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The Implementation in Context (ICON) Framework: A meta-framework of context domains, attributes and features in healthcare
journal contributionposted on 2023-08-24, 05:31 authored by Janet E Squires, Ian D Graham, Wilmer J Santos, Alison M Hutchinson, Chantal Backman, Anna Bergström, Jamie Brehaut, Melissa Brouwers, Christopher Burton, Ligyana Korki de Candido, Christine Cassidy, Cheyne Chalmers, Anna ChapmanAnna Chapman, Heather Colquhoun, Janet Curran, Melissa Demery Varin, Paula Doering, Annette Elliott Rose, Lee Fairclough, Jillian Francis, Christina Godfrey, Megan Greenough, Jeremy M Grimshaw, Doris Grinspun, Gillian Harvey, Michael Hillmer, Noah Ivers, John Lavis, Shelly-Anne Li, Susan Michie, Wayne Miller, Thomas Noseworthy, Tamara Rader, Mark Robson, Jo Rycroft-Malone, Dawn Stacey, Sharon Straus, Andrea C Tricco, Lars Wallin, Vanessa Watkins
Abstract Background There is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals’ use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals’ use of research evidence and the effectiveness of implementation interventions in clinical practice. Methods We conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science. Results In the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes. Conclusions The Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals’ use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.
ContextFrameworkHealthcareImplementationKnowledge translationHumansDelivery of Health CareImplementation ScienceHealth PersonnelQualitative Research4203 Health Services and Systems42 Health SciencesClinical ResearchHealth ServicesGeneric health relevance4203 Health services and systems4206 Public health4407 Policy and administrationPublic Health and Health Services not elsewhere classifiedPolicy and Administration not elsewhere classified