Evidence map›Paper›PMID 27756414›Full record

ArticleImplementation science : IS2016

Implementation, context and complexity.

Carl R May, Mark Johnson, Tracy Finch

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science : IS, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04356274 (Participatory System Dynamics vs Audit and Feedback), which is not on this map. Cited by 486 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
486citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04356274 naenrolling by invitationnot on this mapstarted 2019, after this paper: background citation

Participatory System Dynamics vs Audit and Feedback: A Cluster Randomized Trial of Mechanisms of Implementation Change to Expand Reach of Evidence-based Addiction and Mental Health Care

TypeinterventionalSponsorPalo Alto Veterans Institute for ResearchRan2019 to 2027Enrolled720ConditionsPTSD, Depression, Alcohol Use Disorder, Opioid Use DisorderArmsParticipatory System Dynamics (PSD), Audit and Feedback (AF)
3 · Its place in the literature

Who cites it

486 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  3. Implementing PTSD interventions for hospital nurses and physicians during COVID-19: A scoping review.Archives of public health = Archives belges de sante publique · 2025
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426 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Carl R MayFaculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton, SO17 1BJ, UK. c.r.may@soton.ac.uk.
Mark JohnsonUniversity Hospital Southampton NHS Foundation Trust, Southampton, UK.
Tracy FinchInstitute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.

Funding

Department of Health DRF-2012-05-272
6 · The paper itself

Abstract

backgroundContext is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION: We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems.

conclusionImplementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of 'real world' contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants' discretion over resource mobilisation and actors' contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.

Indexed as

Delivery of Health CareHumansTranslational Research, Biomedical

Identifiers

PMID27756414
PMCPMC5069794

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.