Skip to main content

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

From: Reframing implementation science to address inequities in healthcare delivery

 Key pointsRecommendations
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.