The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in...

Area of Science:

• Implementation Science
• Healthcare Research
• Evidence-Based Practice

Background:

• Contextual factors significantly influence healthcare professionals' adoption of research evidence.
• Existing conceptualizations of context lack clarity, hindering effective implementation interventions.
• A need exists for a structured understanding of context in healthcare settings.

Purpose of the Study:

• To advance conceptual clarity on context in healthcare.
• To develop the Implementation in Context Framework.
• To identify context domains, attributes, and features influencing research evidence use.

Main Methods:

• A meta-synthesis of three studies: concept analysis of 70 literature studies, secondary analysis of 145 healthcare professional interviews, and qualitative interviews with 39 stakeholders.
• Rigorous protocol followed for meta-synthesis to develop the framework.
• Framework refinement through expert feedback in context and implementation science.

Main Results:

• The Implementation in Context Framework conceptualizes context across micro (individual), meso (organizational), and macro (external) levels.
• Six contextual domains identified: actors, organizational climate/structures, social behavior, response to change, processes, and external influences.
• Framework includes 22 core attributes and 108 features illustrating contextual elements.

Conclusions:

• The Implementation in Context Framework is a unique meta-framework for guiding healthcare implementation efforts.
• Provides a comprehensive understanding of context for research evidence use in clinical practice.
• Informs intervention design, aids interpretation of intervention effects, and enhances evidence uptake and sustainability.