Article type
Year
Abstract
Background: Context and implementation of health interventions have received increasing attention over the past decade. Of particular interest is their influence on the effectiveness and reach of complex interventions. Yet, much confusion exists around these terms and their underlying concepts.
Objectives: To analyze both concepts in a state-of-the-art assessment for the health sciences in order to create a common understanding of the use of 'context' and 'implementation' within systematic reviews and Health Technology Assessments (HTA).
Methods: We performed two separate systematic searches for context (EMBASE,MEDLINE) and implementation (Google Scholar) to identify relevant theories, models and frameworks; 17 publications on context and 35 on implementation met our inclusion criteria. Pragmatic utility (PU) concept analysis was employed to analyze both concepts. PU comprises three guiding principles: selection of literature, organization and structuring of literature, and asking analytic questions of literature. Both concepts were analyzed according to four features of conceptual maturity, i.e. consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries.
Results: Context and implementation were highly intertwined, influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not fully articulated. In contrast, definitions of context vary widely, and boundaries with neighboring concepts, such as setting and environment, are blurred; characteristics, preconditions and outcomes are ill-defined.
Conclusions: The maturity of both concepts should be improved further to facilitate operationalization in systematic reviews and HTA, e.g. by developing a framework that will allow an assessment of both concepts.
Objectives: To analyze both concepts in a state-of-the-art assessment for the health sciences in order to create a common understanding of the use of 'context' and 'implementation' within systematic reviews and Health Technology Assessments (HTA).
Methods: We performed two separate systematic searches for context (EMBASE,MEDLINE) and implementation (Google Scholar) to identify relevant theories, models and frameworks; 17 publications on context and 35 on implementation met our inclusion criteria. Pragmatic utility (PU) concept analysis was employed to analyze both concepts. PU comprises three guiding principles: selection of literature, organization and structuring of literature, and asking analytic questions of literature. Both concepts were analyzed according to four features of conceptual maturity, i.e. consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries.
Results: Context and implementation were highly intertwined, influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not fully articulated. In contrast, definitions of context vary widely, and boundaries with neighboring concepts, such as setting and environment, are blurred; characteristics, preconditions and outcomes are ill-defined.
Conclusions: The maturity of both concepts should be improved further to facilitate operationalization in systematic reviews and HTA, e.g. by developing a framework that will allow an assessment of both concepts.