Table 3 Summary of research implications

Making culture visible and explicit in the implementation process

• Use CA models to document the process of adaptation and specify what was adapted during the implementation process.

• Develop user friendly CA guidelines and models that can be used in usual care settings.

• Integrate CA guidelines and steps into existing implementation strategies.

What to adapt

• Continue to empirically identify the core components of EBTs in order to provide directions for adaptation, if necessary.

• If adaptations to the EBTs are necessary, CA frameworks can be used to identify what and how elements of the delivery and content of the EBT needs to be adapted to enhance their cultural congruence.

• Examine how providers’ training should be adapted to increase providers’ adoption of EBT, particularly around issues of cultural competence.

• Examine how adaptation to the context of practice may facilitate implementation outcomes and help reduce mental health care disparities.

Key players driving cultural adaptations and implementation

• Further specify and document the necessary skills to be an effective facilitator and cultural adaptation specialist.

• Examine how facilitator and cultural adaptation specialist can collaborate within an implementation team to enhance the implementation of EBTs.

• Examine how to train a person to incorporate the skills and knowledge of a facilitator and cultural specialist.

Expanding the contextual lens

• Examine how the use of adapted or un-adapted EBTs shown to be effective in racial and ethnic minority communities may enhance providers’ and organizations’ acceptance of EBTs and facilitate their adoption of new practices.

• Apply methods and steps used in CA models to examine outer contextual factors to gain a deeper understanding of how the local ecology, social norms, and community culture can impact the implementation process.

• Continue to build the science of CBPR by identifying the core participatory principles and collaborative processes that can facilitate implementation of EBTs in minority communities.

• Empirically test the effectiveness that participatory approaches compared to other implementation strategies have on implantation outcomes.

• Examine how different service delivery options can help address workforce shortage issues in historically underserved communities.

• Cost-effectiveness analyses need to examine whether culturally adapted EBTs result in better outcomes compared to their costs and whether the potential clinical and implementation benefits of culturally adapted EBTs outweigh their costs when compared to un-adapted interventions and usual care across different implementation outcomes.

When to adapt

• Examine how cultural adaptations (if necessary) can be integrated within the implementation process and within existing implementation strategies.