Harnessing Implementation Science to Increase the Impact of Health Equity Research

Chinman M, Woodward EN, Curran GM, Hausmann LRM
Source: Med Care
Publication Year: 2017
Study Design: Other Study Design
Type of Literature: White
link: https://www.ncbi.nlm.nih.gov/pubmed/28806362
Abstract

BACKGROUND:
Health disparities are differences in health or healthcare between groups based on social, economic, and/or environmental disadvantage. Disparity research often follows 3 steps: detecting (phase 1), understanding (phase 2), and reducing (phase 3), disparities. Although disparities have narrowed over time, many remain.

OBJECTIVES:
We argue that implementation science could enhance disparities research by broadening the scope of phase 2 studies and offering rigorous methods to test disparity-reducing implementation strategies in phase 3 studies.

METHODS:
We briefly review the focus of phase 2 and phase 3 disparities research. We then provide a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research.

RESULTS:
Most health disparities research emphasizes patient and provider factors as predominant mechanisms underlying disparities. Applying implementation science frameworks like the Consolidated Framework for Implementation Research could help disparities research widen its scope in phase 2 studies and, in turn, develop broader disparities-reducing implementation strategies in phase 3 studies. Many phase 3 studies of disparity-reducing implementation strategies are similar to case studies, whose designs are not able to fully test causality. Implementation science research designs offer rigorous methods that could accelerate the pace at which equity is achieved in real-world practice.

CONCLUSIONS:
Disparities can be considered a “special case” of implementation challenges-when evidence-based clinical interventions are delivered to, and received by, vulnerable populations at lower rates. Bringing together health disparities research and implementation science could advance equity more than either could achieve on their own.

Insights Results

Overview of article

  • Much of the existing research on health disparities focuses on patient and provider factors as predominant underlying mechanisms. In turn, most existing strategies to reduce disparities target patients and/or providers and rarely target system-level factors that likely contribute to health disparities. Broadening the scope of disparities research to include larger ecological levels (e.g., clinics, hospitals, systems) and factors that indirectly influence healthcare delivery (e.g., leadership support for a focus on equity) could open additional research avenues that yield better equity outcomes

Methods of article

  • This study briefly reviews the focus of phase 2 and phase 3 disparities research. The study then provides a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research
  • Overall, there are relatively few efficacious and effective implementation strategies that have been tested for their impact on disparities, as documented in multiple literature reviews commissioned by Robert Wood Johnson Foundation’s (RWJF) Finding Answers initiative

Results

  • While implementation science tools can be helpful in designing disparities research to address factors across multiple ecological levels that may contribute to disparities, it’s important to recognize that implementation science is not a panacea for reducing disparities. For instance, although implementation science exposes aspects of the healthcare system that are not often the focus of health disparities research, it can also leave out issues that are important for increasing uptake of an evidence-based practices and reducing health disparities that are outside the control of healthcare systems (e.g., availability of healthy food, exercise space, poverty)

Key takeaways/implications

  • Not every disparity is a result of inadequate or inequitable healthcare delivery. Research on biological underpinnings of health disparities is needed to ensure treatment advancements are effective across all patient populations. However, bringing together health disparities research and implementation science could advance equity more effectively than either could achieve on their own
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