Integrating systems thinking with global implementation science to co-learn and co-create mental health interventions and strategies with Maya Indigenous community partners

Although researchers have called for participatory, equitable, and decolonial global implementation research to be conducted, practical examples on how to do so are scarce, particularly in partnership with historically marginalised groups. In this Viewpoint, we share four recommendations on how to instil systems thinking principles into global implementation research to make it more participatory and equitable. Our recommendations centre around co-learning with community partners to gain a deep understanding of their preferences and the system, to then co-creating interventions and implementation strategies that consider structural drivers of health and centre around Indigenous knowledges and practices. For each recommendation, we contrast the traditional implementation science approach with our participatory systems thinking approach. We also suggest eight phases inspired by systems thinking principles and tools that researchers can follow to align with our recommendations. We share practical examples emerging from our experiences collaborating with policy makers and Maya Indigenous community partners with lived mental health experience in co-creating mental health interventions in rural Guatemala. Drawing from our team's discussions, we reflect on the ways in which our participatory systems thinking approach has brought us closer to conducting equitable implementation research. We also reflect on how historical and structural determinants of social inequities permeate our efforts to ensure research relevance, participation, and trust among partners.