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Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23. doi: 10.1370/afm.1549.

Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.

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Department of Family & Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA.



We aimed to advance the internal and external validity of research by sharing our empirical experience and recommendations for systematically reporting contextual factors.


Fourteen teams conducting research on primary care practice transformation retrospectively considered contextual factors important to interpreting their findings (internal validity) and transporting or reinventing their findings in other settings/situations (external validity). Each team provided a table or list of important contextual factors and interpretive text included as appendices to the articles in this supplement. Team members identified the most important contextual factors for their studies. We grouped the findings thematically and developed recommendations for reporting context.


The most important contextual factors sorted into 5 domains: (1) the practice setting, (2) the larger organization, (3) the external environment, (4) implementation pathway, and (5) the motivation for implementation. To understand context, investigators recommend (1) engaging diverse perspectives and data sources, (2) considering multiple levels, (3) evaluating history and evolution over time, (4) looking at formal and informal systems and culture, and (5) assessing the (often nonlinear) interactions between contextual factors and both the process and outcome of studies. We include a template with tabular and interpretive elements to help study teams engage research participants in reporting relevant context.


These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.


change; context; generalizability; methods; organizational; patient-centered medical home; practice-based research; primary care; research design; transformation; validity

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