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      Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes

      research-article
      1 , 2 , 3 ,
      BMC Health Services Research
      BioMed Central
      Context, Determinants, Barriers, Frameworks, Implementation

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          Abstract

          Background

          The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned.

          Methods

          A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines.

          Results

          The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers’ implementation experiences. Six of the frameworks explicitly referred to “context”, but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership.

          Conclusions

          The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-019-4015-3) contains supplementary material, which is available to authorized users.

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          Most cited references60

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          THE ESSENTIAL IMPACT OF CONTEXT ON ORGANIZATIONAL BEHAVIOR.

          T G Johns (2006)
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            Enabling the implementation of evidence based practice: a conceptual framework

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              PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice

              Background The Promoting Action on Research Implementation in Health Services, or PARIHS framework, was first published in 1998. Since this time, work has been ongoing to further develop, refine and test it. Widely used as an organising or conceptual framework to help both explain and predict why the implementation of evidence into practice is or is not successful, PARIHS was one of the first frameworks to make explicit the multi-dimensional and complex nature of implementation as well as highlighting the central importance of context. Several critiques of the framework have also pointed out its limitations and suggested areas for improvement. Discussion Building on the published critiques and a number of empirical studies, this paper introduces a revised version of the framework, called the integrated or i-PARIHS framework. The theoretical antecedents of the framework are described as well as outlining the revised and new elements, notably, the revision of how evidence is described; how the individual and teams are incorporated; and how context is further delineated. We describe how the framework can be operationalised and draw on case study data to demonstrate the preliminary testing of the face and content validity of the revised framework. Summary This paper is presented for deliberation and discussion within the implementation science community. Responding to a series of critiques and helpful feedback on the utility of the original PARIHS framework, we seek feedback on the proposed improvements to the framework. We believe that the i-PARIHS framework creates a more integrated approach to understand the theoretical complexity from which implementation science draws its propositions and working hypotheses; that the new framework is more coherent and comprehensive and at the same time maintains it intuitive appeal; and that the models of facilitation described enable its more effective operationalisation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0398-2) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                susanne.bernhardsson@vgregion.se
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                25 March 2019
                25 March 2019
                2019
                : 19
                : 189
                Affiliations
                [1 ]ISNI 0000 0001 2162 9922, GRID grid.5640.7, Department of Medical and Health Sciences, Division of Community Medicine, , Linköping University, ; SE-581 83 Linköping, Sweden
                [2 ]Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
                [3 ]ISNI 0000 0000 9919 9582, GRID grid.8761.8, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, , University of Gothenburg, The Sahlgrenska Academy, ; Gothenburg, Sweden
                Author information
                http://orcid.org/0000-0001-8212-7678
                Article
                4015
                10.1186/s12913-019-4015-3
                6432749
                30909897
                c3c18f13-b32c-4d6b-8485-e43ba0c4d236
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 May 2018
                : 15 March 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                context,determinants,barriers,frameworks,implementation
                Health & Social care
                context, determinants, barriers, frameworks, implementation

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