Defining the external implementation context: an integrative systematic literature review.

Area of Science:

• Health Services Research
• Implementation Science
• Public Health

Background:

• Effective implementation of evidence-based interventions (EBIs) is crucial for realizing their full impact.
• Research often overlooks external facilitators and barriers impacting EBI implementation.
• Understanding the external implementation context is vital for complex health interventions interacting with their environment.

Purpose of the Study:

• To identify external context constructs that influence the implementation of complex EBIs.
• To systematically review and categorize factors beyond organizational boundaries affecting intervention success.

Main Methods:

• An integrative systematic literature review was conducted.
• Data collection involved iterative literature searches across disciplines, journals, authors, and databases.
• Inductive thematic content analysis was used to develop construct categories.

Main Results:

• Eight external context constructs were identified: professional influences, political support, social climate, local infrastructure, policy/legal climate, relational climate, target population, and funding/economic climate.
• These constructs represent empirically observed factors documented to impact implementation.

Conclusions:

• This study is the first to systematically identify empirically observed external context factors impacting implementation.
• The identified constructs align with and potentially expand upon existing implementation frameworks.
• Future research should focus on operationalizing and measuring these external context constructs for better assessment.