Table 1

Perspectives mapped to role of context and evaluation activities

PerspectiveRole of contextCharacteristic evaluation activityImportant elements of context to consider
Intervention perspectiveContext tends to have a ‘disruptive’ role in enhancing or impairing intervention effectsHealth Technology Assessment*Characteristics of usual care
Existing skills, training and expertise
Resources acceptability and feasibility
‘Partial’ system perspectiveContextual variation potentially explains differential effects across organisationsHealth Services Delivery ResearchOrganisational context, culture and values
Acceptability and feasibility
System perspectiveContextual variation represents a form of ‘chaos’ against which evaluators identify common mechanismsHealth Systems and Public Health ResearchAs above, but extended to include economic, cultural, social, gender and political factors
  • The above perspectives lie on a continuum; a ‘partial system perspective’ characterises a scenario that acknowledges selective aspects of a wider system but does not engage with the full range of system factors.

  • *Increasingly initiatives such as EUnetHTA or INTEGRATE-HTA endorse a societal perspective of health technology assessment (HTA). Organizations such as the WHO are increasingly moving from clinical recommendations to clinical/health system (hybrid) guidelines, further blurring such distinctions.