Defining the external implementation context: an integrative systematic literature review

Abstract

BackgroundProper implementation of evidence-based interventions is necessary for their full impact to be realized. However, the majority of research to date has overlooked facilitators and barriers existing outside the boundaries of the implementing organization(s). Better understanding and measurement of the external implementation context would be particularly beneficial in light of complex health interventions that extend into and interact with the larger environment they are embedded within. We conducted a integrative systematic literature review to identify external context constructs likely to impact implementation of complex evidence-based interventions.MethodsThe review process was iterative due to our goal to inductively develop the identified constructs. Data collection occurred in four primary stages: (1) an initial set of key literature across disciplines was identified and used to inform (2) journal and (3) author searches that, in turn, informed the design of the final (4) database search. Additionally, (5) we conducted citation searches of relevant literature reviews identified in each stage. We carried out an inductive thematic content analysis with the goal of developing homogenous, well-defined, and mutually exclusive categories.ResultsWe identified eight external context constructs: (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, and (8) funding and economic climate.ConclusionsThis is the first study to our knowledge to use a systematic review process to identify empirically observed external context factors documented to impact implementation. Comparison with four widely-utilized implementation frameworks supports the exhaustiveness of our review process. Future work should focus on the development of more stringent operationalization and measurement of these external constructs.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3046-5) contains supplementary material, which is available to authorized users.

Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes

“…This knowledge was used to inform the next steps of the project, which were to design the co-development process for developing the practice approaches, together with local stakeholders, and to implement the practices in the local organisations. The conceptual matrix by Watson et al [32] was used to systematically identify external context factors that may influence the co-development and implementation process.…”

“…Authors of the applied conceptual framework on the external context note, the conceptual matrix may not cover all aspects of external context (e.g. physical environment such as topography) and the categories are not entirely mutually exclusive [32]. While we gained valuable insights into the current situation by this systematic approach, the context information may therefore to some extent still be incomplete.…”

“…Conceptual framework for analysis Figure 1 depicts the conceptual framework for the situational analysis. We structured our analysis along analytical categories, based on Watson et al (2018) [32] who recently developed a conceptualization of the external context influencing implementation of practices in health and social care. To derive empirically observed external context factors, they conducted an iterative literature analysis, and an inductive thematic content analysis.…”

“…Resulting from this work, they developed homogenous, well-defined, and mutually exclusive context categories. We selected this framework, which includes an exhaustive list of external context factors, to identify factors that may impact the implemention of our own practice approaches in a structured way, an approach supported by authors own observations [32]. The taxonomy consists of eight context constructs (see Table 1): (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, (8) funding and economic climate ( [32], p. 6).…”

“…It has been argued that complex interventions may unfold differently in different contexts [30] and replicating them in different jurisdictions without modifying according to context often leads to disappointing results [31]. Evidence from complexity and implementation science strongly suggests that external factors, governing practice within the service context, may be a major driver or barrier for successful implementation [32][33][34]. Consequently, a good understanding of the current practice, service utilisation, and the existing needs in the Tyrolean pilot region, is a pre-condition for developing and implementing the planned practice changes.…”