The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma
Sidney Annerstedt, Kristi
Mölsted Alvesson, Helle
Kasteleyn, Marise J
van der Kleij, Rianne
van Olmen, Josefien
AffiliationUniv Arizona, Dept Commun Environm & Policy
MetadataShow full item record
PublisherPUBLIC LIBRARY SCIENCE
CitationDaivadanam M, Ingram M, Sidney Annerstedt K, Parker G, Bobrow K, Dolovich L, et al. (2019) The role of context in implementation research for non-communicable diseases: Answering the ‘how-to’ dilemma. PLoS ONE 14(4): e0214454. https://doi.org/10.1371/journal.pone.0214454
Rights© 2019 Daivadanam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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AbstractIntroduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.
NoteOpen access journal.
VersionFinal published version
SponsorsCanadian Institutes of Health Research; Canadian Stroke Network; Grand Challenges Canada; Chinese Academy of Medical Sciences; International Development Research Centre; National Council of Science and Technology, Mexico; European Commission; Fogarty International Center; National Institutes of Health; Indian Council of Medical Research; National Heart, Lung, and Blood Institute; Medical Research Council, United Kingdom; Medical Research Council, South Africa; National Health and Medical Research Council, Australia; National Institute of Neurological Disorders and Stroke, United States
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