Implementing implementation science in global health

The Lancet Global Health has just celebrated its 10-year anniversary. In this time, the journal has strived to promote the wellbeing of people in low-income and middle-income countries and of vulnerable populations worldwide by disseminating rigorous evidence to improve health equity. Nonetheless, a research-to-practice gap persists in global health. Implementation science is tasked with bridging this gap, transforming evidence into contextually appropriate practices. A focus on implementation in global health not only adds momentum towards real-world health impact, but it also empowers stakeholders in the communities of study and it encourages interdisciplinary and intersectional collaboration. We believe it is time to create more space for implementation science in global health journals because we need the science of delivery (of evidence-based interventions) as much as the science of discovery. To further our understanding of this field, we consulted eminent implementation scientists from Australia, Bangladesh, China, Nepal, Ghana, the UK, and the USA. We also attended the First Pearl River Implementation Science International Symposium as part of the 2023 Global Health South Forum in Guangzhou, China. We were amazed by the abundance of implementation theories, models, and frameworks as well as the diverse methodological approaches that implementation science employs across several disciplines. We also recognised the challenges of grappling with the “wicked” problems of implementation within the dynamic and interactive contextual determinants at multiple levels. Nonetheless, the progress of implementation science has been slow in the last decade, possibly due to the following impediments. First, implementation science can fail to close the research-to-practice gap, since the actual uptake of implementation knowledge by practitioners is low. To pass the knowledge from implementation scientists to practitioners, it must begin with the most relevant research question based on contextual experience. This contextual experience can only come from meaningful engagement with and leadership by community stakeholders and researchers based in the location of study. Only relevant, practical, accessible knowledge will find its way to a sustainable uptake in the communities where it is needed. Second, empirical research on implementation often uses theories in a symbolic or superficial way, and most existing frameworks remain untested in practice. We believe that implementation research should be theoretically informed, meaning that theories are used to guide data collection, analyses, and interpretation; or better, that research should be theoretically informative—ie, research contributes to the testing and refinement of theories in different settings and populations. Third, implementation research can be limited by entrenched outcome measures, such as fidelity and feasibility. We need to develop novel measurements on stakeholder engagement and community preferences. In the meantime, although challenging to measure, it would be a missed opportunity to not record the impact of implementing evidence-based interventions on health and equity. We acknowledge that implementation cannot just follow the scientific evidence while overlooking the community-defined evidence, and that it is not necessarily clear what evidence should be prioritised for implementation. In this sense, evidence for implementation must be viewed and produced through the lens of dignity, respecting and empowering community stakeholders. It is our humble hope that offering The Lancet Global Health as a platform for implementation science will help to facilitate its progress. We aim to prioritise implementation research that has high practical utility, that is theoretically informed (or better, theoretically informative), and which has impactful outcomes that benefit communities in accordance with their own wants and needs. We particularly welcome studies led by researchers and practitioners based in the communities, and those involving community stakeholders at all stages of study. We respect diversity of methods in implementation science, as long as the methods used are appropriate to answer the research question. Ideally study designs should be guided by theories, models, or frameworks and inform multiple levels of the health system and treatment cascade (or have the potential to). We hereby announce our long overdue encouragement of the submission of more work on implementation research and practice to our journal, and we look forward to having you join this endeavour to advance implementation science in global health. When dignity meets evidenceWe are all entitled to dignity because we possess certain ethically important features. One of those human features is that we are knowers. We know things. We learn. We make sense of what we know. We interpret our realities and the systems within which we have our being. If this feature is not respected, one's dignity is violated. There is a kind of knowledge practice we may call dignity-based practice. Full-Text PDF Achieving justice in implementation: the Lancet Commission on Evidence-Based Implementation in Global HealthWith the launch of the Sustainable Development Goals ( SDGs ) in 2015, global leaders committed to the health and wellbeing of every person on the planet by 2030. With the development of numerous life-saving and life-enhancing innovations, the potential for using science and technology to achieve this goal has never been greater. Yet with far too many innovations there are stark and unacceptable inequities in availability and access. Further, a high proportion of effective interventions are not being put into practice effectively at scale, particularly in low-income and middle-income countries (LMICs) where scalability and sustainability of interventions with quality have been especially challenging. Full-Text PDF