Evaluating the impact of context within implementation research

The uptake of evidence-based healthcare interventions is challenging with, on average, a 17-year time gap between the generation of evidence and the implementation of change in routine practice. One of the key challenges to successful implementation requiring consideration is context. However, despite its noted importance, context remains a poorly understood construct, with a lack of consensus regarding how it should be accounted for within research. Subsequently, this research addressed this gap by exploring the following research questions: How does context influence the implementation of a collective leadership team intervention? Does context contribute to variances in implementation success across settings? If so, how? A systematic review was conducted which highlighted that inconsistencies exist when defining, assessing, and analysing context. These findings supported the development of an operational definition of context and the creation of a practical approach for measuring the construct. Using a multiple case study design and a triangulation of qualitative research methods (involving observation and interview data), this practical method was applied to evaluate how context influences implementation within two multidisciplinary healthcare teams. Two overarching themes were generated from the data. The first revealed the bidirectional influence of context and implementation, highlighting how these concepts dynamically interact, respond, and mutually evolve. The second theme addressed the micropolitical concepts of power, authority, and influence as essential contextual determinants impacting implementation. This thesis contributes to the implementation science literature by 1) developing an operational definition of context to improve the coherency and consistency with which the term is used; 2) advancing a practical method that captures the dynamism of the concept and creates actionable, detailed findings; and 3) exposing the impact of team-level contextual factors on implementation success. This valuable knowledge will help researchers negotiate the everyday realities of healthcare, supporting the successful implementation of change in routine practice.Author's signature in PDF - ROR2022-05-04 JG: signature removed from PD