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The inner context is typically understood as micro- and meso-level influences, whereas the outer context refers to macro-level influences beyond the organization, e. The fact that relatively few frameworks address the outer context wider environment indicates an emphasis on determinants that exist at organizational and lower-aggregate levels e.

May et al. This scepticism is relevant and points to the importance of identifying and accounting for key context dimensions in individual studies. Nevertheless, implementation scientists have focused primarily on the individual and organizational levels. While implementation science is a young field, its future development would benefit from drawing from other disciplines which have dealt more with the impact of the macro system, e. The literature on implementation context has suggested that there are two different context conceptualizations: context as something concrete and passive, e.

Most of the frameworks identified in this review emphasize the active view of context, indicating that it is widely recognized that context is not merely a passive backdrop to implementation.

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The view of context as a physical place implies a positivist notion of context, i. Organization theorists [ 84 , 85 ] have described context as a socially constructed phenomenon that is difficult to manipulate or manage. However, the underlying assumption of the frameworks instead is that it is possible to break down the context into its constituent parts, which can be influenced to have an impact on implementation outcomes on the premise of a cause-and-effect relationship between the context and outcomes. Furthermore, some of the frameworks have spawned instruments to measure and quantify various aspects of the context, underscoring an essentially objectivist understanding of the context in implementation science.

A few recently published reviews have also attempted to identify determinant frameworks, but have used different, albeit overlapping, selection criteria and research questions. Li et al. All six of those determinants were included among the 12 context dimensions we identified in our review. While the review by Li et al. A review by Strifler et al. Discussion about the meaning and relevance of context is not unique to implementation science. This is somewhat similar to implementation science, in that the intervention, e. This perspective of context resembles the view conveyed in the implementation science frameworks in this review.

Various forms of context have been described, including spatial context everything we do occurs in a place , temporal context events are often defined by their sequential properties , cognitive context influences how information is perceived, processed and stored , and social and cultural contexts influence how we understand the world and ourselves [ 94 , 95 , 96 , 97 ]. The temporal aspect of context was not explicitly addressed in any of the frameworks in this review other than time being considered a limited resource time availability.

However, it seems obvious that the timing of implementation could have an impact on the outcomes. For instance, successful results seem less likely if the implementation of an evidence-based practice coincides with numerous other change initiatives or if it occurs during a time of change fatigue, i. Although not explicitly mentioned in any of the frameworks, the timing of implementation may be considered an underlying influence on time availability and organizational readiness to change. Some limitations of this review should be acknowledged.

We only searched two databases and we may not have identified all relevant determinant frameworks. Although our searches yielded thousands of hits, most publications were excluded because they did not describe a determinant framework according to our definition. Our focus on health care settings may have led us to miss relevant frameworks used in other fields, such as public health, community-based services, and in disciplines such as psychology, sociology, organizational theory and political science, which limits the generalizability of our findings.

We did not attempt any kind of quality assessment of the included publications or frameworks. This was not considered feasible due to the variety in study design and scope of the different publications.


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This scoping review of 17 determinant frameworks in implementation science shows that there is considerable variation with regard to how the frameworks were developed, the terms used to denote contextual determinants, how context is defined and conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Most of the included frameworks provide only a limited and narrow description and definition of context, and a broad range of terms is used to denote various contextual determinants. Context is generally not described consistently, coherently or comprehensively in determinant frameworks, and there is inconsistency with regard to which contextual determinants are addressed.

Still, it was possible to identify common dimensions of the context based on the frameworks, the most frequently used being organizational support, financial resources, social relations and support, leadership, and organizational culture and climate. Our categorization of context dimensions may help the implementation researcher to consider the relevance of the various determinants in a structured way. Ultimately, however, the findings of this review are consistent with the observation by Pfadenhauer et al.

It is important that researchers are aware of how context is defined or interpreted in studies, which context dimensions are considered, and why these dimensions might be relevant. The challenge for the researcher is to identify the most important context dimensions and address these in the research. Although it is difficult to capture all potentially relevant influences in any given study, recognition of core context dimensions can facilitate research that incorporates a theory of context, i.

A thoughtful application of the concept and a more consistent terminology will enhance transparency, simplify communication among researchers, and facilitate comparisons across studies. Together, these advances will further our understanding of the role of context within implementation science. J Adv Nurs.


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Dopson S, Fitzgerald L. The active role of context. In: Dopson S, Fitzgerald L, editors. Knowledge to action? Evidence-based health care in context. New York: Oxford University Press; The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q. What context features might be important determinants of the effectiveness of patient safety practice interventions? BMJ Qual Saf. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.

Ann Fam Med. Edwards N, Barker PM. The importance of context in implementation research. J Acquir Immune Defic Syndr. Identifying the domains of context important to implementation science: a study protocol. Implement Sci. Context and implementation: a concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes. Implementation, context and complexity. Nilsen P. Making sense of implementation theories, models and frameworks. Enabling the implementation of evidence-based practice: a conceptual framework.

Qual Health Care. Rycroft-Malone J. Models and frameworks for implementing evidence-based practice: linking evidence to action. Oxford: Wiley-Blackwell; Validation of the theoretical domains framework for use in behaviour change and implementation research. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care.


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Adelaide: The Joanna Briggs Institute; PLoS Med. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. Implementation research: a synthesis of the literature. Diffusion of innovations in service organisations: a systematic literature review. Malden, MA: Blackwell Publishing; Improving patient care: the implementation of change in health care.

Chichester: Wiley; Using evidence: how research can inform public services. Bristol: The Policy Press; Knowledge translation in health care. Chichester: John Wiley; Rycroft-Malone J, Bucknall T. Dissemination and implementation research in health. Kelly B, Perkins DF, editors. Handbook of implementation science for psychology in education. Cambridge: Cambridge University Press; Greenhalgh T. How to implement evidence-based healthcare. Hoboken, NJ: John Wiley; A thematic analysis of theoretical models for translating science in nursing: mapping the field.

Nurs Outlook. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice.

The qualitative content analysis process. Cole FL. Content analysis: process and application. Clin Nurse Spec. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. Determinants of innovations within health care organizations. Int J Qual Health Care. A practical, robust implementation and sustainability model PRISM for integrating research findings into practice. Implementation science: key concepts, themes and evidence for practitioners in educational psychology.

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Organizational behaviour. London: Kogan Page; Hall P. Interprofessional teamwork: professional cultures as Barriers. J Interprof Care. The nonspread of innovations: the mediating role of professionals. Acad Manag J. Fitzgerald L, Dopson S. Professional boundaries and the diffusion of innovation. Hillman AL. Managing the physicians: rules versus incentives. Health Aff. Hudson B. Sutker WL. Proc Bayl Univ Med Cent. Mittman BS. Implementation science in health care. Involvement drivers: a study of nurses and physicians in improvement work. Q Manage Health Care. Denison DR. What is the difference between organizational culture and organizational climate?

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Sailor, G. Dunlap, G. Horner Eds. The article demonstrates exactly why a gap exists. Researchers seem to go off in their own little words and develop hilarious concepts that outside of political pressure, no administrator or teacher will actually implement. For instance It is hard to take research seriously when it is written more to impress colleagues and chalk up a publication, rather than communicate to a wider audience. I have attended AERA for nearly 15 years, and this same problem always amazes me.

Researchers of education continue to speak an entirely different language than educators and then wonder why there exists such a gap. So true, Richard. I had the same thoughts. Considering that the article was sponsored by the same people who are trying to solve a pragmatic problem, I just shake my head and wonder what they are thinking. I am mystified. Scholars please explain, help me understand. In these situations, I change identifying details. Certain details, like a unique physical trait combined with a sport or interest could be enough to identify the client.

Therefore, I change those types of details as well. To strengthen the teaching force, we must find the right teachers. Professional learning communities challenge existing norms in schools. An educational psychologist describes life as a school board member. Back Psychology Today. Back Find a Therapist. Back Get Help. Back Magazine. Subscribe Issue Archive. Back Today. Consider Sleep and Screen Time. Inflammation and the 3 Paths of Depression in Older Adults. Bridging the Research to Practice Gap Innovative research methods and dissemination practices are leading the way.

Post by Dr. Joseph M. References Chorpita, B. Why the gap? Submitted by Richard on August 16, - pm. Your comment Submitted by Bobby on August 16, - pm. Post Comment Your name. E-mail The content of this field is kept private and will not be shown publicly. Notify me when new comments are posted. All comments. Replies to my comment. Leave this field blank. More Posts. Learning the Lessons of Teacher Selection To strengthen the teaching force, we must find the right teachers.