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      Implementation science should give higher priority to health equity


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          There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity.

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          We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts.


          Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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          Most cited references147

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          Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

          An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
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            Structural racism and health inequities in the USA: evidence and interventions

            The Lancet, 389(10077), 1453-1463
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              Is Open Access

              A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project

              Background Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. Methods Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. Results Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. Conclusions This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0209-1) contains supplementary material, which is available to authorized users.

                Author and article information

                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                19 March 2021
                19 March 2021
                : 16
                : 28
                [1 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Prevention Research Center, , Brown School at Washington University in St. Louis, ; 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
                [2 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, , Washington University School of Medicine, Washington University in St. Louis, ; St. Louis, MO 63130 USA
                [3 ]GRID grid.166341.7, ISNI 0000 0001 2181 3113, Department of Community Health and Prevention, , Drexel University Dornsife School of Public Health, ; 3215 Market Street, Philadelphia, PA 19104 USA
                [4 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Health Communication Research Laboratory, , Brown School at Washington University in St. Louis, ; 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
                [5 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Center for Diabetes Translation Research and Center for Obesity Prevention and Policy Research, , Brown School at Washington University in St. Louis, ; 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
                Author information
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 10 January 2021
                : 9 March 2021
                Funded by: FundRef http://dx.doi.org/10.13039/100007316, Division of Cancer Prevention, National Cancer Institute;
                Award ID: P50CA244431
                Funded by: FundRef http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;
                Award ID: P30DK092950
                Award ID: R25DK123008
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000130, National Center for Chronic Disease Prevention and Health Promotion;
                Award ID: U48DP006395
                Custom metadata
                © The Author(s) 2021

                implementation science,equity,health inequities
                implementation science, equity, health inequities


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