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12.3.3  Variation in context and culture

Some interventions, particularly non-pharamcological interventions, may work in some contexts but not in others; the situation has been described as program by context interaction (Hawe 2004).  Context factors might pertain to the host organization in which an intervention is offered, such as the expertise, experience and morale of the staff expected to carry out the intervention, the competing priorities for the staff’s attention, the local resources such as service and facilities made available to the program and the status or importance given to the program by the host organization. Broader context issues might include aspects of the system within which the host organization operates, such as the fee or payment structure for healthcare providers.  Context factors may also pertain to the characteristics of the target group or population services (such aspects include the cultural and linguistic diversity, socioeconomic position, rural/urban setting) may mean that a particular style of care or relationship evolves between service providers and consumers that may or may not match the values and technology of the program.  For many years these aspects have been acknowledged (but not clearly specified) when decision makers have argued that results of evidence reviews from other countries do not apply in their own country.


Whilst some programs/interventions have been transferred from one context to another and benefits have been observed, others have not (Resnicow 1993, Lumley 2004). Authors should take caution when making generalizations from one context to another. Authors should report on the presence (or otherwise) of context-related information in intervention studies, where this information is available (Hawe 2004).