The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma

Meena Daivadanam, Maia Ingram, Kristi Sidney Annerstedt, Gary Parker, Kirsty Bobrow, Lisa Dolovich, Gillian Gould, Michaela Riddell, Rajesh Vedanthan, Jacqui Webster, Pilvikki Absetz, Helle Mölsted Alvesson, Odysseas Androutsos, Niels Chavannes, Briana Cortez, Praveen Devarasetty, Edward Fottrell, Francisco Gonzalez-Salazar, Jane Goudge, Omarys HerasmeHannah Jennings, Deksha Kapoor, Jemima Kamano, Marise J. Kasteleyn, Christina Kyriakos, Yannis Manios, Kishor Mogulluru, Mayowa Owolabi, Maria Lazo-Porras, Wnurinham Silva, Amanda Thrift, Ezinne Uvere, Ruth Webster, Rianne Van Der Kleij, Josefien Van Olmen, Constantine Vardavas, Puhong Zhang

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.

Original languageEnglish
Article numbere0214454
Pages (from-to)e0214454
JournalPLoS One
Issue number4
Publication statusPublished - 8 Apr 2019

Bibliographical note

Publisher Copyright:
© 2019 Daivadanam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

All Science Journal Classification (ASJC) codes

  • General Biochemistry,Genetics and Molecular Biology
  • General Agricultural and Biological Sciences


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