Context is the situation within which something exists or happens, and that can help explain it.
From an evidence-based health care perspective, the importance of context has been acknowledged and recently defined as the varied characteristics of providers and users of health care, internal organisational arrangements, infrastructures and networks, responsiveness to change, and the broader healthcare system. [1] Each of these elements has the potential to influence or modify the use of evidence by healthcare providers, policy makers, and those accessing care. As providers of evidence-based palliative care information CareSearch recognises the importance of this and contextual intelligence which has been described as the ability to understand the limits of knowledge and to adapt that knowledge to an environment different from the one in which it was developed. [2] Tailoring information requires an understanding of context, and where the audience is diverse it requires an efficient approach to understanding differences in contexts and the consequent implications for the access and use of evidence and information. .
As discussed back in December 2019 this recognition, that providing access to information is often of itself not enough, prompted us to undertake the CareSearch Engagement Project; a project aimed at the development and testing of a structured approach to uncovering sector specific contexts and information channels. By engaging with our audiences, we hoped to better understand their contexts and needs, and how relevant information is identified and disseminated.
For the Engagement Project we purposely chose three very different sectors to test our approach: aged care; allied health; and patients, carers, and families. These sectors differ widely in many respects including organisational structure, member health literacy and role, and regulation of activity. Initially examining published literature for insights into the context of each sector, we complemented this with a series of workshops to speak directly with sector representatives to either correct or confirm our understanding, and to provide further insights. The project has now ended but the findings continue to inform CareSearch activity. So, what are some of the things we have learnt?
We learnt that, broadly speaking our understanding of individual sector contexts was correct, and this likely reflects, in part, the CareSearch model of co-creation and collaboration. [3] But we also learnt that only the sector can provide the detail required to fully adapt knowledge to their context. It is the nuanced differences and challenges that inform effective tailoring and adaptation.
All three sectors were challenged by the flood of available information, the lack of time or capacity to absorb it all, and the demands of providing or advocating for care at the end of life. Traditional information channels were often offered as avenues for dissemination but as the conversation progressed, difficulty finding the time to access even those was acknowledged. To this end, rapid access via online channels should provide a welcome shortcut, but instead, the plethora of options often leaves people confused. Established channels with highly selected ‘information bites’ and a range of formats are preferred.
Across sectors there was an expectation that information should be tailored or easily adapted to local needs, and the easiest way to achieve this is to ‘ask us’ or ‘write with us for us’. It should also state who the information is for and why it is important so that it can be easily recognised as relevant and brought to people’s attention. Remove the guess work. For care providers it should also indicate ‘what I can stop doing in order to take on the new things that I should be doing’. A growing list is both overwhelming and unrealistic and can mean that the simple measures are overlooked for more exciting but less impactful innovations.
We also learnt that across sectors there is an urgent need for clarity around roles and expectations, ‘what is our role and who is in charge?’ This will determine the information needed. People also need help to identify where they or the person they are caring for are on the journey, and they need to be shown the basics before taking on the complexities. ‘Learning to swim from the diving board’ is rarely optimal but frequently experienced.
Finally, trust is essential. For health and care professionals this often means a transparent link to evidence and a clear pathway to help them explore further. This fosters trust but also helps them to adapt the information to local needs. For others it is sufficient to know that evidence underpins the resources being provided, but ‘delivery of information by those I trust will always win any competition for my attention’.
Informing people with vastly different backgrounds, literacy levels and capacity, as well as roles is a challenge. Yet end of life is a universal experience that will impact us all. It is an inherently individual experience and the support and information provided must be inclusive and easily personalised. The Engagement Framework has highlighted that there are no short cuts, whether information is delivered via traditional or new channels time must be invested to learn the contextual details surrounding its delivery and use.
References
- Squires JE, Graham I, Bashir K, Nadalin-Penno L, Lavis J, Francis J, et al. Understanding context: A concept analysis. J Adv Nurs. 2019 Dec;75(12):3448-3470. doi: 10.1111/jan.14165. Epub 2019 Sep 4. PMID: 31359451.
- Khanna T. Contextual Intelligence [internet]. Harv Bus Rev. 2014 Sep [cited 2020 Jun 3].
- Collier A, Hodgins M, Johnston B, Tieman J. Evidence-based palliative care: How can we account for the messy world of practice? Palliat Med. 2019 Jul;33(7):723-725. doi: 10.1177/0269216319845977. PMID: 31287386.
Dr Katrina Erny-Albrecht, Senior Research Fellow at CareSearch, College of Nursing and Health Sciences, Flinders University