Inequity in Implementation: A perspective from two implementation science students
Health disparities are, sadly, familiar to many working in health and health services. There is little argument that health disparities are important issues to address. A wealth of evidence demonstrates the economic and social costs of these unjust outcomes. Implementation science is positioned to address health disparities because it is the study and practice of taking what works and ensuring that it reaches communities who need it most. Yet, the field continues to grapple with understanding disparities using implementation research methods, understanding inequity in context, and equitably implementing evidence-based programs. As implementation science students we are building key research and practice skills and we recognize the inequity in implementation. Our observations center on equity training available to the implementation workforce and tools and frameworks that consider both implementation and equity.
As the field of implementation science has grown, the availability of didactic courses and mentoring opportunities focused on implementation research and disparities has also grown. As described by Boyce et al. there are a number of available training resources and career grants for those interested in implementation research and disparities.1 But other areas also need attention. Notably, training on collaborating and building relationships with underrepresented communities. Vulnerable populations should be represented, not through means of tokenism, but as ongoing and valued contributors. These members bring an understanding of culture and context critical for various attributes of successful implementation including, feasibility, acceptance, and adaptability. A blog post by DuMont, Metz, and Woo, also highlight the importance of training on inclusion and collaboration within implementation teams. Cultivating trust in collaboration, providing equitable compensation for researchers and community members, and being immersed in communities to understand context and systemic issues are some of the training needs the authors highlighted.
In addition to researchers, it is also important that practitioners be trained about equity in implementation. Implementation researchers do not fill in the gap for the practice workforce. There must be investment in equity training for the professionals who are responsible for implementing interventions and programs.
Beyond training, there are a dearth of implementation tools and frameworks that include a focus on equity. Woodward et al. appropriately describe this challenge, noting that without an explicit focus on health equity, existing implementation frameworks may neglect implementation issues that contribute to healthcare disparities.2 Indeed, existing tools that omit equity may exacerbate existing inequities by leading researchers to focus on determinants that are less relevant for vulnerable populations experiencing the disparities.2 Developing such tools offers implementation researchers opportunities to adequately promote health equity. These frameworks are critical to address health disparities.
With its focus on effective introduction and sustainment of effective practices, implementation science has much to contribute to reducing disparities and improving equity in health. But the field must strengthen the focus on equity among the implementation science workforce and develop tools useful for examining implementation and equity. These are areas we are committed to addressing as future researchers and practitioners. We will continue to challenge the current and future implementation science workforce to better integrate equity in implementation.
Read the full Boyce et al. abstract
Read the full Woodward et al. abstract
1. Boyce CA. Building the next generation of implementation science careers to advance health equity. Ethnicity & disease. 2019;29(suppl 1):77-82. doi: 10.18865/ed.29.S1.77.
2. Woodward EN, Matthieu MM, Uchendu US, Rogal S, Kirchner JE. The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment. Implement Sci. 2019;14(1):26. Published 2019 Mar 12. doi:10.1186/s13012-019-0861-y