Development of a coding frame for context analysis in implementation: insights from Sumamos Excelencia project

Qualitative research is essential in implementation science for analyzing context, barriers, and facilitators. It is recommended to ground context analysis in implementation theories, models, and frameworks; however, selecting, applying, and reporting them can be challenging, limiting comparability and scientific progress. Structured approaches, such as qualitative content analysis, supported by coding frames enhance rigor and transparency. This study addresses these challenges by applying and tailoring implementation frameworks to assess the implementation context and develop a coding frame to analyze qualitative data collected during the Sumamos Excelencia implementation project, carried out in Spanish healthcare units using a multifaceted implementation strategy. Schreier’s qualitative content analysis methodology was used to guide the development of the coding frame, following its content-driven process phases (selecting, structuring and generating, revising and expanding) and meeting its requirements for unidimensionality, mutual exclusiveness, exhaustiveness, and saturation. As part of the review, we selected and integrated several implementation theories, models, and frameworks (the Consolidated Framework for Implementation Research, the Tailored Implementation for Chronic Diseases checklist, the Expert Recommendations for Implementing Change, and the Exploration, Preparation, Implementation, Sustainment framework) to inform and structure the analysis. The integration of the selected frameworks resulted in a coding frame composed of 4 levels, 11 sublevels, 16 categories, and 82 contextual factors. The levels include factors related to the individuals involved in the implementation, the characteristics of the unit (internal context), the external context of the unit and the project’s global implementation strategy. The strategies and the temporal phases were also incorporated into the coding frame. This coding frame systematically captures context complexity, integrating constructs from multiple theories, models, and frameworks. Each framework provided valuable, complementary insights in the development of the coding frame, enabling a comprehensive analysis of the complexity and multi-level aspects of context and implementation process. This coding frame also provides a practical tool for mixed methods implementation studies, enabling novice researchers and healthcare professionals to analyze the context comprehensively. Future research should validate and refine this coding frame across diverse settings to enhance its utility in advancing the field of implementation science.