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Open Access Publications from the University of California

Context matters: The experience of 14 research teams in systematically reporting contextual factors important for practice change

  • Author(s): Tomoaia-Cotisel, A
  • Scammon, DL
  • Waitzman, NJ
  • Cronholm, PF
  • Halladay, JR
  • Driscoll, DL
  • Solberg, LI
  • Hsu, C
  • Tai-Seale, M
  • Hiratsuka, V
  • Shih, SC
  • Fetters, MD
  • Wise, CG
  • Alexander, JA
  • Hauser, D
  • Mcmullen, CK
  • Scholle, SH
  • Tirodkar, MA
  • Schmidt, L
  • Donahue, KE
  • Parchman, ML
  • Stange, KC
  • et al.

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PURPOSE 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 fi ndings (internal validity) and transporting or reinventing their fi ndings 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 identifi ed the most important contextual factors for their studies. We grouped the fi ndings 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 fi ndings 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 fi eld interested in improving the internal and external validity and impact of health care research.

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