Making sense of context in integrated care: a comparative analysis of frameworks for implementation in complex health and social care systems

Purpose Context is increasingly recognised as a central determinant of whether integrated care interventions succeed or fail. Yet the proliferation of contextual analysis frameworks with different epistemological perspectives and empirical applications has created uncertainty about how to make sense of context in complex health and social care systems. This paper critically compares thirteen influential frameworks to examine how they conceptualise, assess and operationalise context for integrated care implementation. Design/methodology/approach A structured and theory-informed comparative analysis was undertaken. Frameworks were purposively selected based on relevance to health and social care, conceptual clarity, empirical use and applicability to complex or multi-level settings. Each framework was examined across five analytical dimensions: epistemological foundations, conceptual structure, methodological guidance, empirical application and relevance to integrated care. An interpretive synthesis approach enabled cross-framework comparison without collapsing diverse paradigms into a single model. Findings Frameworks varied substantially in their assumptions about knowledge, causality, and system behaviour. While tools such as CFIR and Theoretical Domains Framework offer structured and widely used taxonomies, newer frameworks; including ICON, CICI, NASSS and the Context Coding Framework, better reflect the dynamic, relational and cross-boundary nature of integrated care. Participatory and realist approaches add value through attention to mechanisms, reflexivity and power, but often lack procedural guidance. No single framework fully captures the multi-level and emergent properties of integrated care systems highlighting the need for purposeful combination rather than substitution. Practical implications The analysis highlights the need for hybrid and adaptive approaches to contextual analysis, supported by greater epistemological awareness and attention to power, equity and inter-organisational dynamics. The paper offers guidance for selecting and combining frameworks depending on purpose, stage of implementation and system context. Originality/value To our knowledge, this is the first study to systematically compare contextual frameworks through the lens of integrated care. It provides conceptual orientation and practical sensemaking to support more context-sensitive, adaptive and relational approaches to integrated care implementation.