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Defining and assessing context in healthcare implementation studies: a systematic review.
BMC Health Serv Res. 2020 Jun 29; 20(1):591.BH

Abstract

BACKGROUND

The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context.

METHODS

Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach.

RESULTS

Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29).

CONCLUSIONS

This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.

Authors+Show Affiliations

University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland. lisa.rogers@ucdconnect.ie. University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland. lisa.rogers@ucdconnect.ie.University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland. University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland.University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland. University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32600396

Citation

Rogers, L, et al. "Defining and Assessing Context in Healthcare Implementation Studies: a Systematic Review." BMC Health Services Research, vol. 20, no. 1, 2020, p. 591.
Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res. 2020;20(1):591.
Rogers, L., De Brún, A., & McAuliffe, E. (2020). Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Services Research, 20(1), 591. https://doi.org/10.1186/s12913-020-05212-7
Rogers L, De Brún A, McAuliffe E. Defining and Assessing Context in Healthcare Implementation Studies: a Systematic Review. BMC Health Serv Res. 2020 Jun 29;20(1):591. PubMed PMID: 32600396.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining and assessing context in healthcare implementation studies: a systematic review. AU - Rogers,L, AU - De Brún,A, AU - McAuliffe,E, Y1 - 2020/06/29/ PY - 2019/08/19/received PY - 2020/04/13/accepted PY - 2020/7/1/entrez PY - 2020/7/1/pubmed PY - 2020/7/1/medline KW - Context KW - Contextual factors KW - Healthcare KW - Implementation science KW - Systematic review SP - 591 EP - 591 JF - BMC health services research JO - BMC Health Serv Res VL - 20 IS - 1 N2 - BACKGROUND: The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. METHODS: Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. RESULTS: Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). CONCLUSIONS: This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/32600396/Defining_and_assessing_context_in_healthcare_implementation_studies:_a_systematic_review L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05212-7 DB - PRIME DP - Unbound Medicine ER -
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