Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

Implementation science has great potential to improve the health of communities and individuals who are not achieving health equity. However, implementation science can exacerbate health disparities if its use is biased toward entities that already have the highest capacities for delivering evidence-based interventions. In this article, we examine several methodologic approaches for conducting implementation research to advance equity both in our understanding of what historically disadvantaged populations would need—what we call scientific equity—and how this knowledge can be applied to produce health equity. We focus on rapid ways to gain knowledge on how to engage, design research, act, share, and sustain successes in partnership with communities. We begin by describing a principle-driven partnership process between community members and implementation researchers to overcome disparities. We then review three innovative implementation method paradigms to improve scientific and health equity and provide examples of each. The first paradigm involves making efficient use of existing data by applying epidemiologic and simulation modeling to understand what drives disparities and how they can be overcome. The second paradigm involves designing new research studies that include, but do not focus exclusively on, populations experiencing disparities in health domains such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations who have experienced high levels of disparities. To date, our scientific enterprise has invested disproportionately in research that fails to eliminate health disparities. The implementation research methods discussed here hold promise for overcoming barriers and achieving health equity.Ethn Dis. 2019;29(Suppl 1):83-92; doi:10.18865/ ed.29.S1.83.

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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

Implementation Research and Practice ◽

10.1177/26334895211049482 ◽

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.

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A Comparative Analysis of Two Streams of Implementation Research

Journal of Public and Nonprofit Affairs ◽

10.20899/jpna.3.1.3-22 ◽

2017 ◽

Vol 3 (1) ◽

pp. 3 ◽

Cited By ~ 8

Author(s):

Stephen Roll ◽

Stephanie Moulton ◽

Jodi Sandfort

Keyword(s):

Implementation Science ◽

Program Implementation ◽

Implementation Research ◽

Public Affairs ◽

Implementation Framework ◽

Evidence Based Practices ◽

Comparative Review ◽

State Of Research ◽

Research Stream ◽

New Research

Increased pressure for evidence-based practices in policymaking and administration has led to the growth of a new research stream of implementation science. Little is known about how this new stream of research compares with scholarship on policy implementation within public administration. This paper provides a comparative review of more than 1,500 journal articles on policy and program implementation published between 2004-2013. Using bibliometric analysis and a content analysis of abstracts, implementation articles within public affairs journals and in the emerging implementation science stream are analyzed in terms of their content, methods, and focus. Following a multi-level implementation framework, this analysis considers the level at which research is taking place within the different venues of implementation research. Through this systematic review, this paper provides new insights about the current state of research, opening up new avenues for scholars to substantively engage with and contribute to this important area of study.

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Advancing health equity through a theoretically critical implementation science

Translational Behavioral Medicine ◽

10.1093/tbm/ibab008 ◽

2021 ◽

Author(s):

Claire Snell-Rood ◽

Elise Trott Jaramillo ◽

Alison B Hamilton ◽

Sarah E Raskin ◽

Francesca M Nicosia ◽

...

Keyword(s):

Health Disparities ◽

Implementation Science ◽

Health Equity ◽

Knowledge Production ◽

Structural Violence ◽

Critical Theories ◽

The Social ◽

Political Forces ◽

Power Inequality

AbstractWhile implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity. First, theories of postcoloniality and reflexivity foreground attention to the role of power in knowledge production and to the ways that researchers and interventionists may perpetuate the inequalities shaping health. Second, theories of structural violence and intersectionality can help us to better understand the unequal burden of health disparities in the population, thereby encouraging researchers to think beyond single interventions to initiate partnerships that can impact overlapping health vulnerabilities and influence the upstream causes of vulnerability. Finally, theories of policy and governance encourage us to examine the social-political forces of the “outer context” crucial for implementation and sustainability. The incorporation of critical theories could enhance implementation science and foster necessary reflexivity among implementation scientists. We contend that a theoretically critical implementation science will promote better science and, more importantly, support progress toward health equity.

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A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

10.21203/rs.3.rs-32704/v1 ◽

2020 ◽

Author(s):

Eva N Woodward ◽

Rajinder Sonia Singh ◽

Phiwinhlanhla Ndebele-Ngwenya ◽

Andrea Melgar Castillo ◽

Kelsey S. Dickson ◽

...

Keyword(s):

Implementation Science ◽

Health Equity ◽

Implementation Research ◽

Clinical Encounter ◽

Implementation Framework ◽

Research And Practice ◽

Practical Guide ◽

Interview Guide ◽

Practical Guidelines ◽

Science Framework

Abstract Background: Due to limited systematic integration of health equity and implementation science, it is imperative to provide researchers and practitioners tools to guide implementation in settings where there is inequitable implementation of an intervention. Our prior work documented and piloted the first published adaptation of an existing implementation science framework with health equity determinants to create the Health Equity Implementation Framework. We suggested how others’ might adapt their preferred implementation science frameworks with three health equity domains: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal influences (including but not limited to social determinants of health). This manuscript is a practical guide to utilize three health equity domains in implementation research and practice.Methods: We describe in greater depth than in our previous publication domains typical in implementation determinants frameworks and three adaptations: domains known to affect health equity. For each domain, we compiled definitions with supporting literature, defined relevant subdomains, showcased an illustrative example, and suggested sample measures, both quantitative and qualitative.Results: We describe how to incorporate the three health equity domains in one’s preferred implementation science framework, or how to use the Health Equity Implementation Framework specifically. Practical guidelines follow ten published recommendations on how to use frameworks in implementation research and practice. We describe a new case study in which the framework guided evaluation.Conclusions: Incorporating health equity domains within implementation frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. The practical guidance and tools provided can assist implementation scientists and practitioners to concretely address inequity in implementation across populations to capture and analyze information used to assess health outcomes.Contributions to the LiteratureSpecific definitions of implementation and three health equity domains with examples of how they have been applied in published literature and sample measures.Practical tools, including a qualitative interview guide and codebookCase study of how the Health Equity Implementation Framework guided analysis in an implementation study

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Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity

Ethnicity & Disease ◽

10.18865/ed.29.s1.113 ◽

2019 ◽

Vol 29 (Suppl 1) ◽

pp. 113-118 ◽

Cited By ~ 3

Author(s):

John M. Westfall ◽

Rebecca Roper ◽

Anne Gaglioti ◽

Donald E. Nease, Jr.

Keyword(s):

Primary Care ◽

Health Disparities ◽

Community Health ◽

Health Equity ◽

Implementation Research ◽

Clinical Care ◽

Research Networks ◽

Practice Based Research ◽

Care Practices ◽

Primary Care Practices

While the vast majority of people receive their medical care in community primary and specialty care clinics, most clinical research is performed in academic tertiary care hospitals and hospital clinics. Practice-based research networks are most commonly collections of primary care practices that work together to ask and answer health questions for their patients and communities and are an integral part of the translational pathway from discovery to practice to community health. Community primary care practices are at the front line of health equity issues; equity in clinical care, equity in community health, equity in social determinants of health, and equity in health outcomes. Practice-based research networks can gather and combine data from dozens of communities, hundreds of practices and thousands of patients to address health equity and disparities across the full spectrum of community and public health to clinical and primary care. This article will briefly outline the history of PBRNs, types of PBRNs, locations, topics, and patient outcomes over the past 25 years. Current PBRN efforts to address health disparities and improve health equity will be described. New PBRN opportunities to address health disparities and approaches to advance implementation research for health equity in the practice and community will be described. Readers will be challenged to consider ways to engage practice-based research networks in their health equity efforts.Ethn Dis. 2019;29(Suppl 1):113-118; doi:10.18865/ed.29.S1.113.

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Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity

Ethnicity & Disease ◽

10.18865//ed.29.s1.113 ◽

2019 ◽

Vol 29 (Suppl 1) ◽

pp. 113-118

Author(s):

John M. Westfall ◽

Rebecca Roper ◽

Anne Gaglioti ◽

Donald E. Nease, Jr.

Keyword(s):

Primary Care ◽

Health Disparities ◽

Community Health ◽

Health Equity ◽

Implementation Research ◽

Clinical Care ◽

Research Networks ◽

Practice Based Research ◽

Care Practices ◽

Primary Care Practices

While the vast majority of people receive their medical care in community primary and specialty care clinics, most clinical research is performed in academic tertiary care hospitals and hospital clinics. Practice-based research networks are most commonly collections of primary care practices that work together to ask and answer health questions for their patients and communities and are an integral part of the translational pathway from discovery to practice to community health. Community primary care practices are at the front line of health equity issues; equity in clinical care, equity in community health, equity in social determinants of health, and equity in health outcomes. Practice-based research networks can gather and combine data from dozens of communities, hundreds of practices and thousands of patients to address health equity and disparities across the full spectrum of community and public health to clinical and primary care. This article will briefly outline the history of PBRNs, types of PBRNs, locations, topics, and patient outcomes over the past 25 years. Current PBRN efforts to address health disparities and improve health equity will be described. New PBRN opportunities to address health disparities and approaches to advance implementation research for health equity in the practice and community will be described. Readers will be challenged to consider ways to engage practice-based research networks in their health equity efforts.Ethn Dis. 2019;29(Suppl 1):113-118; doi:10.18865/ed.29.S1.113.

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