific evidence base reference translation to “practice and policy,” there has been relatively little emphasis in the USA on implementation at the policy level, especially related to cancer control. If we are to achieve the full benefits of scientific discovery on population and public health, we will need to consider policy as a critical mechanism by which evidence can be translated to practice. We have a robust set of methods within implementation science that are increasing the pace of adoption and maintenance of evidence-based programs in a variety of settings. Building on these efforts, the time is right to expand our focus to include policy implementation.

Dissemination and Implementation Research in Health

2017 ◽  
Keyword(s):  
Evidence Base ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Collaborative Partnerships ◽  
Social Service Agencies ◽  
Effective Interventions ◽  
Health Related Research ◽  
Health Related ◽  
Dissemination And Implementation Research ◽  
Policies And Programs

Fifteen to twenty years is how long it takes for the billions of dollars of health-related research to translate into evidence-based policies and programs suitable for public use. Over the past 15 years, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental health, and health care settings. Dissemination and implementation (D&I) research seeks to understand how to best apply scientific advances in the real world, by focusing on pushing the evidence-based knowledge base out into routine use. To help propel this crucial field forward, leading D&I scholars and researchers have collaborated to put together this volume to address a number of key issues, including: how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes. D&I studies must also take into account the barriers to uptake of evidence-based interventions in the communities where people live their lives and the social service agencies, hospitals, and clinics where they receive care. The challenges of moving research to practice and policy are universal, and future progress calls for collaborative partnerships and cross-country research. The fundamental tenet of D&I research—taking what we know about improving health and putting it into practice—must be the highest priority. This book is nothing less than a roadmap that will have broad appeal to researchers and practitioners across many disciplines.

scholarly journals Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

2021 ◽  
Vol 2 ◽  
pp. 263348952110494
Author(s):  
Rachel C. Shelton ◽  
Prajakta Adsul ◽  
April Oh ◽  
Nathalie Moise ◽  
Derek M. Griffith
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Health Inequities ◽  
Evidence Based ◽  
Racial Equity ◽  
Structural Racism ◽  
Core Elements ◽  
Evaluation Approaches

Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.

scholarly journals The contribution of implementation science to improving the design and evaluation of integrated care programmes for older people with frailty

2019 ◽  
Vol 27 (3) ◽  
pp. 232-240 ◽  
Author(s):  
Euan Sadler ◽  
Jane Sandall ◽  
Nick Sevdalis ◽  
Dan Wilson
Keyword(s):  
Older People ◽  
Integrated Care ◽  
Implementation Science ◽  
Stakeholder Engagement ◽  
Implementation Strategies ◽  
Evidence Base ◽  
Future Research ◽  
Content Type ◽  
Policy Practice ◽  
Local Setting

Purpose The purpose of this paper is to discuss three potential contributions from implementation science that can help clinicians and researchers to design and evaluate more effective integrated care programmes for older people with frailty. Design/methodology/approach This viewpoint paper focuses on three contributions: stakeholder engagement, using implementation science frameworks, and assessment of implementation strategies and outcomes. Findings Stakeholder engagement enhances the acceptability of interventions to recipients and providers and improves reach and sustainability. Implementation science frameworks assess provider, recipient and wider context factors enabling and hindering implementation, and guide selection and tailoring of appropriate implementation strategies. The assessment of implementation strategies and outcomes enables the evaluation of the effectiveness and implementation of integrated care programmes for this population. Research limitations/implications Implementation science provides a systematic way to think about why integrated care programmes for older people with frailty are not implemented successfully. The field has an evidence base, including how to tailor implementation science strategies to the local setting, and assess implementation outcomes to provide clinicians and researchers with an understanding of how their programme is working. The authors draw out implications for policy, practice and future research. Originality/value Different models to deliver integrated care to support older people with frailty exist, but it is not known which is most effective, for which individuals and in which clinical or psychosocial circumstances. Implementation science can play a valuable role in designing and evaluating more effective integrated care programmes for this population.

scholarly journals Strengthening methods for tracking adaptations and modifications to implementation strategies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amber D. Haley ◽  
Byron J. Powell ◽  
Callie Walsh-Bailey ◽  
Molly Krancari ◽  
Inga Gruß ◽  
...  
Keyword(s):  
Implementation Science ◽  
Implementation Strategy ◽  
De Novo ◽  
Scale Up ◽  
Implementation Strategies ◽  
Effective Strategies ◽  
Implementing Change ◽  
Reporting Framework ◽  
Health Related ◽  
Seeking Help

Abstract Background Developing effective implementation strategies requires adequate tracking and reporting on their application. Guidelines exist for defining and reporting on implementation strategy characteristics, but not for describing how strategies are adapted and modified in practice. We built on existing implementation science methods to provide novel methods for tracking strategy modifications. Methods These methods were developed within a stepped-wedge trial of an implementation strategy package designed to help community clinics adopt social determinants of health-related activities: in brief, an ‘Implementation Support Team’ supports clinics through a multi-step process. These methods involve five components: 1) describe planned strategy; 2) track its use; 3) monitor barriers; 4) describe modifications; and 5) identify / describe new strategies. We used the Expert Recommendations for Implementing Change taxonomy to categorize strategies, Proctor et al.’s reporting framework to describe them, the Consolidated Framework for Implementation Research to code barriers / contextual factors necessitating modifications, and elements of the Framework for Reporting Adaptations and Modifications-Enhanced to describe strategy modifications. Results We present three examples of the use of these methods: 1) modifications made to a facilitation-focused strategy (clinics reported that certain meetings were too frequent, so their frequency was reduced in subsequent wedges); 2) a clinic-level strategy addition which involved connecting one study clinic seeking help with community health worker-related workflows to another that already had such a workflow in place; 3) a study-level strategy addition which involved providing assistance in overcoming previously encountered (rather than de novo) challenges. Conclusions These methods for tracking modifications made to implementation strategies build on existing methods, frameworks, and guidelines; however, as none of these were a perfect fit, we made additions to several frameworks as indicated, and used certain frameworks’ components selectively. While these methods are time-intensive, and more work is needed to streamline them, they are among the first such methods presented to implementation science. As such, they may be used in research on assessing effective strategy modifications and for replication and scale-up of effective strategies. We present these methods to guide others seeking to document implementation strategies and modifications to their studies. Trial registration clinicaltrials.gov ID: NCT03607617 (first posted 31/07/2018).

Climate change glossary for public health practice: from vulnerability to climate justice

2020 ◽  
pp. jech-2020-213889
Author(s):  
Chris G Buse ◽  
Rebecca Patrick
Keyword(s):  
Public Health ◽  
Climate Change ◽  
Health Equity ◽  
Public Health Practice ◽  
Climate Justice ◽  
Intersectoral Collaboration ◽  
Local Health ◽  
Health Community ◽  
Health Related Research ◽  
Health Related

Climate change is an emerging and growing field of practice for the international public health community. As practitioners, researchers and policy-makers grapple with the local health impacts of climate change, there is an increasing need to clarify key terminology to support public health actors engage and respond in ways that promote intersectoral collaboration. This contribution introduces the public health discourse on climate change, with a particular focus on its implications for health equity. After defining key terms and existing adaptation practices, climate justice and assets-oriented inquiry into the intersectional determinants of health are discussed as future opportunities for addressing health equity in climate and health-related research and practice.

scholarly journals Commentary: Policy Implementation Science - An Unexplored Strategy to Address Social Determinants of Health

2021 ◽  
Vol 31 (1) ◽  
pp. 133-138
Author(s):  
Karen M. Emmons ◽  
David A. Chambers
Keyword(s):  
Physical Education ◽  
Policy Implementation ◽  
Implementation Science ◽  
Health Equity ◽  
Social Determinants ◽  
Scientific Evidence ◽  
Natural Experiments ◽  
Great Opportunity ◽  
Policy Proposal ◽  
Implementation Processes

This commentary explores the ways in which robust research focused on policy implementation will increase our ability to understand how to – and how not to – ad­dress social determinants of health.We make three key points in this commen­tary. First, policies that affect our lives and health are developed and implemented every single day, like it or not. These include “small p” policies, such as those at our workplaces that influence whether we have affordable access to healthy food at work, as well as “large P” policies that, for example, determine at a larger level whether our children’s schools are required to provide physical education. However, policies interact with context and are likely to have differential effects across different groups based on demographics, socioeconomic sta­tus, geography, and culture. We are unlikely to improve health equity if we do not begin to systematically evaluate the ways in which policies can incorporate evidence-based approaches to reducing inequities and to provide structural supports needed for such interventions to have maximal impact. A policy mandating physical education in schools will do little to address disparities in fitness and weight-related outcomes if all schools cannot provide the resources for physical education teachers and safe activity spaces.Second, as we argue for an increased emphasis on policy implementation science, we acknowledge its nascent status. Although the field of implementation science has be­come increasingly robust in the past decade, there has been only limited application to policy. However, if we are strategic and systematic in application of implementation science approaches and methods to health-related policy, there is great opportunity to discover its impact on social determinants. This will entail fundamental work to de­velop common measures of policy-relevant implementation processes and outcomes, to develop the capacity to track policy proposal outcomes, and to maximize our capacity to study natural experiments of policy implementation.Third, development of an explicit policy implementation science agenda focused on health equity is critical. This will include efforts to bridge scientific evidence and policy adoption and implementation, to evaluate policy impact on a range of health equity outcomes, and to examine differen­tial effects of varied policy implementation processes across population groups.We cannot escape the reality that policy influences health and health equity. Policy implementation science can have an important bearing in understanding how policy impacts can be health-promoting and equitable.Ethn Dis. 2021;31(1):133-138; doi:10.18865/ed.31.1.133

scholarly journals Fostering Healthy Mental, Emotional, and Behavioral Development Through Effective Implementation and Scale-Up

2020 ◽  
Vol 15 (3) ◽  
pp. 86-112
Author(s):  
Erin Kellogg
Keyword(s):  
Implementation Science ◽  
Scale Up ◽  
Implementation Strategies ◽  
Science Research ◽  
Well Being ◽  
The United States ◽  
Behavioral Development ◽  
Evidence Base ◽  
Effective Strategies ◽  
Effective Implementation

The evidence base around what causes mental, emotional, and behavioral disorders is substantial. Likewise, researchers have found methods for preventing and treating disorders, as well as for promoting healthy mental, emotional, and behavioral well-being. However, high rates of these disorders continue to persist in children and adolescents across the United States. A recent report from the National Academies of Sciences, Engineering, and Medicine entitled Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda explores updated research in epidemiology, risk and protective factors, effective strategies, and implementation science that will help diverse partners and stakeholders better support healthy mental, emotional, and behavioral development. This paper outlines the implementation science research related to programs detailed in the report and emphasizes the key components for successful intervention implementation and scale-up. It highlights the necessity of identifying core intervention components, as well as other factors such as community partnerships, implementation strategies, and the systems capacities necessary for increasing success and sustainability.

Adaptation in Dissemination and Implementation Science

2017 ◽  
Author(s):  
Ana A. Baumann ◽  
Leopoldo J. Cabassa ◽  
Shannon Wiltsey Stirman
Keyword(s):  
Implementation Science ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Research And Practice ◽  
Implementation Outcomes ◽  
Dissemination And Implementation Science ◽  
Dissemination And Implementation Research

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

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