‘What are we doing here?’: Implementation science and the politics of research as context

The medical-scientific enterprise has benefited from implementation science’s (IS) fundamental insight: that contextual factors contribute to the success or failure of evidence-based interventions. Yet, IS often fails to account for the institutional commitments of research as an essential element of ‘context.’ In doing so, it may fail to acknowledge that its own institutional commitments to scientific research are themselves key power dynamics affecting how social change is thought of or how interventions are designed. This paper leverages two long-term ethnographic projects studying behavioral interventions to examine how structural conditions shape service delivery. We draw from two intervention projects: e-mental health research in Australia, and an overdose prevention clinical trial in the US. We demonstrate how the prioritization of funders’ interests, the political economy of evidence-based interventions, and the epistemic commitments of intervention research dictate what seems feasible or possible, conflicting with the moral and ethical values of intervention researchers themselves. This paper contributes to critical public health scholarship by demonstrating how IS risks legitimizing structural inequities by absorbing institutional logics rather than challenging them. The disconnect between researchers’ private critiques and the field’s focus on intervention adoption merits ongoing research that examines how IS knowledge production itself reinforces systemic injustice.