Making Context Assessment Manageable: How to Slice and Dice Context in Different Ways
By Dr. Sobia Khan, Director of Implementation and Dr. Julia E. Moore, Executive Director
8-min read
Whenever we face huge implementation challenges, we often realize that these challenges are related to context. So what is context? Context is big and hard to unpack. That's because anything that relates to something happening in a larger setting or system can be a contextual factor. Also, we know that context is different depending on where you live and work and what kinds of systems you reside in. So certain contextual factors might have more importance in some settings and systems versus others.
This is what makes assessing context so complex. At TCI, whenever we talk to people about context we often get many questions about how to make sense of context and what the best frameworks/tools are to assess context.
Setting context assessment goals
Rather than thinking about contextual factors as a monolith, it helps to think about contextual factors that are categorized to different levels of the system, or to different phases of implementation. The reality is that you are always going to pay attention to context throughout your implementation journey; it helps to focus in on what type of context you might want to think about at certain moments of time instead of becoming overwhelmed with all the factors you might have to think of all the time.
Considering context across levels of the system (e.g., inner and outer setting)
One way to do this is to focus on the question(s) you are asking about context. A good general question is, “what are the factors within our setting that might make it challenging for us to implement the THING we want to implement?” Another good general question is, “what are the factors outside of our setting that might make it challenging for us to implement the THING we want to implement?” These questions are ‘pulse check’ questions, in the sense that you are generally orientating yourselves to the helpful or hindering contextual factors. Questions like these tap into levels of the system. One of the most commonly used frameworks to consider contextual factors is the Consolidated Framework for Implementation Research (CFIR), which describes contextual factors in this embedded way (see Dr. Jonathan Caballero’s description of the updated version of the CFIR in this bulletin!)
Considering context across phases of implementation (e.g., exploration, preparation, implementation, sustainability)
It is likely that you will consider contextual factors throughout your whole implementation journey. Therefore, you might consider asking more specific questions related to context along the way to make your assessments even more manageable. Some questions here might include, “what contextual factors are impacting our decision to adopt a THING?; what contextual factors might affect fit of the THING within our setting/ adaptations of the THING to fit our setting?; what contextual factors make the setting ready to implement?; and, what contextual factors are impacting ongoing implementation/sustainability?” These questions tap into the phases of implementation and help you make sense of the dynamic nature of context while you are implementing. The Exploration – Preparation- Implementation – Sustainment (EPIS) model wonderfully parses out contextual factors by phase.
Introducing the Context Compass Framework
Our brand-new Context Compass Framework can be a helpful tool if you want to think about the intersections between levels of context and context by implementation phase. We used the CFIR and EPIS as the basis of this model, reviewed other frameworks to add in factors that are relevant to different global contexts, and added decision points along the way to help you navigate through the contextual factors.
Sometimes people are dismissive of contextual frameworks because they don’t see themselves in that framework. The truth is, there are excellent frameworks and tools out there that are highly comprehensive, and these are meant to be relevant to multiple contexts, not just yours. To make it yours, it’s okay to adapt them to be more reflective of what the reality of your context is.
For example, in my calls with global health teams, many people have cited things like political instability and environmental instability as factors that might change the relative priority of the THING (and therefore affect adoption and fit). In the case of these teams, they may want to specify this in their assessment framework, therefore adapting an existing framework. We added a subfactor related to instability in the Context Compass Framework to be inclusive of different settings – however, if this is not applicable to your context, you can always remove it from your assessment.
The point is to think critically about what’s in and what’s out based on relevance, which can further help you make a context assessment more manageable and pragmatic for you.
Applying an assessment framework or tool
Using a context framework or tool is just like using any other data collection and mapping method that you may be familiar with and that we have talked about extensively (e.g., mapping barriers and facilitators to the theoretical domains framework). It is up to you how rigorous your data collection methods are based on your needs, objectives and resources. Context assessments can employ full surveys and setting observations, or they can be done in natural opportunities during meetings and other conversations. After collecting data, it helps to work with your team to make sense of the data by applying it to a framework or tool you have selected, and deciding which factors are the most prominent in terms of what’s going well, and what’s not going so well, in implementation.
As the interest in using implementation science to guide large and small change efforts gains momentum, we are hearing more and more about the need to understand and address contextual factors – so we are delving into context this year. Currently in the works, we are building the Context Compass an interactive online tool which can help you and your team explore ways to address context factors. A beta version of this tool is available in Implementation, Spread, and Scale and will be launched publicly in June! Stay tuned.
This article was featured in our monthly Implementation in Action bulletin! Want to receive our next issue? Subscribe here.