Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity.
Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity.
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DOI：
10.1177/26334895211049482
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发表时间：
2021-01
影响因子：
--
通讯作者：
Griffith, Derek M.
中科院分区：
文献类型：
--
作者：
Shelton, Rachel C.;Adsul, Prajakta;Oh, April;Moise, Nathalie;Griffith, Derek M.
关键词：
尽管实施科学(IS)有望减少卫生不平等现象，但在促进卫生公平方面仍存在重大差距和机会。在这些努力中，确定种族平等和反种族主义方针的优先次序至关重要，这样才不会因选择的框架、方法、干预措施和战略没有反映结构性种族主义及其影响而无意中加剧不平等。在现有关于结构性种族主义和反种族主义研究的基础上，我们讨论了增进对结构性种族主义作为一个系统如何影响种族健康不平等以及在种族和族裔多样化社区中不公平地实施循证干预措施的理解的重要性。我们概述了明确应用反种族主义镜头来解决结构性种族主义及其通过IS的表现的建议。反种族主义镜头提供了一个框架，通过帮助人们将种族主义确定为健康不平等的根本原因，并批判性地检查种族主义如何嵌入对种族和族裔多样化人口产生不同影响的政策、结构和制度，从而指导应对、解决和消除种族主义和种族特权的努力。我们为反种族主义镜头在信息系统领域的应用提供指导，重点放在执行研究中选定的核心要素上，包括：(1)利益攸关方参与；(2)概念框架和模型；(3)发展、选择、适应EBI；(4)评价方法；和(5)实施战略。我们强调需要在实施科学家中建立反种族主义框架的基础，以促进持续的自我反省、问责和对种族公平的关注，并提供问题来指导这种反思和考虑。最后，我们反思现在是IS优先关注正义、种族公平和现实世界公平影响的关键时刻。正在朝着考虑健康公平和反种族主义镜头的方向迈进，这是加强这一领域和提高其影响的核心。在通过实施科学促进卫生公平方面存在着重要的差距和机会。从历史上看，实地常用的框架、措施、干预措施、战略和方法没有明确地侧重于公平，也没有考虑结构性种族主义在塑造健康和不公平地提供循证做法/方案方面的作用。这项工作力求在结构性种族主义与健康研究的长期历史基础上再接再厉，并力求就如何应用反种族主义的视角来选择执行研究的核心要素提供指导。我们强调了实地思考和考虑在以下方面采用反种族主义方法的重要机会：1)利益攸关方/社区参与；2)概念框架的使用；3)循证干预措施的发展、选择和适应；4)评价方法；5)实施战略(例如，如何提供循证做法、方案和政策)；以及6)研究人员如何进行研究，重点是种族公平。对于执行科学领域来说，这是一个重要的时刻，通过在他们的工作中应用反种族主义的镜头，优先关注正义、公平和现实世界的影响。
Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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