Narrowing the health equity gap. How can implementation science proactively facilitate the cultural adaptation of public health innovations?
Zoe Fehlberg, Marlena Klaic, Samantha Croy, Stephanie Best
Abstract
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.