Reimagining Innovation in Health Equity: Making a Case for a Community embedded Participatory Learning Site for Adivasi Health Research.

Introduction: This paper explores the development of the Realist Implementation Action Research Lab (RIAL), a participatory learning site aimed at addressing health disparities among Adivasi communities in India. Despite national health improvements, Adivasis face significant health inequities. RIAL employs a realist-inspired, theory-driven design to co-create solutions with communities, fostering collaboration among diverse stakeholders. The paper discusses insights from the establishment of RIAL, focusing on strategies implemented, opportunities identified, challenges encountered, and lessons learned to inform public health research and practice for Adivasi populations. Methods: We utilized processual analysis to examine the evolving dynamics of RIAL, combining historical and current documentation with collaborative team reflections. Context-Mechanism-Outcome (CMO) configurations were developed to tailor interventions to community needs and foster stakeholder engagement. These methods emphasized the contextual nature of health interventions, aligning with a systems-oriented, participatory approach. The establishment of RIAL involved consultations with community-based organizations, capacity-building workshops, and collaborative platforms to engage community leaders, healthcare providers, and policymakers, ensuring a participatory and contextually relevant foundation. Results: RIAL's implementation highlighted the importance of reconfiguring power dynamics and fostering participatory processes. Strategies included co-design workshops, town hall assemblies, and capacity-building sessions, which enhanced community ownership and engagement. Challenges such as gender norms, logistical barriers, and resistance from non-Adivasi stakeholders were encountered, but iterative adaptation allowed for overcoming these barriers. Key findings included improved intervention receptivity, such as the successful relocation of a deaddiction clinic to a community-trusted NGO hospital and the implementation of sports-based psychosocial interventions for Adivasi youth, which demonstrated increased mental health awareness and reduced stigma. Conclusion: RIAL exemplifies the potential of participatory and context-aware methodologies in addressing health inequities among marginalized populations. Although scalability and resource availability pose limitations, this paper advocates for a shift from techno-centric solutions to those that are participatory, emphasizing sustained community engagement and co-creation of health interventions. The insights from RIAL's implementation offer potential implications for adapting similar models in other contexts, aiming to reduce health disparities through inclusive research practices.