UNASSIGNED: Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers.
UNASSIGNED: The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities.
UNASSIGNED: International.
UNASSIGNED: The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last.
UNASSIGNED: The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research.
UNASSIGNED: A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes.
UNASSIGNED: Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.

UNASSIGNED: Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors.
UNASSIGNED: This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses.
UNASSIGNED: The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an \"excellent\" versus \"poor\" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc.
UNASSIGNED: Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

OBJECTIVE: This consensus statement from Sports Medicine Australia and the Australian Psychological Society aims to provide guidance to practitioners on the ways that physical activity can be promoted to maximise benefits to mental health.
METHODS: Following the Clinical Consensus Statement protocol, an expert group comprised of eight members with expertise in physical activity and mental health articulated recommendations regarding five physical activity contextual factors: type, physical environment, delivery, domain, and social environment.
RESULTS: To optimise the mental health benefits of physical activity, we recommend: i) activity selection be guided by factors associated with adherence and enjoyment as opposed to any specific type (type); ii) facilitators (i.e., teachers, coaches, instructors, practitioners) deliver organised physical activity sessions using an instructional style that satisfies individuals\' basic needs for autonomy, competence and social connection (delivery); iii) participation in physical activity with others who provide support, facilitate positive interactions, or make people feel valued, so long as it does not undermine a preference to be active alone (social environment); iv) where possible and appropriate, some physical activity should be undertaken outside in pleasant natural environments (physical environment); and, v) at least some physical activity be undertaken during leisure-time or via active travel, where possible prioritising activities one personally chooses to undertake (domain).
CONCLUSIONS: The type, domain, physical and social environment of physical activity, as well as the way in which it is delivered, will determine mental health outcomes. Practitioners can use these recommendations to optimise the effects of physical activity on mental health.

To develop an operational definition of contextual factors (CF) [1].
Based on previously conducted interviews, we presented three CF types in a Delphi survey; Effect Modifying -, Outcome Influencing - and Measurement Affecting CFs. Subsequently, a virtual Special Interest Group (SIG) session was held for in depth discussion of Effect Modifying CFs.
Of 161 Delphi participants, 129 (80%) completed both rounds. After two rounds, we reached consensus (≥70% agreeing) for all but two statements. The 45 SIG participants were broadly supportive.
Through consensus we developed an operational definition of CFs, which was well received by OMERACT members.

There has been a lack of consensus on which criteria are important when selecting health-related outcome measures (HROM), especially in primary health care A Delphi consensus was undertaken to identify core criteria for selecting among different HROM and contextual factors affecting decision-making.
A Delphi survey using standard methodology (consensus set as 75% agreement) was sent to primary care practitioners, administrators, policymakers, researchers and experts in HROM development. Criteria (n = 35) were selected from a targeted literature search; questions probed contextual factors that may influence selection of core criteria including the following: 1) weighting, 2) clinical contexts, and 3) core areas.
Participants (n = 45) achieved consensus on 17 items in round 1 (plus four new criteria), with one more item in round 2. Unequal weighting of criteria was favored, and the type of clinical scenario did not influence selection of HROM.
Eighteen core criteria from 39 were identified for inclusion in a core set, reflected predominately aspects of feasibility and acceptability. This is the first study providing evidence that contextual factors affect selection of HROM in a core criteria set. Care in primary health care is complex, and therefore, the items not reaching consensus may reflect this heterogeneity.

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their \'programme theory\', how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP - the intended outcome.