title: Identifying the domains of context important to implementation science: a study protocol.
abstract: BACKGROUND
  There is growing recognition that "context" can and does modify the effects of implementation interventions aimed at increasing healthcare professionals' use of research evidence in clinical practice. However, conceptual clarity about what exactly comprises "context" is lacking. The purpose of this research program is to develop, refine, and validate a framework that identifies the key domains of context (and their features) that can facilitate or hinder (1) healthcare professionals' use of evidence in clinical practice and (2) the effectiveness of implementation interventions.
  
  
  METHODS
  A multi-phased investigation of context using mixed methods will be conducted. The first phase is a concept analysis of context using the Walker and Avant method to distinguish between the defining and irrelevant attributes of context. This phase will result in a preliminary framework for context that identifies its important domains and their features according to the published literature. The second phase is a secondary analysis of qualitative data from 13 studies of interviews with 312 healthcare professionals on the perceived barriers and enablers to their application of research evidence in clinical practice. These data will be analyzed inductively using constant comparative analysis. For the third phase, we will conduct semi-structured interviews with key health system stakeholders and change agents to elicit their knowledge and beliefs about the contextual features that influence the effectiveness of implementation interventions and healthcare professionals' use of evidence in clinical practice. Results from all three phases will be synthesized using a triangulation protocol to refine the context framework drawn from the concept analysis. The framework will then be assessed for content validity using an iterative Delphi approach with international experts (researchers and health system stakeholders/change agents).
  
  
  CONCLUSIONS
  This research program will result in a framework that identifies the domains of context and their features that can facilitate or hinder: (1) healthcare professionals' use of evidence in clinical practice and (2) the effectiveness of implementation interventions. The framework will increase the conceptual clarity of the term "context" for advancing implementation science, improving healthcare professionals' use of evidence in clinical practice, and providing greater understanding of what interventions are likely to be effective in which contexts.
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, Canada. jasquires@ohri.ca.|Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. jasquires@ohri.ca.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Squires
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. igraham@ohri.ca.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. igraham@ohri.ca.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia. alison.hutchinson@deakin.edu.au.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Hutchinson
authors.affiliation: Psychology Department, University College London, London, UK. s.michie@ucl.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: School of Health Sciences, City University London, London, UK. Jill.Francis.1@city.ac.uk.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor and School of Medicine, University of Michigan, Ann Arbor, MI, USA. salesann@med.umich.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Sales
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. jbrehaut@ohri.ca.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. jbrehaut@ohri.ca.
authors.forename: Jamie
authors.initials: J
authors.lastname: Brehaut
authors.affiliation: School of Nursing, Dalhousie University, Halifax, Canada. jacurran@dal.ca.|IWK Health Centre, Halifax, Canada. jacurran@dal.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Curran
authors.affiliation: Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Canada. noah.ivers@utoronto.ca.
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada. lavisj@mcmaster.ca.
authors.forename: John
authors.initials: J
authors.lastname: Lavis
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. slinklater@ohri.ca.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Linklater
authors.affiliation: Planning, Research and Analysis Branch, Ontario Ministry of Health & Long Term Care, Toronto, Canada. shannon.fenton@ontario.ca.
authors.forename: Shannon
authors.initials: S
authors.lastname: Fenton
authors.affiliation: Community Health Sciences, University of Calgary, Calgary, AB, Canada. tnosewor@ucalgary.ca.
authors.forename: Thomas
authors.initials: T
authors.lastname: Noseworthy
authors.affiliation: IWK Health Centre, Halifax, Canada. jocelyn.vine@iwk.nshealth.ca.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Vine
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. jgrimshaw@ohri.ca.|Department of Medicine, University of Ottawa, Ottawa, Canada. jgrimshaw@ohri.ca.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
mesh_terms: D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D036301:Qualitative Research; D012107:Research Design