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Table 2 Definitions of context, implementation and setting based on Pragmatic Utility concept analysis [37]

From: Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework


Context reflects a set of characteristics and circumstances that consist of active and unique factors, within which the implementation is embedded. As such, context is not a backdrop for implementation, but interacts, influences, modifies and facilitates or constrains the intervention and its implementation. Context is usually considered in relation to an intervention, with which it actively interacts. It is an overarching concept, comprising not only a physical location but also roles, interactions and relationships at multiple levels.


Implementation is an actively planned and deliberately initiated effort with the intention to bring a given intervention into policy and practise within a particular setting. These actions are undertaken by agents who either actively promote the use of the intervention or adopt the newly appraised practises. Usually, a structured implementation process consisting of specific implementation strategies is used and underpinned by an implementation theory.


Setting refers to the specific physical location, in which the intervention is put into practise and interacts with context and implementation.