Table 1 Characteristics of implementation science and cultural adaptations

Definition

‘the scientific study of methods to promote the integration of research findings and evidence-based interventions into health care policy and practice’ (PAR-10-038).

“the systematic modification of an evidence-based treatment (EBT) to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns meanings and values’[17].

Example of research questions

• How to balance the need to maintain the fidelity of established interventions as they were created, and customize them to local context to increase their relevance, appropriateness, use and uptake?

• What elements of the EBTs need to be adapted to enhance their fit, cultural relevance, and social validity to a specific ethno-cultural group or setting?

• How to involve and get genuine buy-in and collaboration from multiple stakeholders in the process of implementation?

• How does the culturally adapted EBT retain the active ingredients of the original EBT?

• How to sustain interventions given constrained financial and human resources and shifting political climates and priorities?

• Will the culturally adapted EBT achieve better client outcomes than the original intervention?

Fidelity perspectives

Balance adaptation and fidelity

Balance adaptation and fidelity

Emphasis of cultural elements

Organizational level and knowledge exchanges between stakeholders

Provider and client levels

Typical unit of analysis

Providers, clinical units, organizations or systems, communities

Patients, families/caregivers, providers

Potential challenges in reducing racial and ethnic disparities in mental health care

• Most implementation trials do not quantify or directly examine their impact in reducing racial and ethnic mental health care disparities

• Culturally adapted EBTs are rarely used in usual care settings

• Few implementation strategies exist for transporting EBTs in racially and ethnically minority communities

• Culturally adapted EBTs lack explicit attention to implementation context and implementation strategies

• Most implementation trials do not document the adaptation process when implementing EBT

• Limited evidence that culturally adapted EBTs are more cost- effective than non-adapted EBTs