Multiple Levels and Examples of Key Contextual Factors
| Contextual Category | Subcategory | Examples | ||
|---|---|---|---|---|
| Biological | Organ system Cellular mechanisms | Genetic and physiological mechanisms that create interaction effects between diseases and treatments Basic understanding of multimorbidity | ||
| Genomics | ||||
| Person | Personal goals and preferences | Goals and preferences for process and outcomes of care Personal hopes and expectations and life goals (short and long term) Concerns about care | ||
| Medical characteristics | Functional status Degree of symptom distress—especially pain Mental health, cognition, mood Complexity of conditions and care regimen Specific dominant conditions Capacity for self-care | |||
| Cultural factors | Language Race, ethnicity, cultural background Personal preferences (eg, religiosity, privacy) Ability to advocate for self | |||
| Resources | Financial resources Insurance benefits Housing, living situation Transportation and access to care Educational attainment, literacy Health literacy and numeracy Social isolation, connectedness to others, communication Presence of family, unpaid caregiver Peer support | |||
| Family | Capacity of family to provide care | Ability to provide care and personal services Emotional support Proximity and availability Financial resources Ability to advocate for patient within health care system Legal considerations | ||
| Social and cultural context of family | Family dynamics (including potential for abuse, neglect) Cohesion and ability to make decisions as a unit Family’s connection to the community and health care system Preferences for care and caregiving, including location for caregiving | |||
| Community | Physical characteristics of the community | Climate Urban, rural, suburban Connectivity of community—eg, broadband, telephone, other resources Transportation system (including accessibility) Safety of community Potential for recreation Physical infrastructure and built environment Healthy food, air, and water quality | ||
| Health care infrastructure | Link between community resources and the health care system Health care marketplace Available clinicians Implementation of health care policy Availability and skills of community health workers | |||
| Demographics | Socioeconomic status of community Diversity (race, ethnicity, sex, age, culture) Employment | |||
| Social culture | Civic culture (eg, organized volunteer groups) Employment for individuals with multiple chronic conditions Acceptance of diversity, openness to interventions etc Social networking, social norms | |||
| Health care system | Delivery | Continuity of care Access to mental health care What is measured and incentivized Accessibility of system: responsiveness, ease of communication, patient centeredness Integration, fragmentation, structure of health care system | ||
| Resources | Financing, sources of revenue, reimbursement structure Physical infrastructure Extent of and allocation of resources | |||
| Communications and information technology | Information systems Patient and caregiver access to information systems and information Information flow—between whom? | |||
| Workforce | Supply—professional and nonprofessional Abilities and skills How systems use care teams and who is on them | |||
| Education and training | Scope of practice Match between training and needs Ongoing workforce education and training | |||
| Policy | Financial | What is paid for, and what is not paid for? By whom? To whom? For what? Who is eligible? Benefit design | ||
| Quality | What is measured? What are the outcomes that matter? Which measures are imposed in which settings? | |||
| Legal, regulatory | Scope of practice, licensing laws Privacy protection Health care workforce protections, labor laws | |||
| Political environment | Local and policy effects | |||
| Economic environment | Effects on community, health care system | |||
| Media environment | What is communicated? To whom? | |||