How should you decide which aspects of context to analyse in order to apply research to improve clinical practice?
Can I suggest that stakeholders who have high interest, influence and power are best able to identify the key aspects of context that are likely to be influenced by any proposed improvement or intervention.
Why do I say this?
We know that the local context is important to the way research can be used to improve clinical practice. There is an understanding, inspired by the Knowledge to Action framework, that context needs to analysed and understood in order to adapt and apply the research evidence. If the local context is sufficiently different from that where the original research was implemented, there is a need to tailor the intervention to the different local context.
So how best should you analyse context, as in the local and external environments, to make these comparisons? Several tools and frameworks have been developed to direct this analysis. The Health Foundation (UK) have produced a summary document Perspectives on Context. The PARiHS (Promoting Action on Research Implementation in Health Services) framework proposes diagnostic evaluation of both context and the research evidence as a prerequisite for designing interventions for change. While there are some commonalities between these two sets of recommendations, there are also insights to be gained from business and project management, including analysis of stakeholders, force fields, root causes and many more.
There is a risk of needing to analyse every aspect of both external and internal environments. How can you be sufficiently broad and critical to identify which aspects of the local context are important for a specific issue where it has been noted that current practice is not applying the best quality research evidence? With careful engagement, those stakeholders with high level of power, influence and interest in the area often have the best understanding of their local context. However, the next challenge is to facilitate a shared critical review of their own context, so that they can highlight the issues and areas for detailed analysis.