Ethnography and user-centered design to inform context-driven implementation

Abstract

Despite pervasive findings pointing to its inextricable role in intervention implementation, context remains poorly understood in implementation science. Existing approaches for describing context (e.g., surveys, interviews) may be narrow in scope or superficial in their elicitation of contextual data. Thus, in-depth and multilevel approaches are needed to meaningfully describe the contexts into which interventions will be implemented. Moreover, many studies assess context without subsequently using contextual information to enhance implementation. To be useful for improving implementation, though, methods are needed to apply contextual information during implementation. In the case example presented in this paper, we embedded an ethnographic assessment of context within a user-centered design approach to describe implementation context and apply that information to promote implementation. We developed a patient-reported outcome measure-based clinical intervention to assess and address the pervasive unmet needs of young adults with cancer: the Needs Assessment & Service Bridge (NA-SB). In this paper, we describe the user-centered design process that we used to anticipate context modifications needed to deliver NA-SB and implementation strategies needed to facilitate its implementation. Our ethnographic contextual inquiry yielded a rich understanding of local implementation context and contextual variation across potential scale-up contexts. Other methods from user-centered design (i.e., translation tables and a design team prototyping workshop) allowed us to translate that information into specifications for NA-SB delivery and a plan for implementation. Embedding ethnographic methods within a user-centered design approach can help us to tailor interventions and implementation strategies to their contexts of use to promote implementation.

Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project

“…Some of these quantitative and qualitative approaches have been criticized for focusing only on specific levels (e.g., the meso/organizational level) or "only provid[ing] a cursory view of complex and dynamic contexts" [29]. However, alongside quantitative and/or qualitative methods, ethnographic methods can complement both these types of data, thereby facilitating in-depth insights in organizational and contextual processes that influence implementation.…”

“…However, alongside quantitative and/or qualitative methods, ethnographic methods can complement both these types of data, thereby facilitating in-depth insights in organizational and contextual processes that influence implementation. An ethnographic approach can help highlight interactions within the context that remain undetected by other methods, but that may have a substantial impact on the intended implementation [29]. Furthermore, details that may not be obvious to the interviewee (e.g., ritualized everyday actions, cultural and social norms) or differences between what is said and what is done can be identified via ethnographic methods [95][96][97].…”

“…And what contextual information they generate is rarely linked to subsequent phases in their IS project [28]. In cases where contextual analysis is treated not as a separate foundational phase of an IS project, but as an add-on, contextual data are commonly only performed retrospectively, as part of a process evaluation [19,29]. This obviously excludes any chance of applying any contextual information to the IS project's next apply the results to intervention development/adaption and choices of contextually tailored implementation strategies.…”

Methodological approaches to study context in intervention implementation studies: an evidence gap map

“…However, recent studies increasingly emphasize the relevance of direct (e.g., ethnographic) observations in implementation research. These allow insider perspectives, including, for example, records of contextual aspects that implementation agents may take for granted and omit to mention, or tasks performed differently than generally reported [106][107][108][109].…”

“…In addition to probing more deeply into the context (e.g., to uncover hidden processes), these require fewer resources than traditional methods. This efficiency makes them particularly useful for contextual analyses, which are rarely wellresourced [108,110,111].…”