Future Directions for Providing Conceptual Clarity Related to Context in Implementation; Comment on “Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis”

Document Type : Commentary


1 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

2 Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

3 Children’s Hospital of Philadelphia, Philadelphia, PA, USA

4 Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

5 Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

6 Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA

7 Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA

8 Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA


In implementation science, contextual inquiry guides the implementation process for successful uptake of evidence-based practices. However, the conceptualization and measurement of context varies across frameworks and stakeholders. To move the field forward, future efforts to advance the understanding of context should incorporate input from implementation stakeholders through co-creation, elicit stakeholders’ perspectives in low- and middle-income countries (LMICs) to generate a more comprehensive list of determinants, and refine inconsistencies in terminology to promote research synthesis. Greater conceptual clarity and generalizability in contextual inquiry will enable improved communication and collaboration, thus facilitating a shift in focus to development and evaluation of implementation strategies to improve healthcare and health outcomes.


  1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:1258/jrsm.2011.110180
  2. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. doi:1007/s10488-010-0319-7
  3. Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21. doi:1186/s13012-015-0209-1
  4. Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81-95. doi:1007/s12160-013-9486-6
  5. Flottorp SA, Oxman AD, Krause J, et al. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013;8:35. doi:1186/1748-5908-8-35
  6. Lane-Fall MB, Curran GM, Beidas RS. Scoping implementation science for the beginner: locating yourself on the "subway line" of translational research. BMC Med Res Methodol. 2019;19(1):133. doi:1186/s12874-019-0783-z
  7. Kislov R, Pope C, Martin GP, Wilson PM. Harnessing the power of theorising in implementation science. Implement Sci. 2019;14(1):103. doi:1186/s13012-019-0957-4
  8. Sales AE, Barnaby DP, Rentes VC. Letter to the editor on "the implementation research logic model: a method for planning, executing, reporting, and synthesizing implementation projects" (Smith JD, Li DH, Rafferty MR. the implementation research logic model: a method for planning, executing, reporting, and synthesizing implementation projects. Implement Sci. 2020;15 (1):84. Doi:1186/s13012-020-01041-8). Implement Sci. 2021;16(1):97. doi:10.1186/s13012-021-01169-1
  9. Squires JE, Hutchinson AM, Coughlin M, et al. Stakeholder perspectives of attributes and features of context relevant to knowledge translation in health settings: a multi-country analysis. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.32
  10. Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv Res. 2019;19(1):189. doi:1186/s12913-019-4015-3
  11. Metz A. Implementation Brief: The Potential of Co-Creation in Implementation Science. https://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/resources/NIRN-Metz-ImplementationBreif-CoCreation.pdf. Published 2015.
  12. Means AR, Kemp CG, Gwayi-Chore MC, et al. Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implement Sci. 2020;15(1):17. doi:1186/s13012-020-0977-0
  13. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:1186/1748-5908-4-50
  14. Davis M, Beidas RS. Refining contextual inquiry to maximize generalizability and accelerate the implementation process. Implement Res Pract. 2021;2:2633489521994941. doi:1177/2633489521994941
Volume 11, Issue 8
August 2022
Pages 1577-1579
  • Receive Date: 01 October 2021
  • Revise Date: 16 December 2021
  • Accept Date: 19 December 2021
  • First Publish Date: 20 December 2021