A two-way street: bridging implementation science and cultural adaptations of mental health treatments

Implementation Science

Ana A Baumann¹  Leopoldo J Cabassa² 

[1] George Warren Brown School of Social Work, Washington University in St. Louis, 600 S. Taylor, Suite 122, St. Louis, 63110, Missouri, MO, USA;Department of Psychiatry, College of Physicians & Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, USA

关键词: Mental health care disparities;    Implementation science;    Cultural adaptation;   

Others  :  813430
DOI  :  10.1186/1748-5908-8-90

 received in 2012-09-14, accepted in 2013-08-08,  发布年份 2013

【 摘 要 】

Background

Racial and ethnic disparities in the United States exist along the entire continuum of mental health care, from access and use of services to the quality and outcomes of care. Efforts to address these inequities in mental health care have focused on adapting evidence-based treatments to clients’ diverse cultural backgrounds. Yet, like many evidence-based treatments, culturally adapted interventions remain largely unused in usual care settings. We propose that a viable avenue to address this critical question is to create a dialogue between the fields of implementation science and cultural adaptation. In this paper, we discuss how integrating these two fields can make significant contributions to reducing racial and ethnic disparities in mental health care.

Discussion

The use of cultural adaptation models in implementation science can deepen the explicit attention to culture, particularly at the client and provider levels, in implementation studies making evidence-based treatments more responsive to the needs and preferences of diverse populations. The integration of both fields can help clarify and specify what to adapt in order to achieve optimal balance between adaptation and fidelity, and address important implementation outcomes (e.g., acceptability, appropriateness). A dialogue between both fields can help clarify the knowledge, skills and roles of who should facilitate the process of implementation, particularly when cultural adaptations are needed. The ecological perspective of implementation science provides an expanded lens to examine how contextual factors impact how treatments (adapted or not) are ultimately used and sustained in usual care settings. Integrating both fields can also help specify when in the implementation process adaptations may be considered in order to enhance the adoption and sustainability of evidence-based treatments.

Summary

Implementation science and cultural adaptation bring valuable insights and methods to how and to what extent treatments and/or context should be customized to enhance the implementation of evidence-based treatments across settings and populations. Developing a two-way street between these two fields can provide a better avenue for moving the best available treatments into practice and for helping to reduce racial and ethnic disparities in mental health care.

【 授权许可】

   
2013 Cabassa and Baumann; licensee BioMed Central Ltd.

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