Grounding implementation science in health equity for cancer prevention and control

Abstract

Background The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute’s Consortium for Cancer Implementation Science convened an action group focused on ‘health equity and context’ to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. Discussion In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. Summary To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Community and Partner Engagement in Dissemination and Implementation Research at the National Institutes of Health: An Analysis of Recently Funded Studies and Opportunities to Advance the Field

“…The disparities-focused grants were more likely to be conducted in a community setting or at a communitybased organization and were more likely to involve multi-level interventions as compared to nondisparities grants. These ndings perhaps indicate that D&I researchers are beginning to answer the calls to truly partner with communities and devise multi-pronged strategies that address complex problems, build capacity among D&I researchers, and incorporate equity across implementation focus areas (47,55).…”

Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network

“…Further, CPCRN members noted the need to integrate implementation science frameworks-a core strength of the Network and a reflection of its long history of advancing implementation science in cancer prevention and control. Aligned with the recent calls in implementation science for an explicit focus on health equity, anti-racism, and structural racism, the Health Equity Workgroup sought to further clarify the racial equity paradigm through the additional review of the academic and gray literature [39][40][41]. The R4P framework [42], the Government Alliance on Race and Equity (GARE) [43], and Greenlining Institute [44] were flagged as important resources to center racial equity across the principles.…”

“…The nine equity principles are informed by seminal and contemporary literature and frameworks on health equity, SDH, racial equity, CBPR, and implementation science [37][38][39][40][41][42][47][48][49][50][51][52]. We provide examples of how these guiding principles were applied in CPCRN research with diverse populations in diverse contexts [53,54].…”

Cultural adaptations and cultural factors in EBI implementation with Latinx communities

“…These theories, models, and frameworks (TMFs), constitute organized approaches for guiding adaptation planning ( 40 ). Many of these TMFs have undergone revisions to support a health equity focus ( 41 ). This provides opportunities for incorporating cultural factors into EBIs to increase the EBI's cultural relevance toward producing effective outcomes when delivered with diverse Latinx community residents.…”