Strengthening Implementation Science with a Focus of Equity in Low-Resource Settings: Unanswered Questions, Challenges, and Calls to Action

Background: Implementation science (IS) stands as a bridge between clinical innovation and its routine practice. While crucial, its uptake in low-resource settings presents significant challenges. Despite significant contributions in innovative implementation strategies and policy change, concerns arise when adapting existing IS frameworks to suit low-resource settings. We aim to 1) Define the potential challenges in the uptake of implementation science in low-resource settings of sub-Saharan Africa, and 2) define the core competencies of an implementation scientist in low-resource settings.

Methods: We employed qualitative, participatory design methods to collect, analyze, and interpret results. We invited 29 investigators experienced in research, teaching, and conducting IS in low-resource settings to provide their perspectives on IS in low-resource settings. Our discussion was framed in a workshop style, providing space for open dialogue and innovative thinking. Rapid thematic analysis was conducted using Microsoft Excel software. Emerging themes were identified and categorized, and then a coding tree was created and agreed upon by the facilitators and coders. Results were communicated to participants with an invitation to provide additional feedback, which was incorporated in the final results.

Results: The four sub-themes describing challenges in the uptake of IS included (1) Limited IS capacity in low-resource settings, (2) Challenges in the applicability of IS in low-resource settings, (3) Barriers to changing the traditional approach to IS and how we view implementation science, and (4) Barriers to IS in general. Competencies required for an implementation scientist in low-resource settings included (1) cultural humility, (2) operationaling IS, and (3) partnering to increase advocacy for policy change.

Conclusion: Capacity-building and equity are fundamental cornerstones for IS uptake in low-resource settings. It is vital to develop inclusive and culturally sensitive IS strategies that are tailored to the unique needs and challenges present in low-resource settings.