Table 1.

Characteristics of implementation science and cultural adaptations

Characteristics	Implementation science	Cultural adaptations
Definition	‘the scientific study of methods to promote the integration of research findings and evidence-based interventions into health care policy and practice’ (PAR-10-038).	“the systematic modification of an evidence-based treatment (EBT) to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns meanings and values’ [17].
Example of research questions	• How to balance the need to maintain the fidelity of established interventions as they were created, and customize them to local context to increase their relevance, appropriateness, use and uptake?	• What elements of the EBTs need to be adapted to enhance their fit, cultural relevance, and social validity to a specific ethno-cultural group or setting?
	• How to involve and get genuine buy-in and collaboration from multiple stakeholders in the process of implementation?	• How does the culturally adapted EBT retain the active ingredients of the original EBT?
	• How to sustain interventions given constrained financial and human resources and shifting political climates and priorities?	• Will the culturally adapted EBT achieve better client outcomes than the original intervention?
Fidelity perspectives	Balance adaptation and fidelity	Balance adaptation and fidelity
Emphasis of cultural elements	Organizational level and knowledge exchanges between stakeholders	Provider and client levels
Typical unit of analysis	Providers, clinical units, organizations or systems, communities	Patients, families/caregivers, providers
Potential challenges in reducing racial and ethnic disparities in mental health care	• Most implementation trials do not quantify or directly examine their impact in reducing racial and ethnic mental health care disparities	• Culturally adapted EBTs are rarely used in usual care settings
	• Few implementation strategies exist for transporting EBTs in racially and ethnically minority communities	• Culturally adapted EBTs lack explicit attention to implementation context and implementation strategies
	• Most implementation trials do not document the adaptation process when implementing EBT	• Limited evidence that culturally adapted EBTs are more cost- effective than non-adapted EBTs