The Importance of Contextual Fit when Implementing Evidence-Based Interventions. What Are the Research Implications of Contextual Fit?

09/01/2014

For contextual fit to assume the role it is touted to fill in implementation science, a concerted effort is needed to build a solid empirical foundation. Three initial steps for future research are needed: (a) developing technically adequate measures of contextual fit, (b) documenting the role of contextual fit in the effectiveness and efficiency of implementation, and (c) determining the extent to which questions of contextual fit can be used to assess readiness for implementation. The first step is to develop technically adequate measures of contextual fit. Contextual fit needs to be defined with operational precision. The field needs to agree on the elements of contextual fit that allow strong content validity measures, which must be demonstrated to be both valid and reliable. The challenges related to assessing perceptions need to be addressed, and the field requires multiple approaches for systematically measuring the degree of fit that an intervention has within a specified setting.

The second line of research need involves documenting the role of contextual fit in the effectiveness and efficiency of implementation. We propose that contextual fit improves not only the likelihood that an intervention will be adopted with fidelity, but the efficiency (time, money, personnel) needed to achieve adoption. These are compelling claims, but to date they are claims based more on theory than documented evidence. Once we have valid, reliable measures of contextual fit, the field will be open to systematic studies (both correlational and experimental) that assess the role of contextual fit in implementation.

A related line of research will focus on the extent to which questions of contextual fit may be used to assess “readiness for implementation.” If intervention implementation is delayed until the “exploration” process indicates there is a good match between the intervention and the setting, is the intervention more likely to be implemented? And is investment in building fit before investing in active implementation cost-effective? These and related questions need to be assessed in formal studies.

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