Giving Compass' Take:

• Valéry Ridde and Claire Cole explain how evidence-based solutions only work for the specific context where they are studied. 

• What unique factors influence your context? 

• Learn about achieving collective impact. 

Despite what we might like to think, evidence-based interventions don’t always guarantee impact. That’s in part because a key make–or–break ingredient in this schema is all around us, but often overlooked.

What is it? Context.

PSI: What’s a key area where public health has missed the mark?  

Valéry Ridde: Ask implementation scientists and a collective agreement reigns: health interventions are not optimal prior to implementation. Rather, it’s through implementation that we must adapt interventions so they are optimal to the contexts that surround them.

As public health practitioners, we need to move from being curious primarily about whether interventions are effective, to include curiosity about how and why they’re working, in what contexts — and for whom. How can we take into account the context surrounding the people we are working for and with, and the implementers they rely on for service? How can we improve the design of our programming, and tweak and tailor it as we implement it across varied contexts?

We often look at the impact of a health intervention without accounting for how the intervention was implemented, and what factors influenced its success or flub. As a result, when we see poor results we may deem an intervention ineffective. The intervention, however, may not be the issue. Rather, how we implemented the intervention, and how well we responded to the context that influenced our implementation, is the root we’re too often overlooking.

PSI: Why IS? Why here—why now?  

Claire Cole: We achieve different impact depending on how we respond (or don’t) to the change that is part of the real world in which we implement. This is a key finding acknowledged by IS.

As implementers, we have a responsibility to recognize that a workplan and technical strategy developed at the beginning of a project will necessarily evolve in response to what arises during implementation. If we can embrace that from the outset, we can decide to set ourselves up to generate (and put to use) the types of real-time quantitative and qualitative data we need to “see” when dynamic change is happening—be it within our implementation teams, within our consumers’ communities or within the health systems our consumers depend on.

Read the full interview with Valéry Ridde and Claire Cole about context and impact at PSI.