1. Moore, Justin B. PhD, MS, FACSM

Article Content

Implementation in practice is the "application and integration of research evidence into practice and policy,"1 while implementation science is "the scientific inquiry into questions concerning implementation."2 As such, the implementation of evidence-based practices and the study of the best practices for implementation are foundational to public health research and practice. Accordingly, implementation science and practice are informed by a robust literature and a myriad of models and frameworks. Inherent in many of these frameworks are social determinants of health, the characteristics of the individuals who will deliver the evidence-based practices, and those of the recipients of the interventions to be deployed. Unfortunately, it has not been until recently that the field has overtly acknowledged the role of implementation science in addressing and eliminating health disparities in access to public health services and medical care, as well as the potential of implementation science to achieve health equity. Recently, experts have issued a call to action to the field to explicitly address structural racism in implementation science and issued several recommendations to accomplish this goal.3 I would like to amplify this message and challenge those who might suggest that implementation science and practice are inherently focused on reducing inequity by suggesting that implementation science has as much potential to exacerbate inequity as it does to eliminate disparities. For example, if implementation of an evidence-based practice is only successful in high-resourced settings (eg, well-funded schools, properly staffed clinics) but inconsistently implemented in lower-resourced settings, disparity may become exacerbated. If an evidence-based practice is successfully delivered and received by individuals whose social determinants of health (eg, transportation, housing stability, food security) enable them to engage with the intervention and receive its benefits, inequities will persist among those without. If evidence-based practices are not developed with input from the diverse cultures and communities they are intended to impact, their implementation will only serve as an example of the pervasiveness of structural racism in health and/or medicine. In short, if health equity is not the explicit focus of implementation research and practice, then health equity will never be achieved.


Ultimately, health equity in implementation science and practice can be achieved through community engagement and purposeful scrutiny of the evidence-based practices we select and the methods employed to implement them. We must first begin by determining what evidence is sufficient to support wide-scale dissemination and implementation. Historically, we rely on effectiveness trials, but these can be misleading, as not all trials are pragmatic, and many rely on homogeneous samples that limit generalizability to the diverse communities served by the public health workforce. Many of these evidence-based practices will need to be tailored to accommodate the unique desires and needs of the individuals we serve before they are ready for large-scale implementation, which will require engaging those communities as partners. Second, we must understand that individuals' social determinants of health are impacted by geography, structural racism, and gender inequity. While our implementation science frameworks should include these influences, we must also realize that foundational needs must be met before individuals will have the bandwidth to take on new challenges. For example, it is illogical to expect individuals with food insecurity to worry about weight status and physical inactivity in the presence of hunger and uncertainty. Finally, we must understand that we are working to promote health equity in the same systems that contributed to that inequity. The drivers of inequity are not always obvious; identifying them and addressing them will take eternal vigilance. Only by making health equity explicit in the implementation work that we do can we eliminate disparities and promote health equally for all.




1. Glasgow RE, Eckstein ET, ElZarrad MK. Implementation science perspectives and opportunities for HIV/AIDS research: integrating science, practice, and policy. J Acquir Immune Defic Syndr. 2013;63(suppl 1):S26-S31. [Context Link]


2. Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013;347(8):731-736. [Context Link]


3. Shelton RC, Adsul P, Oh A. Recommendations for addressing structural racism in implementation science: a call to the field. Ethn Dis. 2021;31(suppl 1):357-364. [Context Link]