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Newsletter | South Central MIRECC

Fall 2018, Volume 20, Issue 5 - In this Issue

New Orleans Site Update
Meet the New Fellows

2018 MI Training Evaluation Results
Research to Practice: Using Implementation Science to Enhance Health Disparity Research
FY2019 Education Needs Survey Announcement
Recent Publications
Pilot Study Research Program Applications Due January 2
Implementation, Design and Analysis Support Available for Affiliates

Research to Practice: Using Implementation Science to Enhance Health Disparity Research

Summary by Sonora Hudson, MA and Derrecka Boykin, PhD

An article last year by VA researchers argued that applying implementation science frameworks to health disparity research could speed up the benefit of equity. The article, by Matthew Chinman, Eva Woodward, Geoffrey Curran* and Leslie Hausmann, representing the VA Pittsburgh Healthcare System and Central Arkansas Veterans Healthcare System, appeared in Medical Care.

The authors suggest that current disparities research usually targets patients and providers rather than system components. They build their case by describing how conceptual frameworks in implementation that take system-level factors into consideration can expand the focus of disparity research and by illustrating how implementation research designs and frameworks could be used for testing disparity-reducing strategies in rigorous trials.

The framework espoused by the authors, the Consolidated Framework for Implementation Research (CFIR), could broaden the focus of Phase 2 disparities studies, they argue, because its domains allow consideration of factors beyond the patient-provider context, such as healthcare-organization, community and policy-level influences. This could pinpoint areas for investigation in Phase 3 disparities studies by providing additional information to help structure implementation strategies.

They go on to discuss how Phase 3 disparities studies could include aims identified in Phase 2 studies to test selected implementation strategies. They recommend using the Expert Recommendations for Implementing Change (ERIC) pool of discrete strategies as a standardized way of describing these strategies. A discussion of rigorous research designs in implementation follows, including hybrid designs, which assess both effectiveness and implementation aims simultaneously. These designs can accelerate the pace at which evidence-based interventions are integrated into practice. Hybrid Type I design could be effective, say the authors, if Phase 1 studies have documented disparities in a particular health outcome, effective interventions to improve the target outcome exist, but evidence for effectiveness in a vulnerable population is lacking. The addition of a formative evaluation guided by a framework such as CFIR could identify factors across multiple ecological levels that influence successful delivery of an intervention (already shown to be effective in a larger population) in a vulnerable group.

Other hybrid designs offer advantages for Phase 3 studies that focus on developing the evidence base for disparity-reducing strategies and interventions. For instance, a Hybrid Type II design could test interventions shown to have some effectiveness in a vulnerable group that still need evaluation in a real-world situation to show that a particular implementation strategy would increase adoption. In this case, it would be necessary to analyze both patient and implementation outcomes by subgroups within a vulnerable group. Hybrid Type III designs could be applicable to evaluate an intervention with strong (but not “strongest”) evidence in a vulnerable group. Hybrid Type III studies test whether an implementation strategy improves use of an intervention by collecting data focused on adoption and fidelity of the intervention, with a secondary focus on patient-level health outcomes.

Challenges include the need for research on the ongoing adaptation process of interventions to local contexts and research on the “biological underpinnings of health disparities” to make sure that advances are effective across all populations. Grant agencies must also fund more implementation projects. The best of all possible worlds would be more cross collaboration between implementation scientists and health disparities researchers.

Read the free article at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639697/

*MIRECC Affiliates in bold

Citation: Chinman M, Woodward EN, Curran GM, & Hausmann LRM (2017). Harnessing implementation science to increase the impact of heath disparity research. Medical Care 55 (Suppl. 9 2), S16-23.

 

Last updated: December 15, 2020