Context Matters in Evidence Implementation Globally; Comment on “Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis”

Document Type : Commentary


Faculty of Nursing Sciences, Université Laval, Quebec City, QC, Canada


Context influences the effectiveness of healthcare interventions and should be considered to inform their implementation. However, context remains poorly defined in the knowledge translation (KT) literature. The paper by Squires and colleagues constitutes a valuable contribution to the field of KT as it provides the basis for a comprehensive framework to assess the influence of context on implementation success. In their study, Squires et al identified 66 context features, grouped into 16 attributes. Their findings highlight a great convergence in the context features mentioned by stakeholders across countries, experience levels and roles in KT. Thus, the proposed framework could eventually transfer to several implementation settings. However, all study participants were from high-income countries. It would therefore be important to replicate this research in low- and middle-income countries (LMICs). A common understanding of what context means is essential to assessing its influence on the implementation of healthcare interventions globally.


  1. Pfadenhauer LM, Gerhardus A, Mozygemba K, et al. Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework. Implement Sci. 2017;12(1):21. doi:1186/s13012-017-0552-5
  2. May CR, Johnson M, Finch T. Implementation, context and complexity. Implement Sci. 2016;11(1):141. doi:1186/s13012-016-0506-3
  3. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K. Getting evidence into practice: the meaning of 'context'. J Adv Nurs. 2002;38(1):94-104. doi:1046/j.1365-2648.2002.02150.x
  4. Kitson A, Brook A, Harvey G, et al. Using complexity and network concepts to inform healthcare knowledge translation. Int J Health Policy Manag. 2018;7(3):231-243. doi:15171/ijhpm.2017.79
  5. 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
  6. 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
  7. Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004;13(8):913-924. doi:1111/j.1365-2702.2004.01007.x
  8. 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
  9. 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
  10. Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, et al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med. 2013;11(Suppl 1):S115-123. doi:1370/afm.1549
  11. Möhler R, Köpke S, Meyer G. Criteria for reporting the development and evaluation of complex interventions in healthcare: revised guideline (CReDECI 2). Trials. 2015;16:204. doi:1186/s13063-015-0709-y
  12. Pinnock H, Barwick M, Carpenter CR, et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:i6795. doi:1136/bmj.i6795
  13. Alonge O, Rodriguez DC, Brandes N, Geng E, Reveiz L, Peters DH. How is implementation research applied to advance health in low-income and middle-income countries? BMJ Glob Health. 2019;4(2):e001257. doi:1136/bmjgh-2018-001257
  14. Bergström A, Peterson S, Namusoko S, Waiswa P, Wallin L. Knowledge translation in Uganda: a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework. Implement Sci. 2012;7:117. doi:1186/1748-5908-7-117
  15. Bergström A, Skeen S, Duc DM, et al. Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings. Implement Sci. 2015;10:120. doi:1186/s13012-015-0305-2
Volume 11, Issue 8
August 2022
Pages 1580-1583
  • Receive Date: 22 October 2021
  • Revise Date: 21 December 2021
  • Accept Date: 26 December 2021
  • First Publish Date: 27 December 2021