Juliane Mielke is a Postdoctoral Research Fellow at the Institute of Nursing Science at the University of Basel, Switzerland. She has a background in nursing and worked for several years in acute care settings in Germany and Switzerland. Juliane completed her PhD in 2022 which included the development of a methodology for studying context in implementation science. Her current research focuses on the combination of implementation science, systems science methods and routine data.
Understanding context is essential for successful and sustainable intervention implementation. However, a lack of standardised methodological approaches for contextual analysis limits the assessment and leads to inconsistent reporting of context. We systematically reviewed intervention implementation studies to map and evaluate current methodological approaches to contextual analysis.
Applying a stepwise evidence gap map (EGM) approach, we empirically developed a search strategy to identify intervention implementation studies in PubMed (2015-2020). From a random sample (20%) of articles per year we assessed those in detail that reported on contextual analysis. Data extraction, analysis and evaluation was guided by the Basel Approach for CONtextual ANAlysis (a six-step guidance for contextual analysis) and the Context and Implementation of Complex Interventions (CICI) framework. We created colour coded tables and visual maps to provide an overview on all relevant findings.
We identified 15,286 intervention implementation studies and protocols, of which 3017 were screened for inclusion. Finally, 110 studies were included, with 24 (22%) reporting on contextual analysis.
Only one study used a framework explicitly guiding contextual analysis. Twenty-two studies focused on the meso-level (i.e., organisational characteristics) with socio-cultural aspects most frequently being studied. Commonly applied methods included surveys (n=15) and individual interviews (n=13), with ten studies reporting a mixed-methods analysis. In 18 studies, contextual information was used to inform subsequent project phases (e.g., intervention development/adaption, selecting implementation strategies); nine studies assessed influences of context on implementation and effectiveness outcomes.
This study provides an overview on current methodological approaches to contextual analysis while highlighting their gaps. The huge heterogeneity identified turns contextual analyses into “black boxes”. We strongly recommend taking concerted actions to further develop and test robust methodologies for contextual analysis and consistent reporting (e.g., following BANANA), to increase the quality and consistency of implementation science research.