The context for implementation

Implementation is inseparable from context. By context, we mean the set of circumstances or unique factors in which implementation takes place, for example, an organisation, a community, or the wider system.

The influence of context

The influence of context explains the variation in implementation success (Pfadenhauer et al., 2017). For example, implementing a new programme to reduce re-offending after leaving prison may require specialist staff and intensive engagement. At the same time, the external economic context may mean reduced budgets. This reduces the chances of hiring enough skilled staff members to keep caseloads manageable. The context influences the ability to implement the programme as intended.

Interventions should be designed to leverage favourable contextual factors and overcome unfavourable ones. This may be difficult at times, as contextual factors can change quickly and without warning.

Determined stakeholders can change the context to help implementation. A sympathetic organisational culture, strong leadership, appropriate coaching and mentoring, and well-designed feedback and evaluation mechanisms can all help to influence context in a positive way.

Adapting to local context

Is it better to implement with fidelity, or should we adapt elements of an intervention to suit local contexts?

There is a long-running debate about fidelity and adapting interventions during implementation. Is it better to implement with fidelity (i.e. implementing as originally intended by those who developed the intervention)? Or should we adapt elements of an intervention to suit local contexts? There is evidence to support both views.

In most cases, it is possible to adapt an intervention to some degree while still maintaining the integrity of the intervention. The following points can help when planning and choosing an intervention:

1. Define the intervention?- Define and document the different components of the intervention, and distinguish between the components which are essential for the intervention to be effective (the core components) and those which can/should be adapted to the local context.
2. Identify the core components?– These are essential and indispensable elements of an intervention. They cannot change without undermining it. You will need to work with those who designed or developed the intervention to identify core components and deliver them with fidelity. For some interventions, it is possible that all components will be core.
3. Plan the adaptable components?– These elements may be tailored to local settings. When these elements are not adapted, interventions can be a poor fit for the local setting, generate resistance from those involved, and may result in poor outcomes.

The?Dynamic Sustainability Framework?(Chambers, Glasgow & Stange, 2013) argues that the contexts in which interventions are being delivered are constantly evolving. It is unrealistic to expect a one-size-fits-all approach. The success of sustaining an intervention is dependent on its ongoing adaptation to fit within a setting.

There is limited evidence to guide decisions about what aspects or components of an intervention can or should be adapted. The impact of any adaptations made should be monitored and evaluated on an ongoing basis to ensure that adaptation is effective.