|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.