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Table 1 Reframing elements of implementation science to address inequities in healthcare delivery

From: Reframing implementation science to address inequities in healthcare delivery

  Key points Recommendations
Focus on reach from the very beginning • The underrepresentation of vulnerable populations and communities persist in clinical and implementation trials.
• Equity requires attention to reach and representation in clinical trials and implementation studies
• Studies need to mirror the context where vulnerable populations are served and live.
• Increase enrollment and engagement of vulnerable populations in clinical and implementation trials
• Broaden the settings and communities where implementation studies are conducted
Design and select intervention for vulnerable populations with implementation in mind • The linear process of intervention development contributes to implementation gaps.
• An implementation perspective to intervention development forces developers to consider the fit between the intervention and the implementation context.
• Place implementation outcomes at the forefront of the intervention development process
• Incorporate user-centered designs and participatory approaches to develop interventions with, for and in the community.
Implement what works and develop implementation strategies that can help reduce inequities in care • Evidence based interventions (EBIs) known to reduce inequities in care are not routinely used in real-world settings.
• Implementation strategies can support the adoption of EBI in vulnerable communities.
• Invest in the identification, development, and testing of implementation strategies for EBIs that can reduce healthcare inequities.
• Implementation strategies in vulnerable communities may need to include additional components (e.g., cultural competence, advocacy)
Develop the science of adaptation • Attention to the unique contextual factors that influence healthcare inequities is critical to implement EBIs in vulnerable populations.
• A broader conceptualization of adaptation is critical for addressing healthcare inequities as it expands the purview of adaptations to consider the EBI, implementation strategies, and the context of practice.
• Adaptations need to be done systematically and be guided by frameworks.
• A common data platform can be used to track and help identify optimal adaptation across different contexts and populations.
• Adaptations can be used as an implementation strategy.
Use an equity lens for implementation outcomes • Implementation outcomes are important because they are interrelated with services and client outcomes.
• Limited attention has been given to examining issues of equity in implementation outcomes.
• Descriptive and explanatory studies are needed to identify the factors and mechanisms that contribute to inequities in implementation outcomes
• Conduct studies to develop, test, and refine implementation strategies to achieve equity in implementation outcomes.