Table 1.

Priority questions and considerations for the field to enhance the equitable impact of Implementation Science

1. Enhance and Extend Public Health, Community and Multi-sectoral Partnerships to Promote Health Equity & Equitable Implementation	• How can we better build the trust and trustworthiness of our institutions to facilitate community engagement? • How can we identify and support trusted messengers who can help bridge and synergize community and clinical implementation efforts? • What is the balance of meaningful engagement that is fair, equitable, and does not burnout partners? • What are implementation strategies that can build community capacity, power, resources, and ownership? • How can we overcome the paradox of innovation and disconnect between research to practice to more rapidly learn bi-directionally from community and practice innovations? • What do nexus and bridges need to look like to support more equitable impact in public health and prevention?
2. Revisit, Build, and Re-imagine the Evidence Base Needed to Promote Health Equity and Impact Multiple Levels	• How do we take into consideration other factors beyond implementation with a health equity focus? • How can implementing settings and practitioners balance health needs with social needs in systemically marginalized settings? • How can we address underlying structural factors and social determinants of health that affect implementation? • How can we more rapidly build an evidence base to promote equity with EBIs that can be spread and scaled for greater impact? • What are the values, biases, and assumptions we bring (as individuals and in our scientific disciplines) that have implications for the evidence-base, the selection/prioritization of EBIs, and potential unintended consequences? • What are the key types of adaptations to EBIs that matter for enhancing health equity and/or equitable implementation (while still retaining key components linked to effectiveness)? • How can we optimize benefits to populations experiencing unjust and unfair outcomes? • How can we ensure that costs are captured as part of the evidence generation process and in implementation activities so that we can understand the return on investment, cost savings, and budget impact of delivering equity-focused programs and policies?
3. Prioritize and Elevate a Focus on Policy Development, Dissemination, & Implementation Central to Addressing Equity	• How can we better develop and enact policies that are aligned with evidence that promotes health equity? • How do we more fully develop policies with early input from those affected by the policies? • How can we better accelerate the widespread dissemination and adoption of equity-focused policies and programs? • How can we optimize and enhance the equitable roll out, reach, and sustainability of policies to maximize health benefits and health equity? • What are some of the unintended consequences of policies that may contribute to or reinforce health inequities? • How can we dismantle and remove policies that are disproportionately harmful to marginalized communities and settings but are entrenched and adaptive in our systems and institutions?
4. Be Agile, Responsive and Adaptive in Application of Frameworks, Processes, and Methods to Enhance the Impact of Implementation Science	• How soon should we act on evidence in systemically marginalized communities, even as it is not “perfect” and continues to evolve? • How can we speed the translation of evidence to practice in complex, dynamic, and under-resourced settings? • How can we best measure the pace of research translation in a way that denotes impact? • Does designing EBIs for low-income communities in relation to community needs from the start accelerate speed of uptake over adapting EBIs designed for higher resource contexts and settings? • How can we be more agile and adaptive in learning from both implementation successes and failures in community-based settings and public health settings, to meaningfully reduce health inequities?
5. Identify and Redefine Meaningful Metrics for Equity & Impact in Implementation Science	• What do equitable processes look like in implementation science and how do we track them? • What are meaningful shared indicators and validated measures for equity that are pragmatic for the field? • What types of impacts are most meaningful in the context of health equity? • Is a set of implementation strategies more effective in reducing inequities or promoting equity in implementation outcomes? • What are the mechanisms by which implementation strategies impact implementation outcomes across different sub-groups? • What implementation strategies are feasible, acceptable, appropriate for populations experiencing inequities? • How to adapt implementation strategies for organizations serving populations facing structural barriers, to achieve equity in implementation outcomes?
6. Disseminate Scientific Evidence and Research Findings to Diverse Stakeholders and Partners	• How best might we involve diverse and underrepresented partners early in designing for dissemination efforts? • How can we facilitate widespread and equitable dissemination for a range of types of settings, partners, and cultures? • How can we apply advancements from the science of dissemination and communication to enhance the reach and impact of research findings for a wider range of partners, practitioners, and communities? • How can we ensure that research products and findings reach systemically marginalized communities and settings? • How can we best communicate equity-focused evidence and policies to a range of systems and contexts with variable resources, to influence evidence adoption and use?
7. Extend Focus on De-implementation, Mis-implementation, & Sustainability which are Central to Equity	• What is the prevalence of de-implementation and mis-implementation in lower resource settings and groups? • How do de-implementation and mis-implementation determinants vary in higher and lower resource settings? • For settings experiencing health inequities, how do we best enhance and communicate about underutilization of preventive services while reducing overuse of low-value care? • What implementation and sustainability strategies enhance long-term delivery and transform long-standing patterns of inequities over time? • What determinants matter most for long-term sustainment in low-resources settings and should be prioritized? How are those similar and different than those that matter for implementation? • How can we engage diverse partners in planning for sustainability? • What is the return on investment and broader impact of sustaining preventive and public health interventions, particularly in communities that experience health inequities and settings that have been disinvested?