Perspectives mapped to role of context and evaluation activities
| Perspective | Role of context | Characteristic evaluation activity | Important elements of context to consider |
| Intervention perspective | Context tends to have a ‘disruptive’ role in enhancing or impairing intervention effects | Health Technology Assessment* | Characteristics of usual care Existing skills, training and expertise Resources acceptability and feasibility |
| ‘Partial’ system perspective | Contextual variation potentially explains differential effects across organisations | Health Services Delivery Research | Organisational context, culture and values Acceptability and feasibility |
| System perspective | Contextual variation represents a form of ‘chaos’ against which evaluators identify common mechanisms | Health Systems and Public Health Research | As 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.