Context matters in implementation science

A scoping review of determinant frameworks that describe contextual determinants for implementation outcomes

Bibliographic Data

ID23327926
AuthorsPhoebe Nilsen (0000-0003-0657-9079, Linköping University), Per Nilsen, Susanne Bernhardsson (0000-0001-8212-7678, Region Västra Götaland, corresponding author)
Year2019
Volume19
Issue1
Pages189-189
Publication date2019-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMC Health Services Research (JOURNAL)
Journal identifiersISSN: 1472-6963 • E-ISSN: 1472-6963
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s12913-019-4015-3
PMID30909897
OpenAlexW2941268450
LanguageEN
Citations received99
References cited74

BACKGROUND: The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned. METHODS: A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines. RESULTS: The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers' implementation experiences. Six of the frameworks explicitly referred to "context", but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership. CONCLUSIONS: The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.

Context (archaeology) · Data science · Geography · Health administration · Health services research · Management science · Nursing research · Public health · Computer Science · Engineering · Evaluation and Performance Assessment · Health Informatics · Health Policy Implementation Science · Medicine · Nursing · Participatory Visual Research Methods