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    The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma

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    Author
    Daivadanam, Meena
    Ingram, Maia
    Sidney Annerstedt, Kristi
    Parker, Gary
    Bobrow, Kirsty
    Dolovich, Lisa
    Gould, Gillian
    Riddell, Michaela
    Vedanthan, Rajesh
    Webster, Jacqui
    Absetz, Pilvikki
    Mölsted Alvesson, Helle
    Androutsos, Odysseas
    Chavannes, Niels
    Cortez, Briana
    Devarasetty, Praveen
    Fottrell, Edward
    Gonzalez-Salazar, Francisco
    Goudge, Jane
    Herasme, Omarys
    Jennings, Hannah
    Kapoor, Deksha
    Kamano, Jemima
    Kasteleyn, Marise J
    Kyriakos, Christina
    Manios, Yannis
    Mogulluru, Kishor
    Owolabi, Mayowa
    Lazo-Porras, Maria
    Silva, Wnurinham
    Thrift, Amanda
    Uvere, Ezinne
    Webster, Ruth
    van der Kleij, Rianne
    van Olmen, Josefien
    Vardavas, Constantine
    Zhang, Puhong
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    Affiliation
    Univ Arizona, Dept Commun Environm & Policy
    Issue Date
    2019-04-08
    
    Metadata
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    Publisher
    PUBLIC LIBRARY SCIENCE
    Citation
    Daivadanam 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
    Journal
    PLOS ONE
    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.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Introduction 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.
    Note
    Open access journal.
    ISSN
    1932-6203
    PubMed ID
    30958868
    DOI
    10.1371/journal.pone.0214454
    Version
    Final published version
    Sponsors
    Canadian 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
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0214454
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