Maritim Patricia, Munakampe Margarate Nzala, Nglazi Mweete, Mweemba Chris, Sikombe Kombatende, Mbewe Wilson, Silumbwe Adam, Jacobs Choolwe, Zulu Joseph Mumba, Herce Michael, Mutale Wilbroad, Halwindi Hikabasa
Implementation Science Centre for Advancing Practice and Training (IMPACT), University of Zambia, Lusaka, Zambia.
Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
Implement Sci Commun. 2024 Oct 29;5(1):121. doi: 10.1186/s43058-024-00663-z.
BACKGROUND: As the field of implementation science continues to grow, its key concepts are being transferred into new contexts globally, such as Low and Middle Income Countries (LMICs), and its use is constantly being reexamined and expanded. Theoretical and methodological positions commonly used in implementation research and practice have great utility in our work but in many cases are at odds with LMIC contexts. As a team of implementation scientists based in Zambia, we offer this commentary as a critical self-reflection on what has worked and what could limit us from fully utilizing the field's promise for addressing health problems with contextual understanding. MAIN BODY: We used a 'premortem,' an approach used to generate potential alternatives from failed assumptions about a particular phenomenon, as a way to reflect on our experiences conducting implementation research and practice. By utilizing prospectively imagined hindsights, we were able to reflect on the past, present and possible future of the field in Zambia. Six key challenges identified were: (i) epistemic injustices; (ii) simplified conceptualizations of evidence-informed interventions; (iii) limited theorization of the complexity of low-resource contexts and it impacts on implementation; (iv) persistent lags in transforming research into practice; (v) limited focus on strategic dissemination of implementation science knowledge and (vi) existing training and capacity building initiatives' failure to engage a broad range of actors including practitioners through diverse learning models. CONCLUSION: Implementation science offers great promise in addressing many health problems in Zambia. Through this commentary, we hope to spur discussions on how implementation scientists can reimagine the future of the field by contemplating on lessons from our experiences in LMIC settings.
背景:随着实施科学领域不断发展,其关键概念正在全球范围内被应用于新的情境中,如低收入和中等收入国家(LMICs),并且其应用也在不断地被重新审视和扩展。实施研究与实践中常用的理论和方法立场在我们的工作中具有很大的实用性,但在许多情况下与低收入和中等收入国家的情境不一致。作为一支来自赞比亚的实施科学家团队,我们提供这篇评论,作为对哪些方法有效以及哪些因素可能限制我们在结合情境理解的情况下充分利用该领域解决健康问题的潜力进行的批判性自我反思。 正文:我们采用了“事前剖析”方法,即一种用于从对特定现象的错误假设中生成潜在替代方案的方法,以此来反思我们开展实施研究与实践的经验。通过前瞻性地设想事后认识,我们得以反思赞比亚该领域的过去、现在和可能的未来。确定的六个关键挑战是:(i)认知不公正;(ii)对循证干预措施的概念化过于简化;(iii)对资源匮乏环境的复杂性及其对实施的影响的理论化有限;(iv)研究转化为实践的持续滞后;(v)对实施科学知识的战略传播关注有限;(vi)现有的培训和能力建设举措未能通过多样化的学习模式让包括从业者在内的广泛行为者参与进来。 结论:实施科学在解决赞比亚的许多健康问题方面前景广阔。通过这篇评论,我们希望引发关于实施科学家如何通过思考我们在低收入和中等收入国家环境中的经验教训来重新构想该领域未来的讨论。
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