Defining and assessing context in healthcare implementation studies: a systematic review

Area of Science:

• Healthcare implementation science
• Evidence-based practice
• Health services research

Background:

• A significant 17-year gap exists between evidence generation and its application in healthcare.
• Contextual factors like culture and leadership are crucial for successful implementation but are poorly understood.
• Lack of consensus on defining and measuring context hinders research and practice.

Purpose of the Study:

• To analyze how context is defined and assessed in healthcare implementation science literature.
• To develop a consensus definition of context for effective measurement.
• To address the gap in understanding and operationalizing context in research.

Main Methods:

• Systematic literature review of Medline, PsychInfo, CINAHL, and EMBASE databases.
• Inclusion of empirical studies from the past 10 years evaluating context during healthcare initiative implementation.
• Narrative synthesis of findings from 64 eligible articles.

Main Results:

• A wide variety of definitions and assessment methods for context were identified.
• The Alberta Context Tool was the most common quantitative measure; qualitative studies used diverse frameworks.
• Most studies (50/64) applied measures across study designs, with a focus on individual-level context (29/64).

Conclusions:

• Inconsistencies in defining and measuring context necessitate an operational definition.
• A consensus definition will improve implementation processes by fostering a common understanding.
• Standardized measurement of context is essential for advancing healthcare implementation science.