Assessing the association between the domains of the Atlas Context Assessment and implementation outcomes of the TeamBirth project: a cross-sectional study

We know context matters for successful implementation, but few studies have shown which contextual areas are most influential to implementation outcomes. The Atlas Context Assessment was designed to collect context data and use it to inform the design of appropriate implementation strategies. This cross-sectional study examines the association between organizational context and implementation of a birthing hospital intervention across 23 hospitals in Oklahoma. The study assessed organizational context with the Atlas Context Assessment prior to implementation of the TeamBirth intervention. The analysis estimates the association between specific contextual factors at baseline and the odds of a patient participating in a TeamBirth huddle (during labor and delivery or postpartum). The association was tested by conducting a logistic regression analysis with hospital-level Atlas scores that predict the odds of a patient participating in a huddle, while controlling for multiple covariates. The study identified significant associations between four out of five of the organizational context domains and the odds of participating in a TeamBirth huddle during labor and delivery. Specifically, the ability to implement (aOR = 2.26, 95% CI: 1.04–4.94), the strength of the implementation team (aOR = 2.89, 95% CI: 1.37–6.10), commitment and motivation (aOR = 6.38, 95% CI: 2.38–14.38), and the internal culture (aOR = 4.00, 95% CI: 1.22–13.07) domains were all significantly associated with adoption of the TeamBirth huddles during labor and delivery. Participating in a TeamBirth huddle in the postpartum setting was significantly associated with three out of five Atlas domains (Implementation Team, Commitment and Motivation, and Internal Culture). These findings underscore the critical role of organizational-level contextual factors in determining the implementation success of the TeamBirth project. The application of the Atlas Context Assessment provided valuable insights into which domains, specific barriers and facilitators most influence implementation outcomes. By enabling sites to strategically target these contextual elements, the tool supports the efforts to create a more conducive environment for effective implementation. This study establishes a foundation for future research aimed at optimizing contextual determinants to enhance the adoption and success of healthcare interventions.