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. |