Abstract
BackgroundProper implementation of evidence-based interventions is necessary for their full impact to be realized. However, the majority of research to date has overlooked facilitators and barriers existing outside the boundaries of the implementing organization(s). Better understanding and measurement of the external implementation context would be particularly beneficial in light of complex health interventions that extend into and interact with the larger environment they are embedded within. We conducted a integrative systematic literature review to identify external context constructs likely to impact implementation of complex evidence-based interventions.MethodsThe review process was iterative due to our goal to inductively develop the identified constructs. Data collection occurred in four primary stages: (1) an initial set of key literature across disciplines was identified and used to inform (2) journal and (3) author searches that, in turn, informed the design of the final (4) database search. Additionally, (5) we conducted citation searches of relevant literature reviews identified in each stage. We carried out an inductive thematic content analysis with the goal of developing homogenous, well-defined, and mutually exclusive categories.ResultsWe identified eight external context constructs: (1) professional influences, (2) political support, (3) social climate, (4) local infrastructure, (5) policy and legal climate, (6) relational climate, (7) target population, and (8) funding and economic climate.ConclusionsThis is the first study to our knowledge to use a systematic review process to identify empirically observed external context factors documented to impact implementation. Comparison with four widely-utilized implementation frameworks supports the exhaustiveness of our review process. Future work should focus on the development of more stringent operationalization and measurement of these external constructs.
Highlights
Proper implementation of evidence-based interventions is necessary for their full impact to be realized
Considerable scientific effort has focused on identifying factors affecting translation of evidence-based interventions (EBIs) from research to practice
While conceptual models and empirical studies emphasize the importance of the external implementation context—i.e., factors existing outside the boundaries of the entity or entities leading the implementation of one or more EBIs—to the
Summary
Proper implementation of evidence-based interventions is necessary for their full impact to be realized. Watson et al BMC Health Services Research (2018) 18:209 encounter when implementing EBIs [1, 2], empirical research in this area has focused largely on influences internal to implementing organizations This is a considerable gap considering the recognized influence of both internal and external factors to the implementation process and because external factors are often antecedents of organizational readiness, drive organizational-level policy and processes, and pose greater difficulties in addressing than internal factors because they are typically beyond any single organization’s control to change [3,4,5,6,7,8,9]. All of these options cause obvious problems related to consistency, replicability, and comparability across implementation studies [11]
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