Table 5 Example for considering policy-relevant outer and inner context adaptions (Recommendation 5)

Example scenario

A community health center implements an organizational policy stating that all clients will be offered free HIV testing and counseling services during every clinic visit.

EPIS framework application steps

1. Specify the type of policy and context where it will be implemented (see recommendations 1 and 2) to determine which existing constructs are most relevant.

  • The community health center represents the inner context where implementation of this “little p” policy will occur.

  • The inner context “individual characteristics” construct describes the influence of attitudes toward HIV testing and counseling services that impact implementation success.

2. Ask stakeholders or conduct literature and document review to reveal additional contextual factors might influence policy implementation.

  • Given the historical stigma surrounding HIV, researchers may want to include another construct within the EPIS inner context to measure “provider stigma” toward persons living with HIV.

  • The outer context might be adapted to include “societal stigma” about HIV, hesitation to participate in HIV testing and counseling services.