Context shapes the effectiveness of knowledge implementation and influences improvement. Context is defined as factors, varying by locality, that have been shown to influence improvement. Understanding and overcoming contextual barriers is therefore crucial to implementing effective improvement and change.  

Research Theme Aims

The aim of the Context theme is to synthesise current evidence to produce guidance to support the design of effective, affordable and sustainable context-sensitive improvement strategies and methods.

Within this research theme, we will explore three key issues relating to context:

  • patient, service user and carer factors;
  • capacity for organisational change;
  • social and legal factors.

We will work closely with the Behaviour Change theme within SISCC, which explores the way in which individual/organisational factors and professional interactions shape improvement activity.

Examples of how the Context research theme is supporting the SISCC large-scale improvement programmes is summarised within the Context theme examples.

Our Current Focus

Realist Review - building the evidence base:

We are undertaking a realist review to examine the influence and impact of contextual factors on quality improvement in healthcare, and explore whether quality improvement initiatives can work in all contexts. The review update the evidence-base and explore:

  • which contextual factors are important, and how, why, when and for whom they are important, within varied settings;
  • the dynamic nature of context and change over time, and which aspects of context impact at key points in the improvement trajectory;
  • the influence of context on improvement outcomes (provider and patient-level), spread and sustainability.

Translating evidence into practice:  

Working with the Evidence-Into-Practice project within Neonatal Units; the Regional Workshops have provided the opportunity to disseminate the current context evidence-base to practitioners to  support the developments of improvements within this setting. 

The Realist Review will enhance the impact of  improvement programmes, as vehicles of change.  It will strengthen the context evidence-base by addressing whether quality improvement initiatives can work in all contexts and provide recommendations for the design and delivery of effective, context-sensitive and sustainable improvement interventions.


This first stage of the Realist Review, is to engage with experts and stakeholders, involved in supporting and delivering quality improvement, to gather a wide range of perspectives on the issues of context with improvement projects. 

Over the months of August and September 2017, we hope to interview a wide range of people to explore their views around this. 

If you would like to participate in a short telephone interview (30-45 minutes) please contact Dr Emma Coles

More detailed information on the Review is summarised within this outline.

Key People



Outputs from the Context research theme can be accessed on our publications page.

It is anticipated that the finding from the Realist Review will be available early 2018.