Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

McNulty M, Smith JD, Villamar J, Burnett-Zeigler I, Vermeer W, Benbow N, Gallo C, Wilensky U, Hjorth A, Mastanski B, Schenider J, Brown, CH
Source: Ethn Dis
Publication Year: 2019
Patient Need Addressed: Patient satisfaction/engagement
Intervention Type: Best practices
Type of Literature: White

Implementation science has great potential to improve the health of communities and individuals who are not achieving health equity. However, implementation science can exacerbate health disparities if its use is biased toward entities that already have the highest capacities for delivering evidence-based interventions. In this article, we examine several methodologic approaches for conducting implementation research to advance equity both in our understanding of what historically disadvantaged populations would need—what we call scientific equity—and how this knowledge can be applied to produce health equity. We focus on rapid ways to gain knowledge on how to engage, design research, act, share, and sustain successes in partnership with communities. We begin by describing a principle-driven partnership process between community members and implementation researchers to overcome disparities. We then review three innovative implementation method paradigms to improve scientific and health equity and provide examples of each. The first paradigm involves making efficient use of existing data by applying epidemiologic and simulation modeling to understand what drives disparities and how they can be overcome. The second paradigm involves designing new research studies that include, but do not focus exclusively on, populations experiencing disparities in health domains such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations who have experienced high levels of disparities. To date, our scientific enterprise has invested disproportionately in research that fails to eliminate health disparities. The implementation research methods discussed here hold promise for overcoming barriers and achieving health equity.

Insights Results

Overview of article

  • This article focuses on evaluating ways to gain knowledge on how to design and conduct research and share, adapt and sustain implementation and healthcare successes in partnership with communities in order to diminish health inequities. The article also evaluates the methodological and conceptual considerations about health equity and health disparities in implementation science

Key takeaways/implications

  • Community-partnered participatory research (CPPR) and community-based participatory (CBPR) can help achieve health equity in implementation science. Arriving at a shared research agenda in partnership with communities requires the development of a shared partnership culture, which depends on level of trust, perceived benefit from the research and researchers’ ongoing engagement and commitment to the community’s priorities
  • 3 methodological paradigms may be used in implementation research to address health equity: 1) Using existing data to understand what drives disparities and how they can be overcome – This approach relies on administrative records or research studies to elucidate the extent of population-level disparities, mechanisms that can explain them, and the likely impact of specific implementation strategies on reducing disparities; 2) Including populations with health inequity in new implementation research – This paradigm involves designing new implementation research studies that include, but do not focus exclusively on populations with a history of health disparities (e.g., racial minorities). This approach provides a way of generating information that increases scientific equity through testing of implementation strategies at a higher level. Examples include The Collaborative Care Model (a randomized rollout implementation trial that aims to improve use of antidepressants for Blacks and Hispanics) and Guy2Guy (a technology-delivered peer-based text messaging intervention that can be tailored to diverse groups based on shared linguistic factors, specifically being used for HIV prevention among adolescent men who have sex with men); and 3) Implementation research focused exclusively on populations experiencing inequities – Conducting implementation research that brings evidence-based interventions to populations that have experienced high levels of disparities. This paradigm is challenging to implement because typically populations with health disparities have been underrepresented in effectiveness trials and may be less likely to access the traditional healthcare system
  • These paradigms should be used together to maximize effect. For example, studies that fall within Paradigm 3 can be informed by existing data in Paradigm 1
  • Challenges with the outlined paradigms include lack of availability of necessary data, poor outreach and/or low engagement from disadvantaged populations, and long duration of development of an evidence-based intervention
  • Scaling out implementation strategies should be the guiding methodology for broad-based adoption and to achieve faster implementation