Contextualizing violence prevention – How contextual aspects influence the implementation of a violence prevention initiative in prisons and psychiatry

The aim of this study was to investigate which contextual aspects and mechanisms are decisive in the implementation of an integrated, tailored intervention to prevent violence and threats of violence from patients or inmates towards employees in psychiatric units and in prisons and detention centers. Based on a standardized implementation degree assessment of fidelity, reach and dose delivered, we selected two workplace cases from each sector, one with a high and one with a low implementation degree. Using a realist evaluation framework, we conducted a thematic analysis of the four selected workplace cases to identify prevalent contextual aspects and mechanisms underlying the implementation degree. We found that prioritization, synergy with parallel change processes, and intervention fit, were decisive mechanisms for the successful implementation of the intervention. We also found that lack of resources (staff instability, insufficient time, poor mental resources) and resource-demanding parallel change processes, were contextual aspects that “blocked” all mechanisms. That is, when resources were not available, none of the mechanisms for implementing the intervention was activated. Our findings point to the importance of investigating the role of contextual aspects when assessing the effectiveness of organizational interventions.