Conceptualizing and measuring external context in implementation science: Studying the impacts of regulatory, fiscal, technological and social change

Researchers in the fields of implementation and improvement science have increasingly recognized the importance of context in understanding implementation processes and outcomes (Damschroder et al, 2009; Taylor et al, 2011; Kaplan et al, 2012). To date much of the attention in conceptualizing and measuring contextual factors has targeted internal context, including features of the organizational settings in which improvement and implementation processes occur. The theoretical literature also highlights the importance of external context, however, comprising features of the external environment. We identified several features of external context influencing the progress and success of an ongoing NIMH-funded hybrid effectiveness-implementation study of an innovative HIV/AIDS prevention program (Hamilton et al, 2014). This abstract presents a preliminary taxonomy and definitions of key dimensions of external context and describes the role of this taxonomy in augmenting and elaborating existing frameworks for context in implementation and improvement science.