Janet E. Squires
1,2* 
, Alison M. Hutchinson
3,4 , Mary Coughlin
2, Kainat Bashir
5, Janet Curran
6,7, Jeremy M. Grimshaw
2,8, Kristin Dorrance
9, Laura Aloisio
2, Jamie Brehaut
2,10, Jill J. Francis
11,2, Noah Ivers
12, John Lavis
13 , Susan Michie
14, Michael Hillmer
15, Thomas Noseworthy
16, Jocelyn Vine
7, Ian D. Graham
2,10 1 Department of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.
2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
3 Monash Health, Melbourne, VIC, Australia.
4 School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia.
5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
6 Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada.
7 IWK Health Centre, Halifax, NS, Canada.
8 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
9 Statistics Canada, Ottawa, ON, Canada.
10 School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
11 School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
12 Women’s College Hospital, Toronto, ON, Canada.
13 McMaster University, Hamilton, ON, Canada.
14 University College London, London, UK.
15 Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada.
16 University of Calgary, Calgary, AB, Canada.
Abstract
Background: Context is recognized as important to successful knowledge translation (KT) in health settings. What is meant by context, however, is poorly understood. The purpose of the current study was to elicit tacit knowledge about what is perceived to constitute context by conducting interviews with a variety of health system stakeholders internationally so as to compile a comprehensive list of contextual attributes and their features relevant to KT in healthcare.
Methods: A descriptive qualitative study design was used. Semi-structured interviews were conducted with health system stakeholders (change agents/KT specialists and KT researchers) in four countries: Australia, Canada, the United Kingdom, and the United States. Interview transcripts were analyzed using inductive thematic content analysis in four steps: (1) selection of utterances describing context, (2) coding of features of context, (3) categorizing of features into attributes of context, (4) comparison of attributes and features by: country, KT experience, and role.
Results: A total of 39 interviews were conducted. We identified 66 unique features of context, categorized into 16 attributes. One attribute, Facility Characteristics, was not represented in previously published KT frameworks. We found instances of all 16 attributes in the interviews irrespective of country, level of experience with KT, and primary role (change agent/KT specialist vs. KT researcher), revealing robustness and transferability of the attributes identified. We also identified 30 new context features (across 13 of the 16 attributes).
Conclusion: The findings from this study represent an important advancement in the KT field; we provide much needed conceptual clarity in context, which is essential to the development of common assessment tools to measure context to determine which context attributes and features are more or less important in different contexts for improving KT success.