Using implementation science to mitigate worsening health inequities in the United States during the COVID-19 pandemic

Abstract

With the threat of coronavirus disease 2019 (Covid-19) enduring in the United States, effectively and equitably implementing testing, tracing, and self-isolation as key prevention and detection strategies remain critical to safely re-opening communities. As testing and tracing capacities increase, frameworks are needed to inform design and delivery to ensure their effective implementation and equitable distribution, and to strengthen community engagement in slowing and eventually stopping Covid-19 transmission. In this commentary, we highlight opportunities for integrating implementation research into planned and employed strategies in the United States to accelerate reach and effectiveness of interventions to more safely relax social distancing policies and open economies, schools, and other institutions. Implementation strategies, such as adapting evidence-based interventions based on contextual factors, promoting community engagement, and providing data audit and feedback on implementation outcomes, can support the translation of policies on testing, tracing, social distancing, and public mask use into reality. These data can demonstrate how interventions are put into practice and where adaptation in policy or practice is needed to respond to the needs of specific communities and socially vulnerable populations. Incorporating implementation research into Covid-19 policy design and translation into practice is urgently needed to mitigate the worsening health inequities in the pandemic toll and response. Applying rigorous implementation research frameworks and evaluation systems to the implementation of evidence-based interventions which are adapted to contextual factors can promote effective and equitable pandemic response and accelerate learning both among local stakeholders as well as between states to further inform their varied experiences and responses to the pandemic.

Aiming beyond equality to reach equity: the promise and challenge of quality improvement

“…15 Through disaggregation, covid-19 research has rapidly identified disparities in outcomes and identified the need to design QI to tackle underlying determinants as well as quality of care received. 12 Design better Prioritise tackling barriers identified through your stakeholders of groups least served by the health system. Reaching the most disadvantaged will take innovations in strategies and learning from other groups already showing progress in these areas.…”

“…Measurement should include implementation outcomes such as acceptability and adoption and data elements needed to understand the underlying factors associated with success or failure in reducing inequity as quality improves. Disciplines such as implementation sciences and disparities research offer tools and frameworks that can accelerate this work 1112…”

“…For example, the English NHS has included health equity indicators to identify disadvantaged neighbourhoods and impact of expanding primary care in equity of access 15. Through disaggregation, covid-19 research has rapidly identified disparities in outcomes and identified the need to design QI to tackle underlying determinants as well as quality of care received 12…”

Liminality, disruption, and change: A prismatic look at pandemic education

“…However, due to the underrepresentation of vulnerable populations in the study, it would have missed the identifications of the impacts of in/equity, which emerged in the third team’s analysis. Impacts of inequity on vulnerable populations show up throughout the literature, such as in language (James and Thériault 2020 ), economics (Harper 2020 ), culture (Harper 2020 ), health (Jacobson et al 2020 ), and disability (James and Thériault 2020 ). Any of these can have an impact on digital access (Coyne et al 2020 ).…”

Barriers To and Strategies To Address COVID-19 Testing and Testing Hesitancy: A Rapid Scoping Review

“…Thirteen sources described the availability of testing sites as a process barrier for testing, both in general (10,25,27,32) and in specific communities (18,24,27,29,33). Transportation barriers and access to testing centres play a role in accessing COVID-19 testing sites.…”