The Importance of Contextual Fit when Implementing Evidence-Based Interventions. What Is Contextual Fit?


Contextual fit is the match between the strategies, procedures, or elements of an intervention and the values, needs, skills, and resources of those who implement and experience the intervention. An intervention is said to possess good contextual fit when implementers, recipients, and other stakeholders (e.g., parents, teachers, community members, administrators, and related service systems) identify the intervention as acceptable, doable, effective, and sustainable. The contextual fit of an intervention for a specific setting is local and personal. Contextual fit is defined by those who will be implementing, supporting, and receiving the intervention (Damschroder et al., 2009).

Defining contextual fit requires that we first define an “intervention” and the distinction between the core elements of an intervention and the procedures used to achieve those core elements. We use the term “intervention” to refer to (a) a procedure, or set of procedures (b) designed for use in a specific context (or set of contexts) (c) by a specific set of users (d) to achieve defined outcomes (e) for (a) defined population(s) (c.f. Cook, Tankersley, & Landrum, 2009; Dunst, Trivette, & Cutspec, 2002; Flay et al., 2005; Horner, Sugai & Anderson, 2010). Interventions are what we do to achieve desired outcomes. They include the behaviors, tools, and protocols used for assessment, intervention, data collection, and evaluation. Historically, interventions have been viewed primarily as solutions to specific problems. This approach emphasizes the match between a desired outcome and the intervention, but it ignores the importance of issues like the skills of users, extent of need, values related to intervention options, and capacity for data-based decision making.

More recently, there has been a renewed emphasis on interventions as context dependent—developed with significant assumptions about the specific setting, users, and target populations in and for which they can and should be implemented (Spencer, Detrich, & Slocum, 2012). What might work well in preschool settings may not work well in juvenile justice contexts, mental health clinics, or high schools. When the fit between the setting and the intervention is poor, the likelihood of effective implementation diminishes, and the likelihood that implementation will lead to valued outcomes evaporates (Fixsen et al., 2010; Fixsen et al. 2005).

Contextual fit has gained increased attention as program developers, researchers, and practitioners have recognized the need to define evidence-based interventions by their outcomes, core features, and strategies or intervention packaging to achieve the core features. In the past, “interventions” and “core features” have been synonymous. An intervention package for bullying prevention, drop-out prevention, self-regulation, or early literacy included a set of core features (curriculum content, instructional routines, setting variables) and specific strategies or interventions (specific text, training manuals, video exercises, and family supports). Implementers were expected to purchase or adopt the intervention; in so doing, they would use the intervention procedures to achieve the core features and through the core features the valued outcomes. Experience with large-scale implementation of evidence-based interventions has forced the recognition that intervention strategies for achieving core features may vary across settings (Horner et al., 2013). For example, a core feature of Positive Behavioral Interventions and Supports is defining and teaching a small number of social expectations to all students in the school. The core feature is the building of a school wide social culture with a common set of expectations. However, although this core feature is constant across settings, the specific expectations taught and the process for teaching these expectations can vary across elementary, middle, and high schools and across urban, suburban, and rural schools. The social and ethnic culture of a community may affect how these expectations are constructed and taught. The core feature is held constant, but the procedures to achieve the core feature are adapted to the context. This distinction is relevant because contextual fit applies both to the core features that should be present in an implementation setting and the intervention strategies used to achieve these core features.

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