Fehlberg Zoe, Klaic Marlena, Croy Samantha, Best Stephanie
Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Centre for Population Genomics, Murdoch Children's Research Centre, Melbourne, Australia.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2025 May 21. doi: 10.1007/s00103-025-04057-x.
While the ambitions of innovation in public health are usually geared towards improving health outcomes, an unintended consequence of the innovation process is that it can exacerbate health inequity. People who are disproportionately excluded from accessing the benefits from innovations in public health include, among others, minoritised racial and ethnic communities. Advancing racial and ethnic health equity by centring attention on systemic factors influencing health inequalities-for example, how structural racism influences public health-has gained much focus among researchers, including those in implementation science. Implementation science is a field ideally placed to actively intervene and enhance an equitable process of innovation. One of the key pieces in working towards implementing public health innovation that promotes health equity is progressing the science of adaptation. Cultural adaptation requires systematic changes to an intervention, context, or implementation activity to ensure the relevance and fit for a population, whilst retaining fidelity to the evidence-based components. In this discussion, we propose five implementation science approaches to proactively facilitate cultural adaptation in public health innovation and promote health equity. We discuss (1) structuring cultural adaptation through a formal process and (2) using theory, (3) incorporating inclusive and participatory approaches to cultural adaptation, (4) conceptualising cultural adaptation as an implementation strategy, and (5) investigating cultural adaptation to implementation science data collection tools. Further, we use an example of a precision public health program to exemplify a framework for reporting and making adaptations. Implementation science can use the practice of adaptation as part of the inclusive and equity-driven approaches to the implementation of public health innovation.
虽然公共卫生领域的创新目标通常是改善健康结果，但创新过程的一个意外后果是它可能会加剧健康不平等。在获得公共卫生创新成果方面被不成比例地排除在外的人群中，包括少数族裔和种族社区。通过关注影响健康不平等的系统性因素来推进种族和族裔健康公平——例如，结构性种族主义如何影响公共卫生——已成为包括实施科学领域研究人员在内的众多研究人员关注的焦点。实施科学是一个非常适合积极干预并加强公平创新过程的领域。致力于实施促进健康公平的公共卫生创新的关键环节之一是推进适应科学。文化适应需要对干预措施、背景或实施活动进行系统性改变，以确保其与特定人群的相关性和适应性，同时保持对循证成分的忠实度。在本次讨论中，我们提出了五种实施科学方法，以积极促进公共卫生创新中的文化适应并促进健康公平。我们讨论了：（1）通过正式流程构建文化适应；（2）运用理论；（3）采用包容和参与性的文化适应方法；（4）将文化适应概念化为一种实施策略；（5）研究文化适应在实施科学数据收集工具中的应用。此外，我们以一个精准公共卫生项目为例，阐述一个报告和进行调整的框架。实施科学可以将适应实践作为公共卫生创新实施中包容和平等驱动方法的一部分。
