Characteristics | Implementation science | 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 |