TY - JOUR
T1 - The role of context in implementation research for non-communicable diseases
T2 - Answering the 'how-to' dilemma
AU - Daivadanam, Meena
AU - Ingram, Maia
AU - Annerstedt, Kristi Sidney
AU - Parker, Gary
AU - Bobrow, Kirsty
AU - Dolovich, Lisa
AU - Gould, Gillian
AU - Riddell, Michaela
AU - Vedanthan, Rajesh
AU - Webster, Jacqui
AU - Absetz, Pilvikki
AU - Alvesson, Helle Mölsted
AU - Androutsos, Odysseas
AU - Chavannes, Niels
AU - Cortez, Briana
AU - Devarasetty, Praveen
AU - Fottrell, Edward
AU - Gonzalez-Salazar, Francisco
AU - Goudge, Jane
AU - Herasme, Omarys
AU - Jennings, Hannah
AU - Kapoor, Deksha
AU - Kamano, Jemima
AU - Kasteleyn, Marise J.
AU - Kyriakos, Christina
AU - Manios, Yannis
AU - Mogulluru, Kishor
AU - Owolabi, Mayowa
AU - Lazo-Porras, Maria
AU - Silva, Wnurinham
AU - Thrift, Amanda
AU - Uvere, Ezinne
AU - Webster, Ruth
AU - Van Der Kleij, Rianne
AU - Van Olmen, Josefien
AU - Vardavas, Constantine
AU - Zhang, Puhong
N1 - Publisher Copyright:
© 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.
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85064070700
U2 - 10.1371/journal.pone.0214454
DO - 10.1371/journal.pone.0214454
M3 - Artículo
C2 - 30958868
AN - SCOPUS:85064070700
SN - 1932-6203
VL - 14
JO - PLoS ONE
JF - PLoS ONE
IS - 4
M1 - e0214454
ER -
SDG 3 Good Health and Well-being
SDG 16 Peace, Justice and Strong Institutions