Taking account of context in population health intervention research: guidance for producers, users and funders of research

Craig, Peter; Ruggiero, Erica Di; Frohlich, Katherine L.; Mykhalovskiy, Eric; White, Martin; Campbell, Rona; Cummins, Steven; Edwards, Nancy; Hunt, Kate; Kee, Frank; Loppie, Charlotte; Moore, Laurence; Ogilvie, David; Petticrew, Mark; Poland, Blake; Ridde, Valéry; Shoveller, Jeannie; Viehbeck, Sarah; Wight, Daniel

doi:10.3310/cihr-nihr-01

Cited by 309 publications

(263 citation statements)

References 124 publications

(171 reference statements)

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“…Analytic approaches that help researchers to integrate the concept of context in population‐based health interventions suggest that, rather than treating context as “noise,” investigators need an accurate understanding of the relationship between interventions and their context to determine why and how interventions are successful in some settings but ineffective in others. From this perspective, context refers to any “feature of the circumstances in which an intervention is implemented that may interact with the intervention to produce variation in outcomes.” 26 Craig et al suggested that context domains might include standard of care; the immediate and wider organizational setting of the intervention; geographical environment, both physical and human; demographic, epidemiological, and socioeconomic characteristics of those delivering the intervention and the recipient population; cultural practices, beliefs, and attitudes among those delivering the intervention and the recipient population; legal and ethical rules and conventions; broader policies within which the intervention is embedded; and historical and political factors that affect the acceptability of the intervention (Table 1). 26‐31 Regardless of the framework or theory used, the contextual evaluation of a breast health care system is key to intervention and implementation planning, and should be considered as an ongoing process.…”

Section: Introductionmentioning

confidence: 99%

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Situational analysis of breast health care systems: Why context matters

Duggan

Dvaladze

Stevens

et al. 2020

Cancer

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BACKGROUND: Implementation of evidence-based, resource-appropriate guidelines for breast cancer control should be preceded by a baseline assessment or situational analysis to assess breast health infrastructure, workforce capacity, patient pathways, existing practices, accessibility, and costs. METHODS: To support the assessment of breast health care systems within the broader context in which they exist, the Breast Health Global Initiative (BHGI) developed, tested, and refined a set of situational analysis tools with which to guide the assessment of breast health care capacity, identify the relative strengths and weaknesses of the health system, and support stakeholders in prioritizing actionable items to advance breast cancer care using evidence-based strategies tailored to their setting. The tools address 6 domains of breast health care delivery: 1) breast cancer early detection practices; 2) breast cancer awareness programs; 3) the availability of breast cancer surgery; 4) the availability of pathology; 5) the availability of radiotherapy, and 6) the availability of systemic therapy services. The current study also describes the more comprehensive International Atomic Energy Agency Programme of Action for Cancer Therapy (PACT) integrated missions for PACT (imPACT) review. RESULTS: As of 2020, 5 formal BHGI situational analyses have been performed in India, Brazil, Panama, Tanzania, and Uganda. As of August 2019, a total of 100 imPACT reviews have been conducted in 91 countries. These assessments can contribute to more informed policymaking. CONCLUSIONS: Situational analyses are a prerequisite for the development of resource-appropriate strategies with which to advance breast cancer control in any setting and should assess services across the entire breast health care continuum as well as the broader structural, sociocultural, personal, and financial contexts within which they operate. Cancer 2020;126:2405-2415.

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Section: Introductionmentioning

confidence: 99%

“… a Adapted from Craig P, Di Ruggiero E, Frohlich KL, Mykhalovskiy E, White M. Taking Account of Context in Population Health Intervention Research: Guidance for Producers, Users and Funders of Research. Canadian Institutes of Health Research (CIHR)‐National Institute for Health Research (NIHR); 2018 26 …”

Section: Introductionmentioning

confidence: 99%

Situational analysis of breast health care systems: Why context matters

Duggan

Dvaladze

Stevens

et al. 2020

Cancer

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“…They have demonstrated some evidence of feasibility, as well as the challenges associated with embedding a new approach. With increased interest in the notion of interventions as being contextually contingent, there has been a range of theoretical and methodological consideration of how best to integrate a focus on context into developmental and evaluation processes (24,35,36). In the event of routinised practice, many of these contextual contingencies are already emergent or even established.…”

Section: Discussionmentioning

confidence: 99%

Developing whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: A case-study of innovative local practice within the School Health Research Network

Gobat

Littlecott

Williams

et al. 2020

Preprint

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Background: The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation. Methods: A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales. Results: The study reports seven phases of the pragmatic formative process evaluation that may be undertaken in the development and evaluation of interventions already in routine practice: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify existing intervention programme theory; outcomes; and contextual characteristics that influence programme theory and implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production of an initial intervention logic model with stakeholders; 5) confirmation of logic model with stakeholders; 6) planning for intervention refinement; and 7) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential. Conclusions: Formative, pragmatic process evaluations support researchers, policy-makers and practitioners in developing a robust scientific evidence-base for acceptable and feasible local innovation that does not have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.

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“…Indeed, only one paper (23) providing qualitative data on this topic was found and none were found for rural regions or for LMICs. This is concerning since effective public health policy should be informed by local context (30)(31)(32). What is it, for example, that renders illiteracy a risk factor for not receiving the recommended standard care during pregnancy, delivery, and post-delivery?…”

Section: Introductionmentioning

confidence: 99%

Barriers to Receiving the Recommended Standard Care During Pregnancy by Illiterate Women in Rural, Northern Tanzania

Matovelo

Ndaki

Yohani

et al. 2020

Preprint

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Background: In 2017, an estimated 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a maternal and neonatal health continuity of patient care, yet most women do not meet this recommendation. Surveys suggest that illiteracy limits uptake of the proposed maternal-newborn package, yet little is known about the association between illiteracy and healthcare seeking, particularly in rural regions of low-income countries. This knowledge gap compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. To begin to address this gap this study explores the experiences related to care-seeking by illiterate, pregnant women in rural Tanzania.Methods: A qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 interviews with illiterate women of reproductive age and seven interviews with members of these communities perceived to have some influence on women’s decisions concerning perinatal care services. Themes were coded and their relative importance determined using frequency reports and cross-tabulations. Findings: Three key themes emerged, illiterate women (1) could not read their healthcare cards or public health messaging; (2) spoke the local language, not Swahili, the language used by healthcare providers, and (3) have endeavored to develop coping strategies to overcome these obstacles. In addition, health service providers are often unaware of who is illiterate.Recommendations: More health needs of this group could be met, in the short term, by developing a protocol for health service providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. In the long term, this barrier may be addressed by ensuring that all Tanzanians receive a high-quality, formal education, supporting community health workers, and recruiting healthcare providers from rural areas. A failure of to address the needs of this at-risk group will likely mean that they will continue to experience barriers to achieving the recommended continuity of patient care with detrimental health outcomes for both mothers and newborns.

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Taking account of context in population health intervention research: guidance for producers, users and funders of research

Cited by 309 publications

References 124 publications

Situational analysis of breast health care systems: Why context matters

Situational analysis of breast health care systems: Why context matters

Developing whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: A case-study of innovative local practice within the School Health Research Network

Barriers to Receiving the Recommended Standard Care During Pregnancy by Illiterate Women in Rural, Northern Tanzania

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