The concept of "context" in health care: historical perspective and current views

The concept of "Context" presents various aspects ranging from the emotive to the cognitive, from the structural and organisational to the methodological, from the social to the educational, and therefore merits consideration. Furthermore, the influence of the health context on clinical outcomes has recently had a rebound of attention in biomedical literature, given that the ability of clinicians to modify their professional practice is considered to be strongly influenced by the organisational and managerial milieu of their work. In the past attention was largely focussed on the ability of the environment to modify the health status of individuals and so to cause, or con-cause, diseases. There was instead a relative lack of interest in the influence of the health context on health operators, and, more importantly, in its effect on the relationship between patients and health operators and, in turn, of this latter relationship on clinical outcomes. This interest has recently been investigated and research has provided preliminary evidence that physicians adopting a friendly and reassuring approach are more effective than those who keep visits and counselling at a formal level. An awareness that many features of the concept of context in health care have been relatively little studied should address future research to clarifying scientifically the global role of context in health. The promising findings of the studies available, such as those here illustrated, point to the fact that valid research would be both feasible and effective.