Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

Abstract

Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.

Interventions and policy approaches to promote equity in breastfeeding

“…As highlighted by several authors in this special collection, combining interventions at different levels of the socioecological model is strongly recommended as it would address the different health and social environments necessary for equitable and successful breastfeeding. Future studies and interventions would also benefit from using implementation science frameworks and theories to address structural inequities such as class oppression, racism, and discrimination [ 22 ]. In designing, implementing, and sustaining interventions to reduce breastfeeding inequities, behavioral science research and the co-design of programs based on community needs- and wants will allow to more successfully protect, promote, and support, the right that women have to breastfeed for as long as is recommended or desired.…”

“…While women appreciated the practical, emotional and informational support of peer support interventions, one of the key findings of the study was that while non-for-profit organizations seek to enable women’s access to individual, social and community supportive breastfeeding environments, their needs are not always considered in the service development. Therefore there is a need to take into account contextual issues when conducting community engaged program co-design that effectively meets the community needs and wants [ 22 ].…”

Supporting the Growth of Domestic HIV Implementation Research in the United States Through Coordination, Consultation, and Collaboration: How We Got Here and Where We Are Headed

“…The articles in this special supplement attest to the scientific advances in HIV IR happening in the United States, but critical challenges remain to ending the HIV epidemic. As has been noted recently, the interventions needed to end the transmission of HIV are available; yet, their implementation, with equity, [27][28][29][30] is now the pressing scientific and practical challenge. 13,31 Although funding for HIV implementation research by the NIH has grown since 2013, it pales in comparison with the continued, tremendous investment in discovery and testing of new HIV prevention, treatment, and testing interventions: Less than 5% of all NIH-funded HIV research is related to IR, and only half of that research formally tests implementation strategies.…”

Grounding implementation science in health equity for cancer prevention and control

“…This scholarship recognizes and establishes the role of social determinants of health, structural and interpersonal racism, historical trauma, and cultural-centeredness for implementing evidence-based interventions, programs, practices, and policies (referred to henceforth as EBIs) [ 21 – 23 ]. Despite the development of many EBIs and their demonstrated effectiveness among populations experiencing health inequities, widespread uptake of these interventions to improve population health outcomes has been limited [ 24 – 26 ]. There continues to be a limited focus on understanding the intersection of important social and structural dimensions that impact health and include age, disability, sexual orientation, gender identity, and geographic location (e.g., rural, urban) [ 18 , 19 ], which can have implications for differing access to resources, opportunities, power, and/or obstacles that promote or hinder health.…”

“…For this paper, consistent with prior definitions [ 24 ], we consider and refer to IS as a scientific field that incorporates perspectives from research, practice, and policy with the intent to bridge the gap between these and include a focus on both dissemination and implementation research. We argue that a greater focus is needed in IS on actively promoting health equity through explicit consideration of the social and structural injustices [ 25 , 26 ]. Such an approach is critical and central to implementation science, with important implications for the types of EBIs we prioritize, disseminate, and implement in both our research and practice efforts.…”