title: Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.
abstract: OBJECTIVE
  We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors.
  
  
  METHODS
  Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context.
  
  
  RESULTS
  The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context.
  
  
  CONCLUSIONS
  These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.
authors.affiliation: Department of Family & Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Andrada
authors.initials: A
authors.lastname: Tomoaia-Cotisel
authors.forename: Debra L
authors.initials: DL
authors.lastname: Scammon
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Waitzman
authors.forename: Peter F
authors.initials: PF
authors.lastname: Cronholm
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Halladay
authors.forename: David L
authors.initials: DL
authors.lastname: Driscoll
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Clarissa
authors.initials: C
authors.lastname: Hsu
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hiratsuka
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wise
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Diane
authors.initials: D
authors.lastname: Hauser
authors.forename: Carmit K
authors.initials: CK
authors.lastname: McMullen
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
authors.forename: Manasi A
authors.initials: MA
authors.lastname: Tirodkar
authors.forename: Laura
authors.initials: L
authors.lastname: Schmidt
authors.forename: Katrina E
authors.initials: KE
authors.lastname: Donahue
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
mesh_terms: D006302:Health Services Research; D006801:Humans; D009936:Organizational Innovation; D011320:Primary Health Care
keywords: change; context; generalizability; methods; organizational; patient-centered medical home; practice-based research; primary care; research design; transformation; validity