title: Context and implementation: A concept analysis towards conceptual maturity.
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.
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany. Electronic address: pfadenh@ibe.med.uni-muenchen.de.
authors.forename: Lisa Maria
authors.initials: LM
authors.lastname: Pfadenhauer
authors.affiliation: Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen.
authors.forename: Kati
authors.initials: K
authors.lastname: Mozygemba
authors.affiliation: Institute of Public Health and Nursing Research, University of Bremen, Germany; Health Sciences Bremen, University of Bremen.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Gerhardus
authors.affiliation: Centre for Medical Ethics, University of Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Hofmann
authors.affiliation: University of Sheffield, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Booth
authors.affiliation: Centre for Medical Ethics, University of Oslo, Norway.
authors.forename: Kristin Bakke
authors.initials: KB
authors.lastname: Lysdahl
authors.affiliation: Radboud university medical center, Netherlands.
authors.forename: Marcia
authors.initials: M
authors.lastname: Tummers
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
authors.forename: Jacob
authors.initials: J
authors.lastname: Burns
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany.
authors.forename: Eva Annette
authors.initials: EA
authors.lastname: Rehfuess
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005858:Germany; D019983:Guideline Adherence / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*
keywords: Context; Implementierung; Kontext; Konzeptanalyse; complex interventions; concept analysis; health technology assessment; implementation; komplexe Interventionen; systematic review; systematischer Review: Health Technology Assessment