The Importance of Contextual Fit when Implementing Evidence-Based Interventions. Which Constructs Are the Most Important for Determining Contextual Fit?


To date, contextual fit has been discussed most often as a general concept with overarching implications. There is a need to operationalize the construct in a way that allows for agreement in the field and enables the development of formal measures. Table 2 summarizes themes drawn from the literature to help define elements of contextual fit (Blase, Kiser, & Van Dyke, 2013; Center for Substance Abuse Prevention, 2012; Horner et al., 2003; Sandler, Albin, Horner, & Yovanoff, 2003). Table 1 presents the eight core components of fit and application questions that can be asked for each element.

Table1. Summary of Elements of Contextual Fit

Element Application Questions for Each Element
1a. Is the outcome of the intervention highly valued?
1b. Is the level of current success low enough that there is a need for something different according to:
Those receiving support (children, youth, families, clients)
Those providing support
Those responsible for effective support (administrators, community members, political leaders)
2a. Is the proposed intervention defined with clarity and is detail provided to determine what is done, by whom, when, and why? Are core features defined? Are strategies for achieving the core features defined?
An Evidence-Base
3a. Does empirical evidence exist that the implementation of the core features results in valued outcomes? Does the evidence document the target population, setting conditions, and usability conditions in which valued outcomes were achieved?
4a. Are the time and effort for initial adoption reasonable?
4b. Are the time and effort for sustained adoption as efficient or more efficient than current interventions (given the outcomes generated)?
5a. Are the skills needed to implement the intervention defined?
5b. Are materials and procedures available to establish needed skills?
5c. Does the level of skill development fit professional standards and or the organizational staffing structure?
Cultural relevance
6a. Are the outcomes of the intervention valued by those who receive them?
6b. Are the strategies and procedures consistent with the personal values of those who will perform them?
6c. Are the strategies and procedures consistent with the personal values of those who will receive them?
7a. What time, funding, and materials are required for initial adoption?
7b. What training, coaching, and performance feedback are needed for high-fidelity implementation?
7c. What time, funding, and materials are required for sustained adoption?
7d. What fidelity measures are needed to ensure monitoring of an implementation?
Administrative and organizational support
8a. Is adoption of the intervention supported by key leaders?
8b. Will adoption of the intervention be monitored by key leaders?
8c. Will fidelity and impact of the intervention be monitored by key leaders?
8d. Is there a documented commitment to make the intervention a standard operating procedure?

Contextual fit influences the implementation process at three points. The first is in the exploration and selection of an effective intervention. An intervention should match the skills, values, and resources of those in the implementation context—that is, those who are providing, supporting, and receiving the intervention. Contextual fit plays an important role in selecting the evidence-based intervention that best matches the skills, values, and resources of the local setting.

Second, contextual fit is important to consider when adopting an intervention during the installation and initial implementation stage. The way an intervention is introduced can determine whether it is accepted and adopted by both the community and service providers. The timing, amount, format, and integration of training into an existing service setting can affect the likelihood that the new intervention will be implemented well and yield positive results (assuming that readiness for the intervention has already been established).

The third point of impact where contextual fit affects implementation is in the adaptation of an intervention once it has been implemented. Effective implementation does not end with initial adoption; it is a continuous process of tailoring an intervention to improve efficiency and effectiveness. The sustained use of an intervention may depend on implementers’ ability to continually adapt the intervention as conditions in the setting evolve (McIntosh et al., 2013). Adaptations need to be developed with full consideration of the extent to which they “fit” with the skills, values, and resources of those who use and benefit from the intervention.

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