Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY.
Department of Medicine, University of New Mexico, Albuquerque, NM.
Ethn Dis. 2021 May 20;31(Suppl 1):357-364. doi: 10.18865/ed.31.S1.357. eCollection 2021.
Implementation science (IS) has emerged in response to a striking research-to-practice gap, with the goal of accelerating and addressing the development, translation, and widespread uptake of evidence-based interventions (EBIs). Despite the promise of IS, critical gaps and opportunities remain within the field to explicitly facilitate health equity, particularly as they relate to the role of social determinants of health and structural racism. In this commentary, we propose recommendations for the field of IS to include structural racism as a more explicit focus of our work. First, we make the case for including structural racism as a construct and promote its measurement as a determinant within existing IS frameworks/models, laying the foundation for an empirical evidence base on mechanisms through which such factors influence inequitable adoption, implementation, and sustainability of EBIs. Second, we suggest considerations for both EBIs and implementation strategies that directly or indirectly address structural racism and impact health equity. Finally, we call for use of methods and approaches within IS that may be more appropriate for addressing structural racism at multiple ecological levels and clinical and community settings in which we conduct IS, including community-based participatory research and stakeholder engagement. We see these as opportunities to advance the focus on health equity within IS and conclude with a charge to the field to consider making structural racism and the dismantling of racism an explicit part of the IS research agenda.
实施科学（IS）的出现是为了应对明显的研究与实践之间的差距，旨在加速和解决基于证据的干预措施（EBIs）的开发、转化和广泛应用。尽管实施科学有很大的潜力，但该领域仍然存在着明显的差距和机会，特别是在社会决定因素和结构性种族主义与健康公平的关系方面。在这篇评论中，我们建议将结构性种族主义作为实施科学领域工作的一个更明确的重点。首先，我们提出将结构性种族主义作为一个结构纳入其中，并促进在现有的实施科学框架/模型中对其进行衡量，为研究这些因素如何影响 EBI 的不平等采用、实施和可持续性的机制奠定基础。其次，我们建议考虑直接或间接解决结构性种族主义和影响健康公平的 EBIs 和实施策略。最后，我们呼吁在实施科学中使用可能更适合在我们开展实施科学的多个生态水平和临床及社区环境中解决结构性种族主义的方法和方法，包括社区参与式研究和利益相关者参与。我们认为这些是在实施科学中关注健康公平的机会，并呼吁该领域考虑将结构性种族主义和消除种族主义作为实施科学研究议程的一个明确部分。
