Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions...

Area of Science:

• Health Services Research
• Implementation Science
• Intervention Science

Background:

• Complex intervention effectiveness is influenced by context and implementation.
• Existing frameworks inadequately integrate context and implementation, often focusing narrowly on organizational aspects.
• There is a need for a comprehensive approach to assess context and implementation in complex interventions.

Purpose of the Study:

• To develop a framework for structured and comprehensive conceptualization and assessment of context and implementation of complex interventions.
• To create the Context and Implementation of Complex Interventions (CICI) framework.

Main Methods:

• Iterative development and extensive application of the CICI framework.
• Scoping review, rapid assessments, and pragmatic utility concept analysis to refine concepts.
• Revision and application in systematic reviews, health technology assessment (HTA), and applicability assessments.

Main Results:

• The CICI framework integrates context, implementation, and setting dimensions.
• Context includes seven domains; implementation includes five domains; setting refers to the physical location.
• The framework operates on micro, meso, and macro levels and includes tools for operationalization.

Conclusions:

• The CICI framework simplifies complexity to enhance understanding of intervention effectiveness.
• It integrates context, implementation, and setting, aiding research and communication.
• Applicable in systematic reviews, HTA, primary research, and stakeholder engagement.