Cited by 197Health Policy Implementation ScienceClinical practice guidelines implementationHealth Sciences Research and Education

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Context and implementation: A concept analysis towards conceptual maturity

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Pfadenhauer, Lisa Maria, Mozygemba, Kati, Gerhardus, Ansgar, Hofmann, Bjørn, Booth, Andrew, Lysdahl, Kristin Bakke, Tummers, Marcia, Burns, Jacob, Rehfuess, Eva Annette·2015·Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen

DOI 10.1016/j.zefq.2015.01.004

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Abstract

Context and implementation of health interventions have received increasing attention over the past decade, in particular with respect to their influence on the effectiveness and reach of complex interventions. The underlying concepts are both considered partially mature, limiting their operationalization in research and practice. We conducted systematic literature searches and pragmatic utility (PU) concept analyses to provide a state-of-the-art assessment of the concepts of "context" and "implementation" in the health sciences to create a common understanding for their use within systematic reviews and HTA. We performed two separate searches, one for context (EMBASE, MEDLINE) and the other for implementation (Google Scholar) to identify relevant models, theories and frameworks. 17 publications on context and 35 articles on implementation met our inclusion criteria. PU concept analysis comprises three guiding principles: selection of the literature, organization and structuring of the literature, and asking analytic questions of the literature. Both concepts were analyzed according to four features of conceptual maturity, i.e., consensual definitions, clear characteristics, fully described preconditions and outcomes, and delineated boundaries. Context and implementation are highly intertwined, with both concepts influencing and interacting with each other. Context is defined as a set of characteristics and circumstances that surround the implementation effort. Implementation is conceptualized as a planned and deliberately initiated effort with the intention to put an intervention into practice. The concept of implementation presents largely consensual definitions and relatively well-defined boundaries, while distinguishing features, preconditions and outcomes are not yet fully articulated. In contrast, definitions of context vary widely, and boundaries with neighbouring concepts, such as setting and environment, are blurred; characteristics, preconditions and outcomes are ill-defined. Therefore, the maturity of both concepts should be further improved to facilitate operationalization in systematic reviews and HTAs.

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Additional file 5 of Methodological approaches to study context in intervention implementation studies: an evidence gap map
Mielke, J., Brunkert, T., Zúñiga, F., Simon, M., Zullig, L. L., & De Geest, S. (2024) · Figshare · doi:10.6084/m9.figshare.26554376
Additional file 1 of Anticipated benefits and challenges of implementing group care in Suriname’s maternity and child care sector: a contextual analysis
Martens, N., Hindori‐Mohangoo, A. D., Hindori, M. P., Damme, A. V., Beeckman, K., Reis, R., Crone, M. R., & van der Kleij, R. R. (2023) · Figshare · doi:10.6084/m9.figshare.23993260
Additional file 1 of When complexity matters: a step-by-step guide to incorporating a complexity perspective in guideline development for public health and health system interventions
Movsisyan, A., Rehfuess, E., & Norris, S. L. (2020) · Figshare · doi:10.6084/m9.figshare.13047042
Self-citation
Additional file 3 of Methodological approaches to study context in intervention implementation studies: an evidence gap map
Mielke, J., Brunkert, T., Zúñiga, F., Simon, M., Zullig, L. L., & De Geest, S. (2024) · Figshare · doi:10.6084/m9.figshare.26554370
Additional file 3 of Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care
Dunsmore, J., Duncan, E., MacLennan, S., N’Dow, J., & MacLennan, S. (2024) · Figshare · doi:10.6084/m9.figshare.26758556
Additional file 1 of Organisational implementation climate in implementing internet-based cognitive behaviour therapy for depression
Vis, C., Kleiboer, A. M., Mol, M., Pedersen, C. D., Finch, T. L., Smit, J. H., & Riper, H. M. (2022) · Figshare · doi:10.6084/m9.figshare.19948979
Additional file 2 of Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study
Lyng, H. B., Ree, E., Strømme, T., Johannessen, T., Aase, I., Ullebust, B., Thomsen, L. H., Holen-Rabbersvik, E., Schibevaag, L., Bates, D. W., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26712455
Additional file 2 of Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care
Dunsmore, J., Duncan, E., MacLennan, S., N’Dow, J., & MacLennan, S. (2024) · Figshare · doi:10.6084/m9.figshare.26517907
Additional file 3 of Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study
Lyng, H. B., Ree, E., Strømme, T., Johannessen, T., Aase, I., Ullebust, B., Thomsen, L. H., Holen-Rabbersvik, E., Schibevaag, L., Bates, D. W., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26712458
Additional file 6 of Methodological approaches to study context in intervention implementation studies: an evidence gap map
Mielke, J., Brunkert, T., Zúñiga, F., Simon, M., Zullig, L. L., & De Geest, S. (2024) · Figshare · doi:10.6084/m9.figshare.26554379
Additional file 1 of An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department
Sivertsen, D. M., Becker, U., Andersen, O., & Kirk, J. W. (2021) · Figshare · doi:10.6084/m9.figshare.16726696
Additional file 1 of Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care
Haines, E. R., Dopp, A. R., Lyon, A. R., Witteman, H. O., Bender, M., Vaisson, G., Hitch, D., & Birken, S. A. (2021) · Figshare · doi:10.6084/m9.figshare.14490554
Additional file 1 of The health-related quality of life, mental health and mental illnesses of patients with inclusion body myositis (IBM): results of a mixed methods systematic review
Senn, K. C., Gumbert, L., Thiele, S., Krause, S., Walter, M. C., & Nagels, K. (2022) · Figshare · doi:10.6084/m9.figshare.20087858
Additional file 1 of Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study
Smit, L. C., de Wit, N. J., Nieuwenhuizen, M. L., Schuurmans, M. J., & Bleijenberg, N. (2021) · Figshare · doi:10.6084/m9.figshare.16835168
Additional file 7 of Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study
Queder, A., Arnold, C., Wensing, M., & Poß-Doering, R. (2022) · Figshare · doi:10.6084/m9.figshare.19351055
Additional file 6 of Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study
Queder, A., Arnold, C., Wensing, M., & Poß-Doering, R. (2022) · Figshare · doi:10.6084/m9.figshare.19351052
Additional file 2 of Methodological approaches to study context in intervention implementation studies: an evidence gap map
Mielke, J., Brunkert, T., Zúñiga, F., Simon, M., Zullig, L. L., & De Geest, S. (2024) · Figshare · doi:10.6084/m9.figshare.26554367
Additional file 1 of Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study
Lyng, H. B., Ree, E., Strømme, T., Johannessen, T., Aase, I., Ullebust, B., Thomsen, L. H., Holen-Rabbersvik, E., Schibevaag, L., Bates, D. W., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26712452
Additional file 2 of Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study
Queder, A., Arnold, C., Wensing, M., & Poß-Doering, R. (2022) · Figshare · doi:10.6084/m9.figshare.19351040
Additional file 1 of Exploring the intersection of hermeneutics and implementation: a scoping review
MacLeod, M., McCaffrey, G., Wilson, E., Zimmer, L. V., Snadden, D., Zimmer, P., Jónatansdóttir, S., Fyfe, T., Koopmans, E., Ulrich, C., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26572378
Additional file 2 of Organisational implementation climate in implementing internet-based cognitive behaviour therapy for depression
Vis, C., Kleiboer, A. M., Mol, M., Pedersen, C. D., Finch, T. L., Smit, J. H., & Riper, H. M. (2022) · Figshare · doi:10.6084/m9.figshare.19948982
Additional file 5 of Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care
Haines, E. R., Dopp, A. R., Lyon, A. R., Witteman, H. O., Bender, M., Vaisson, G., Hitch, D., & Birken, S. A. (2021) · Figshare · doi:10.6084/m9.figshare.14490566
Additional file 1 of Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study
Queder, A., Arnold, C., Wensing, M., & Poß-Doering, R. (2022) · Figshare · doi:10.6084/m9.figshare.19351037
Additional file 1 of Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care
Dunsmore, J., Duncan, E., MacLennan, S., N’Dow, J., & MacLennan, S. (2024) · Figshare · doi:10.6084/m9.figshare.26517854
Additional file 1 of Methodological approaches to study context in intervention implementation studies: an evidence gap map
Mielke, J., Brunkert, T., Zúñiga, F., Simon, M., Zullig, L. L., & De Geest, S. (2024) · Figshare · doi:10.6084/m9.figshare.26554364
Additional file 5 of Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care
Dunsmore, J., Duncan, E., MacLennan, S., N’Dow, J., & MacLennan, S. (2024) · Figshare · doi:10.6084/m9.figshare.26758562
Additional file 4 of Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care
Dunsmore, J., Duncan, E., MacLennan, S., N’Dow, J., & MacLennan, S. (2024) · Figshare · doi:10.6084/m9.figshare.26758559
Additional file 5 of Contextual factors influencing physicians’ perception of antibiotic prescribing in primary care in Germany — a prospective observational study
Queder, A., Arnold, C., Wensing, M., & Poß-Doering, R. (2022) · Figshare · doi:10.6084/m9.figshare.19351049
La mise en œuvre des projets d’e-GRH au sein des EES en RDC : Mise en évidence des spécificités enracinées en contexte africain
Li-Mabila, L. L., Cornet, A., Lisein, O., Apitsa, S. M., & Pichault, F. (2026) · Management & Avenir · doi:10.3917/mav.150.0013
Evaluating a co-developed pet robot intervention and implementation for residents with dementia in long-term care
Koh, W. Q., Carroll, T., Gimblett, L., Murphy, E., & Gavin, N. (2026) · Frontiers in Dementia · doi:10.3389/frdem.2026.1791588

Authors: Pfadenhauer, L. M., Mozygemba, K., Gerhardus, A., Hofmann, B., Booth, A., Lysdahl, K. B., Tummers, M., Burns, J., & Rehfuess, E. A.
Affiliations: Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE)
University of Bremen (DE)
University of Oslo (NO)
University of Sheffield (GB)
Radboud University Medical Center (NL)
Corresponding author: Pfadenhauer, Lisa Maria
ORCID: Pfadenhauer, Lisa Maria
Mozygemba, Kati
Gerhardus, Ansgar
Hofmann, Bjørn
Booth, Andrew
Lysdahl, Kristin Bakke
Tummers, Marcia
Burns, Jacob
Rehfuess, Eva Annette
Venue: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
Publisher: Elsevier BV
Published: 2015
Volume: 109
Issue: 2
Pages: 103-114
ISSN: 1865-9217 (ISSN-L)
DOI: 10.1016/j.zefq.2015.01.004
OpenAlex: W1998641377
Semantic Scholar: 93ddce6a560b6dc55062e4dc9a2f4794ee4d6531
Cited by: 189
References: 88
Citations by year: 2026: 7 · 2025: 11 · 2024: 29 · 2023: 18 · 2022: 29 · 2021: 28 · 2020: 23 · 2019: 13 · 2018: 17 · 2017: 9 · 2016: 3 · 2015: 2
FWCI: 19.00
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen (publishedVersion)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: context, implementation, health interventions, complex interventions, conceptual analysis, health technology assessment, operationalization
MeSH terms: Delivery of Health Care, Germany, Health Plan Implementation, Humans, Technology Assessment, Biomedical, Evidence-Based Medicine, Guideline Adherence

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Context and implementation: A concept analysis towards conceptual maturity

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