A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks

Abstract Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation. A scoping review of outer context domains found definitions of outer context and four more common constructs of policy, community, partnerships, and communications in dissemination and implementation science theories. Lay Summary There is still a limited understanding of factors external to the implementing organization and their effects on evidence-based intervention adoption, implementation, and outcomes. This scoping study focuses on understanding definitions of context and important factors of outer context found in dissemination and implementation theories, models, and frameworks. We identified 19 definitions of outer context and 47 frameworks or theories that reported one or more specific constructs of the outer setting. Common domains found were policy (n = 25), community (n = 19), partnerships (n = 13), and communications (n = 13). We described gaps related to the curre