The Importance of Contextual Fit when Implementing Evidence-Based Interventions. Executive Summary

09/01/2014

Implementation science informs us that local context is important to the successful adoption of evidence-based interventions. “Contextual fit” is based on the premise that the match between an intervention and local context affects both the quality of intervention implementation and whether the intervention actually produces the desired outcomes for children and families.

Although the importance of contextual variables is often referenced, there is neither consensus on the specific elements that constitute contextual fit nor a strong research base. In an effort to address these gaps, we propose a set of core elements drawn from the existing literature that can be used to define contextual fit and guide practice, policy, and research.

We define contextual fit as the match between the strategies, procedures, or elements of an intervention and the values, needs, skills, and resources available in a setting. Contextual fit is defined by the perceptions of those who implement, receive, and support an intervention. Practitioners should understand the important role of the decision agent in the fit determination process. Although certain interventions might appear to “fit” on paper, practitioners must have a certain level of motivation, interest, and support for intervention fit to be present.1 Eight elements combine to establish the fit between an intervention and a setting:
 
  1. Need: The extent to which an intervention meets anidentified need for a particular target population. Theoutcomes of an intervention must be valuable to those delivering, supporting, and receiving the intervention. In addition, the intervention should confer a relative advantage above and beyond existing services.
  2. Precision: The extent to which the core features of an intervention—what is to be delivered—are well defined. Interventions that are defined globally are difficult to match with a specific setting because the implementers cannot determine exactly what they should be delivering.
  3. An Evidence-Base: The intervention has demonstrated effectiveness for the target population and the outcome(s) of interest. This typically means the intervention is supported by rigorous, published research with strong internal and external validity.
  4. Efficiency: The intervention needs to be not only effective but practical. An undervalued feature of evidence-based interventions is the level of efficiency (time, personnel, money, materials) needed to generate valued outcomes within the time frames and budgets necessary.
  5. Skills/competencies: Contextual fit requires clarity regarding how implementers will acquire the skills to use an intervention as intended. The training, coaching, orientation, and support needed for personnel to deliver an intervention should be clearly defined.
  6. Cultural Relevance: An intervention should match the values and preferences of those who will (a) implement the intervention, (b) benefit from the intervention, and (c) manage and support the intervention. Personal, societal, cultural, and professional values matter. The type of intervention, how it is implemented, and the intended outcomes should be acceptable to those in the local setting.
  7. Resources: Contextual fit requires the ability and willingness to allocate the resources needed for both initial adoption and sustained implementation.
  8. Administrative and Organizational Support: Contextual fit includes the values and preferences of those making administrative decisions.

Defining, measuring, and applying the elements of contextual fit to large-scale adoption of evidence-based interventions will be both effective and efficient with initial and sustained implementation. The elements of contextual fit have relevance for (a) the design and selection of interventions, (b) the process of initial implementation, and (c) the ongoing adaptation of the interventions needed for sustainability.

We offer recommendations for developing formal measures of contextual fit and use these measures to prompt a rigorous program of scholarship on the impact of contextual fit variables and the likely implications for policy, technical assistance, and the organization of large-scale implementation efforts.

Key Take Away-Messages
 
  • Contextual fit is an undervalued factor affecting the quality with which evidence-based interventions are implemented. Core components of fit to consider include need, precision, evidence, feasibility, skills/competencies, cultural relevance, resources, and administrative and organizational support.
  • Research is needed to better understand the role and process of contextual fit, the elements of contextual fit most important for improving effective implementation, and metrics to assess contextual fit.
  • Policymakers should include contextual fit criteria in Funding Opportunity Announcements to improve the selection, adoption, implementation, and sustainability of supported interventions.
  • Technical assistance should focus on building strong contextual fit before investing in direct implementation efforts.

1Dymnicki et al. (2014) provide a broader discussion of the different components that comprise readiness for implementing evidence-based interventions, one of which is motivation.

 

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