Austad Kirsten, Cordova-Ramos Erika G, Fernandez Alicia, Drainoni Mari-Lynn
Department of Family Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Implement Sci Commun. 2025 May 28;6(1):66. doi: 10.1186/s43058-025-00753-6.
As the population of individuals with non-dominant language preference (NDLP) continues to grow, the field of implementation science has yet to fully address the unique barriers that this population faces in accessing evidence-based interventions (EBIs). Traditional models of cultural adaptation have been designed primarily for single linguistic or ethnic groups, focusing on aligning interventions with specific cultural values, beliefs, and practices. While effective within narrowly defined populations, this approach is not scalable to high-diversity settings where multiple NDLP groups are served simultaneously. In this Commentary, we argue for a reconceptualization of how implementation science approaches language barriers, advocating for all implementation efforts to consider language as a core determinant of success. We highlight how two relatively recent tools developed within implementation science-the Core Function and Form Framework and causal pathway diagrams-can advance EBI adaptation for populations with NDLP. We propose a highly scalable approach that systematically assesses the linguistic, cultural, and social needs of each individual and uses these data to guide individualized tailoring of an intervention, building on the emerging model of "personalized adaptation." We highlight the need to innovate methods to ensure an individualized approach to EBI adaptation is feasible, scalable, and led by communities, with input from end-users. By harnessing the wisdom of the fields of implementation science and cultural adaptation, interventions can be adapted to the linguistic, cultural, and social needs of populations with NDLP to bring us closer to health equity in a diverse world.
随着非主导语言偏好（NDLP）人群的数量持续增长，实施科学领域尚未充分解决该人群在获取循证干预措施（EBI）时所面临的独特障碍。传统的文化适应模式主要是为单一语言或族裔群体设计的，侧重于使干预措施与特定的文化价值观、信仰和实践保持一致。虽然这种方法在狭义定义的人群中有效，但在同时服务多个NDLP群体的高多样性环境中却无法扩展。在这篇评论中，我们主张重新构想实施科学应对语言障碍的方式，倡导所有实施工作都将语言视为成功的核心决定因素。我们强调实施科学领域内最近开发的两个工具——核心功能与形式框架以及因果路径图——如何能够推动针对NDLP人群的EBI适应。我们提出一种高度可扩展的方法，该方法系统地评估每个人的语言、文化和社会需求，并利用这些数据指导基于“个性化适应”这一新兴模式的干预措施的个性化定制。我们强调需要创新方法，以确保针对EBI适应的个性化方法是可行的、可扩展的，并且由社区主导，并得到最终用户的投入。通过利用实施科学和文化适应领域的智慧，干预措施可以适应NDLP人群的语言、文化和社会需求，从而在多元化的世界中使我们更接近健康公平。
