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

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.