--- title: "Contextual factors and practice change: 14 research teams. | Sutter Health" description: "The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation." url: "https://www.sutterhealth.org/research/publications/contextual-factors-practice-change-research-teams-1055312477" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Contextual factors and practice change: 14 research teams. # Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, Cronholm PF, Halladay JR, Driscoll DL, Solberg LI, Hsu C, Tai-Seale M, Hiratsuka V, Shih SC, Fetters MD, Wise CG, Alexander JA, Hauser D, McMullen CK, Scholle SH, Tirodkar MA, Schmidt L, Donahue KE, Parchman ML, & Stange KC. _Ann Fam Med. 11 Suppl 1:S115-23. doi: 10.1370/afm.1549._ 2013-05-01 ## Abstract PURPOSE: We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors. METHODS: Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context. RESULTS: The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context. CONCLUSIONS: These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/23690380) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Estimating the human resource costs of developing and implementing shared medical appointments in primary care.](https://www.sutterhealth.org/research/publications/hr-costs-shared-med-appts-primary-care-1055312455) Stults CD, McClellan S, Panattoni L, Mazza MC, Tai-Seale M. J Ambul Care Manage. 39(1):23-31. 2016 Jan 01 - Publication ### [Physicians’ perception of demand-induced supply in the information age: a latent class model analysis.](https://www.sutterhealth.org/research/publications/demand-induced-supply-in-information-age-1055312706) Shih Y, Tai-Seale M. Health Econ. 21(3):252-69. doi: 10.1002/hec.1710. Epub 2011 Jan 31. 2012 Mar 01 - Publication ### [Comparison of outpatient satisfaction survey scores for Asian physicians and non-Hispanic white physicians.](https://www.sutterhealth.org/research/publications/outpt-satisfaction-survey-scores-asian-vs-nhw-mds-1055312501) Garcia LC, Chung S, Liao L, Altamirano J, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. JAMA Netw Open. 2(2):e190027. doi: 10.1001/jamanetworkopen.2019.0027. 2019 Feb 01 - Publication ### [Actions and processes that patients, family members, and physicians associate with patient- and family-centered care.](https://www.sutterhealth.org/research/publications/pt-and-family-centered-care-actions-and-processes-1055312507) Hsu C, Gray MF, Murray L, Abraham M, Nickel W, Sweeney JM, Frosch DL, Mroz TM, Ehrlich K, Johnson B, Reid RJ. 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Acad Emerg Med. doi: 10.1111/acem.13955. \[Epub ahead of print\] 2020 Mar 09 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/contextual-factors-practice-change-research-teams-1055312477#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Contextual factors and practice change: 14 research teams."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/contextual-factors-practice-change-research-teams-1055312477#medicalscholarlyarticle","name":"Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.","headline":"Contextual factors and practice change: 14 research teams.","abstract":"PURPOSE: We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors. METHODS: Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context. RESULTS: The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context. CONCLUSIONS: These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. 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