What is the phase 'Adapt to Local Context'?
- Once you have identified the problem and selected a practice change (e.g., assess older adults' risk of falls on admission) or intervention (e.g., selecting and using a valid fall risk assessment tool, educating staff on using the tool, and/or having the appropriate staffing levels to conduct a fall risk assessment) you are now ready to consider whether this practice change or intervention is suitable for your practice setting.
- Before you make a practice change or introduce any intervention, you need to determine how well it fits with your context. This phase helps you consider the local context and the implications of introducing the practice change or intervention within that context (Harrison et al., 2013). This phase will help you think about how to adapt the knowledge, such as the evidence on best practices or interventions to your setting while maintaining the integrity of the practice or intervention.
- At this phase, stakeholders (individuals, groups, or institutions that are directly or indirectly influence or are influenced by change) are engaged, at a planning level, to ensure that the knowledge is going to meet the needs of end-users who will be affected by the practice change and that it is compatible with the context.
What is context?
While there are multiple definitions of context, most scholars agree that context can be defined as “everything else that is not the intervention” (Nilsen & Bernhardsson, 2019). Context is the setting or environment where the practice change or intervention is taking place and includes those people involved in the change. Contextual factors that influence the uptake of new knowledge can exist at the micro (individual), meso (organizational) and macro (system) levels (Rogers et al., 2020).
Why is the phase 'Adapt to Local Context' important?
The knowledge (or evidence) that is developed in a controlled setting, such as in a randomized trial, may be difficult to implement in your practice setting. You will need to consider the fit of the knowledge to the end-users who will be using the knowledge in their setting. These end users can include providers, patients/persons and other stakeholders, and they can reside in different settings. Adjustments to the knowledge you are trying to implement, or in other words, to turn the knowledge into routine practice, may be required.
Example: If you are introducing a guideline, not all recommendations may be appropriate to the culture of your end-users, or it may require materials, equipment, or resources that are not available. In this case, you would adapt the guideline, being careful to keep it grounded in the evidence.
Remember: Contextual differences (e.g., the number of resources your setting has, the types of equipment being used) may affect the appropriateness or feasibility of particular recommendations, even when supported by a strong body of evidence.
Understanding your local context is critical for success
- Getting a new practice into the routine workflow can be complex. Researchers found that many implementation plans focus solely on changing staff knowledge, attitudes or behaviour without considering other contextual factors that may impact the success of uptake.
- To be successful, change teams must carefully consider their context and purposefully address a range of contextual factors (e.g., culture, leadership, available resources) in their implementation plan (Nilsen et al., 2020; Squires et al., 2019b).
It improves engagement and support for the change
- Taking the time to adapt knowledge to your local context helps improve acceptance and adherence to best practice changes (Harrison et al., 2010).
- When end users are engaged in the process of adapting knowledge to the local context, there is a greater sense of ownership over its use (Harrison et al., 2010).