Contextual Fit

An emerging and important construct is that of “contextual fit.” This refers to “the match between the strategies, procedures, or elements of an intervention and the values, needs, skills, and resources available in a setting” (Horner & Ross, 2014 , p. 1). On the basis of a systematic review of implementation studies, their outcomes, and lessons learned, Horner and Ross (2014) suggest that there are eight essential elements that need to be considered to establish whether there is an adequate fit between an intervention and a setting (e.g., an adopter, social service agency, community organization, clinical practice) for its delivery. These include (a) “need” or extent to which the intervention addresses a perceived need by stakeholders of a setting; (b) “precision” or the extent to which the features of the intervention and delivery approach for an intervention are clear and replicable; (c) the “evidence base” or whether the intervention has demonstrated efficacy/effectiveness for a targeted population; (d) “efficiency” or the extent to which the intervention is practical; (e) “skills/competencies” or the skills needed by implementers and how they are acquired and sustained; (f) “cultural relevance” or the fit of the intervention with the values and preferences of implementers, administrators, and those who may benefit; (g) “resources” or the time, funding, and materials needed for adoption and maintenance; and (h) “administrative and organizational support” or extent to which adoption is supported by key leaders and if fidelity can be maintained. Horner and Ross have urged for the development and testing of a global contextual fit measure that captures these eight elements, which can then be used to guide and systematically evaluate the implementation potential of a proven intervention.

These eight elements of contextual fit can also serve diagnostically to pinpoint the particular aspects of a context that may pose as a challenge for the implementation of a proven intervention. Knowing which elements may be challenging for implementation can inform and alert an investigator/team to the need to develop strategies to address specific areas of contextual difficulties.

It should be noted that these eight elements focus on the immediate characteristics of a context (e.g., a service organization or practice setting) and do not include considerations related to the large “context” of policy, social trends and values in which a service or practice setting is in turn embedded (see Chapter 1, Figure 1.2). The perspective(s) from which an evaluation of fit should occur is also unclear. For example, these eight elements reflect the perspective of an organization or setting; other criteria are not addressed such as the extent to which a context/setting/ organization itself is malleable and can be modified to fit the requirements for delivery of a particular intervention. In this respect, the contextual fit construct appears to be one-directional—how the intervention fits or needs to be modified to match a context versus the other way around. Other related concepts that may be important to consider in an equation of fit include the “readiness” of an organization to adopt an intervention, or the extent to which it has or could develop appropriate supervisory, payment, and other infrastructures as well as whether it values evidence-based interventions. Another unknown is what constitutes “context” for interventions delivered via technology such as Web-based applications (see Chapter 7).

 
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