Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

Background. Implementation science has great potential to improve the health of communities and individuals that experience disparities. However, it can exacerbate disparities if its use is biased towards entities that already have the highest capacities for delivering evidence-based interventions.

Methods. In this paper 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 with, design research, act, share, and sustain successes in partnership with communities.

Results. 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 such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations that have experienced high levels of disparities. Completed and ongoing prevention studies are presented to illustrate each paradigm. These examples are diverse in content area (e.g., suicide, obesity, HIV) and population (e.g., racial/ethnic groups, transwomen, men who have sex with men) and implementation research design.

Conclusions. 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. These methods need to be thoughtfully applied to address disparities across areas of prevention and investment ought to be proportional to the disparities observed.