Background
Defining context
Context and implementation interventions
Frameworks for context
Methods
Design and objectives
Context study 1: concept analysis
Context study 2: secondary analysis of interviews with healthcare professionals
Sample | TACT | |||||||
---|---|---|---|---|---|---|---|---|
Dataset |
N
| Professional group | Country | Data collection dates | Target | Action | Context | Time |
Red blood cell transfusion-1 | 12 | Intensivists | Canada | April–October 2008 | Patients | Watching and waiting vs. infusing red blood cells | Intensive care units | When patient has borderline hemoglobin |
Red blood cell transfusion-2 | 12 | Orthopedic surgeons | Canada | September–July 2009 | Patients | Watching and waiting vs. infusing red blood cells | General surgery wards | When patient has borderline hemoglobin |
Pre-operative assessment | 11 | Anesthesiologists | Canada | September–October 2009 | Patients | Completing an assessment without a routine electro-cardiography | Pre-assessment units | During pre-operative assessments |
5 | Surgeons | |||||||
Smoking cessation | 10 | Family physicians | Canada | March–October 2009 | Patients | Adherence to a guideline for smoking cessation | Primary care | During patient visit |
Fetal monitoring | 12 | Labor & delivery nurses | Canada | April–May 2010 | Patients | Intermittent auscultation for fetal surveillance | Birthing units | During labor |
Adult computerized tomography head rule | 8 | Emergency room physicians | Canada | March–June 2010 | Patients | Using an adult computerized tomography head rule | Adult emergency room | During emergency room visit for a head injury |
Child computerized tomography head rule | 31 | Physicians | Canada | January–July 2011 | Patients | Using a child computerized tomography head rule | Pediatric emergency room | During emergency room visit for a head injury |
11 | Nurses | |||||||
Bone mineral density screening | 12 | Family physicians | Canada | September–November 2012 | Patients ≥50 years | Order a bone mineral density screen | Physician’s office | At next available appointment when find out about Fragility Fracture |
Hand hygiene | 22 | Physicians | Canada | September 2012–Feb 2013 | Patients | Hand hygiene | Medical and surgical wards | Before initial contact, after contact, before aseptic procedures, and after bodily fluid exposure |
20 | Residents | |||||||
4 | Infection Control Specialists | |||||||
Donation after cardio-circulatory death | 24 | Intensivists | Canada | October–July 2014 | Patients | Donation after cardio-circulatory death | Hospitals that perform organ donation | At circulatory death |
16 | ICU nurses | |||||||
15 | Organ Donor Coordinators | |||||||
Fit: feedback intervention trial | 12 | Doctors | UK | February 2006 | Patients | Hand hygiene | Intensive care units and elderly medical units | While in the hospital |
32 | Nurses | |||||||
Preconception care guidelines | 22 | Physicians | Australia | October–November 2007 | Patients | Adherence to guidelines for preconception care | Primary care (general practitioner office) | During patient visit |
Lower back imaging | 21 | Chiropractors | Canada and USA | February–July 2010 | Patients | Managing back pain without an x-ray | Private clinics | During patient visit |
The sample and data
Data analysis
Context study 3: semi-structured interviews with health system stakeholders and change agents
Sample
Data collection and analysis
Data triangulation
Step | Description |
---|---|
1. Sorting | • The findings from each context study will be sorted and separated into three files (1 file/context study) |
• The contents of each file will then be reviewed to identify its key categories | |
2. Convergence coding | • A convergence-coding matrix will be created to compare the three files with respect to: |
° the meaning and interpretation of categories | |
° the frequency and prominence of categories | |
° specific examples supporting or explaining a particular category | |
• A convergence-coding scheme will then be applied: | |
• Agreement (full agreement between the sets of results on both elements of comparison, e.g., meaning and prominence are the same) | |
• Partial agreement (agreement on one but not both components, e.g. meaning or prominence of categories is the same) | |
• Silence (one set of results covers the category or example while another set of results is silent on the category or example) | |
• Dissonance (disagreement between the sets of results on both elements of comparison, e.g., meaning and prominence are different; and specific examples provided are different) | |
• The purpose of this coding scheme is to: | |
° determine convergence between the three sets of results on the identity and prominence of the categories presented | |
° determine convergence of the coverage and specific examples provided in relation to each category | |
3. Convergence assessment | • All compared segments will be reviewed to provide a global assessment of the level of convergence |
• When and where team members have different perspectives on convergence or dissonance will be documented | |
4. Completeness comparison | • The nature and scope of the context domains (and their features) will be compared for each inquiry to enhance the completeness of our united set of findings and identify key differences in scope/coverage |
• In this step, the aim is to broaden the range of findings to ensure completeness in perspective and how a category is characterized | |
• To obtain a holistic view of the data, categories will now also be synthesized into broader themes through consensus | |
5. Team member comparison and 6. feedback | Steps 5 and 6 will occur concurrently |
• The assessments of convergence/dissonance and completeness of the united set of findings among the team will be compared to: | |
° clarify interpretations of the findings and | |
° reach consensus | |
• At a face-to-face team meeting, a 1-day discussion will be held where findings of the triangulation will be provided to the full research team for feedback and discussion | |
• In instances of disagreement, the rationale behind the assigned categories | |
• and themes will be discussed to come to consensus. Level of agreement between the team should meet or exceed 70 | |
• Any changes proposed by the team (where they can be accommodated by overall findings) into final data interpretation will be incorporated |