Assessing and understanding
context collection
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💡 Collections are curated with carefully selected videos, publications, and toolkits, all organised by our dedicated e-Hub team.
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In this collection, you’ll explore how to assess and understand context in implementation research and practice.
Learning focuses on what context is, why it matters, and how it shapes implementation success. You’ll examine practical ways to identify and analyse contextual factors—such as systems, policies, and cultures—and how to adapt interventions accordingly.
Through frameworks, mixed-method approaches, and real-world case studies, you’ll see how working with context improves relevance, feasibility, and sustainability, especially in low- and middle-income settings.
This collection introduces key concepts and methods for assessing and understanding context in implementation research and scale up.
- Introduction: Start with foundational readings and guidance from our Getting started with implementation research page to learn what context is, why it matters, and how it influences implementation success.
- e-Hub Programmes: Explore lectures from the Fundamentals and Advanced Programmes that explain how to identify, analyse, and apply contextual insights using frameworks such as CICI. Real-world examples include the Access Cancer Care India and Kerala Diabetes Prevention Program projects.
- Resources and toolkits: Access practical frameworks and tools—including the WHO TDR Implementation Research Toolkit, CICI Framework, RE-AIM and PRISM, and ExpandNet—to guide context assessment and adaptation.
- Case studies: Learn from GACD-funded projects such as TB and Tobacco and School-EduSalt in China, which show how understanding context can inform policy, strengthen health systems, and enable sustainable implementation.
From our 'Getting started...' webpage
Assessing and understanding context is a fundamental step in implementation research for non-communicable disease (NCD) programmes. Context shapes how, why, and whether interventions succeed. It includes social, cultural, economic, and system-level factors that influence implementation feasibility, relevance, and sustainability.
Understanding context allows researchers to tailor interventions to local realities—such as affordability of healthy food, cultural values around tobacco, or how new tools fit into existing healthcare systems. Context assessment should be systematic and ongoing, guiding design, adaptation, and interpretation throughout implementation.
Recommended reading:
- The role of context in implementation research for non-communicable diseases: Answering the ‘how-to’ dilemma (Daivadanam et al. 2019) – click here
- Context matters in implementation science: a scoping review of determinant frameworks (Nilsen and Bernhardsson, 2019) – click here
- Defining and assessing context in healthcare implementation studies: a systematic review (Rogers et al. 2020) – click here
To find out how to get started with implementation research, click here.
From our Fundamentals Programme
We continue with assessing and understanding context in the implementation research process.
In this lecture from our Fundamentals Programme, Zahra Aziz introduces the concept of context in implementation research—what it means, why it matters, and how it shapes the success of implementation efforts. Zahra highlights how frameworks can guide structured approaches to assessing context and how applying mixed methods deepens understanding of local environments. She emphasises that working with, rather than against, context enables adaptation of interventions and implementation strategies to meet specific local needs.
Next, Arunah Chandran demonstrates the practical application of context assessment in the Access Cancer Care India project. In this lecture, Arunah illustrates how meaningful stakeholder engagement formed the foundation of understanding context and how a validated, three-step tool was developed to assess health system capacity in lower resourced settings. She discusses how combining surveys, focus groups, interviews, and policy analyses provided insights across multiple contextual levels, driving the project’s success.
From our Advanced Programme
Next, we move on to explore how context and complexity interact within the process of scaling up non-communicable disease (NCD) interventions.
In this lecture from our Advanced Programme, Lisa Pfadenhauer unpacks the dynamic interplay between context, complexity, and scale up. Lisa explains why context must be treated as a fluid, adaptive system rather than a static backdrop to implementation. Learners are guided through the Context and Implementation of Complex Interventions (CICI) Framework, which offers a structured approach to conceptualising and analysing context in complex interventions. The lecture highlights how considering complexity helps ensure that scale-up efforts remain relevant, feasible, and sustainable in real-world conditions.
🔗 Download the slides (pdf)
Next, Dike Ojji builds on this by addressing how to assess context when implementing interventions at scale. Dike introduces practical approaches for identifying and prioritising contextual factors, illustrating how rigorous context assessment can enhance intervention design, delivery, and outcomes. Through examples from large-scale NCD initiatives, learners see how mixed methods—combining qualitative and quantitative insights—can generate a comprehensive understanding of context, informing strategic decision-making throughout the scale-up process.
🔗 Download the slides (pdf)
In the At scale in the real world session, Kavumpurathu Thankappan presents the Kerala Diabetes Prevention Program as a case study. This session demonstrates how frameworks and contextual insights were applied to guide adaptation and scale-up decisions. Kavumpurathu highlights how continuous engagement with local stakeholders and responsiveness to contextual changes were central to the programme’s success, offering valuable lessons for scaling up interventions in diverse settings.
🔗 Download the slides (pdf)
From our Resources and toolkit library
In this section, we provide a curated selection of key resources focused on assessing and understanding context in implementation science practice. These resources have been chosen to help you explore practical frameworks, tools, and real-world applications for analysing and working with context in implementation research and scale up.
Below, you’ll find links to toolkits, frameworks, and publications that offer structured approaches and practical guidance for assessing contextual factors and integrating them into implementation design and evaluation.
WHO TDR Implementation Research Toolkit (Second Edition)
🔗 Click here
A comprehensive, step-by-step toolkit for planning and conducting implementation research. It includes practical methods for analysing context, identifying barriers and facilitators, and adapting interventions to local environments.
Context and Implementation of Complex Interventions (CICI) Framework
🔗 Click here
Developed by Pfadenhauer et al. (2017), this framework provides a systematic way to conceptualise and assess context, complexity, and their interrelationships in implementation research.
RE-AIM and PRISM website
🔗 Click here
These complementary frameworks guide users in designing, implementing, and evaluating programmes with explicit attention to contextual factors, promoting equity and sustainability in real-world practice.
ExpandNet Scaling Up Framework
🔗 Click here
A practical framework developed by WHO and partners to analyse and plan for scaling up interventions, with a strong focus on understanding and adapting to contextual conditions that influence success.
Implementation Science Journal
🔗 Click here
An open-access, peer-reviewed journal publishing cutting-edge research on implementation contexts, frameworks, and methods for studying real-world complexity.
From our case studies
In this section, you will explore real-world examples that illustrate how context assessment and understanding local environments are integral to effective implementation research and scale up. These case studies demonstrate how situational analyses, stakeholder engagement, and adaptive strategies ensure that interventions remain relevant, feasible, and sustainable across diverse health systems and populations.
Together, they show how assessing context—social, structural, cultural, and policy-related—forms the foundation for informed decision-making and successful implementation outcomes.
INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT)
This case study outlines the situational analysis conducted through the INDEPENDENT project in India, which aimed to integrate depression treatment within diabetes care using a collaborative care model. The team conducted a comprehensive contextual assessment—identifying barriers in mental health access, provider capacity, and care coordination. Culturally tailored interventions were developed to align with patient needs, resulting in improved mental health and cardiometabolic outcomes. The project highlights how understanding context drives effective integration of services in low-resource settings.
Implementing the Kerala Diabetes Prevention Program (KDPP) in India
This case study highlights how contextual assessment shaped the design and delivery of the Kerala Diabetes Prevention Program. The research team conducted extensive situational analyses, policy reviews, and stakeholder engagement to identify contextual barriers and enablers within Kerala’s health system. These insights guided the adaptation of intervention components to align with local structures and resources. The project demonstrates how working with context—rather than against it—can enhance programme uptake, equity, and long-term sustainability.
The Importance of Establishing Acceptability for Lung Diseases in Senegal
This case highlights how contextual understanding determines the acceptability and real-world effectiveness of new interventions. The introduction of the ‘HotPot’ solar oven aimed to reduce smoke-related respiratory disease, but despite laboratory success, community adoption was limited. The study revealed critical sociocultural and contextual barriers—such as cooking practices and household preferences—underscoring the necessity of assessing acceptability and lived experience early in the implementation process.
From GACD's impact case studies
GACD impact case studies show how assessing and understanding context is essential to successful implementation and scale up of NCD interventions. The examples below demonstrate how tailoring approaches to local systems, policies, and cultures can enable lasting change.
Integrating tobacco cessation within TB programmes in Pakistan, Bangladesh, and Nepal
This project embedded smoking cessation within routine TB care by assessing and adapting to differing health system contexts. Through collaboration with policymakers and programme staff, context-specific strategies were developed to fit local governance and training structures. The intervention led to inclusion of tobacco cessation in national TB guidelines, health worker training, and surveillance systems, and informed WHO global guidance on integrating tobacco control into TB programmes.
Reducing salt intake through a school-based education programme in China
The School-EduSalt project used contextual insights from schools and households to design a culturally relevant approach to salt reduction. By engaging children as health messengers to influence family behaviour, the project achieved significant reductions in salt intake and blood pressure. Its success informed national nutrition policies and evolved into the large-scale AppSalt initiative, expanding implementation through digital platforms.
To access GACD’s growing number of impact case studies, click here.
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