Implementation, context and complexity
By Carl R. May, Mark A. Johnson, Tracy Finch. Implementation Science, 2016
794 citations recorded by the source corpus.
BackgroundContext is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice.DiscussionWe present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems.ConclusionImplementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
Subfields: General Health Professions, Management Science and Operations Research
View Paper: https://www.semanticscholar.org/paper/6473263e7f0252fc52c284ce2b6f5c6d170975f8
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In General Health Professions
Citations in the corpus
- When complexity science meets implementation science: a theoretical and empirical analysis of systems change (2018, methodology): “CASs are distributed in space and behave dynamically across time, with idiosyncratic interactions among agents at the local level determining the context, and the present and future behaviors of the system [24].”
- Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework (2017, background): “tive system, where significant changes at a micro, meso or macro level can become manifest over time [92].”