Attributes of context relevant to healthcare professionals’ use of research evidence in clinical practice: a multi-study analysis

Abstract

Background To increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles. Methods We conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals’ perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators). Results We identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority ( n = 12, 86%) of attributes of context across multiple ( n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators). Conclusions There was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting. Electronic supplementary material The online version of this article (10.1186/s13012-019-0900-8) contains supplementary material, which is available to authorized users.

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

“…Our results can also be compared to a multi-study analysis investigating attributes of context found relevant by HCPs in the implementation of evidence-based practices [ 13 ]. The main theme of our study was also found as one of several core contextual factors in this secondary analysis of 145 interviews from 11 studies in different clinical contexts (not including oncology) [ 13 ]. That study also revealed that regulatory and legislative standards were less commonly described attributes that varied in their relevance across clinical contexts [ 13 ].…”

“…Our study generally highlights the need to further investigate outer setting variables in implementation studies. In order to do so, it is necessary to develop further tools to measure those variables [ 13 ] and to distinguish between modifiable and unmodifiable variables [ 49 ]. Last, but not least, future research on treatment decision making processes should further investigate the role of treatment costs and financial toxicity.…”

“…This is in line with the implementation science literature in general. While context factors have been recognized as potential influences on the uptake of innovations [ 12 ], they are still frequently neglected and empirical studies are limited [ 13 ].…”

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

“…Testing and providing views on the validity of the framework A total of 102 (28%) articles described testing or validating PARIHS, or provided comments on the validity of or parts of the framework with a focus on: ▪ The validity of the whole framework (e.g., [24,74,157,195,209]) ▪ The validity of context (e.g., [155,190,280,287,308]) ▪ The validity of facilitation (e.g., [23,58,182,206]) ▪ The validity of evidence (e.g., [255]) ▪ Identifying gaps in the framework (e.g., [64,170,326]) Over the review study period (1998 to 2019), among empirical studies, there was a shift from primarily studying the context element of the framework to more articles evaluating the whole framework. This was also evident in the pattern found in the protocols, which mostly focused on testing facilitation (e.g., [58,182,206]).…”

Rugged landscapes: complexity and implementation science

“…The final type of complexity is context-specificity, the tendency for a program's effectiveness to vary based on context [17]. Programs that are successful in some region or population may perform poorly when adopted elsewhere.…”