Two proponents of theory-based approaches to evaluation that have found favour in the UK in recent years are Theories of Change and Realistic Evaluation. In this article we share our evolving views on the points of connection and digression between the approaches based on our reading of the theory-based evaluation literature and our practice experience. We provide a background to the two approaches that emphasizes the importance of programme context in understanding how complex programmes lead to changes in outcomes.We then explore some of the differences in how `theory' is conceptualized and used within the two approaches and consider how knowledge is generated and cumulated in subtly different ways depending on the approach that is taken. Finally, we offer our thoughts on what this means for evaluators on the ground seeking an appropriate framework for their practice.

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Across the public sector there is concern that service uptake is inequitably distributed by socioeconomic circumstances and that public provision exacerbates the existence of inequalities either because services are not allocated by need or because of differential patterns of uptake between the most and least affluent groups. A concept that offers potential to understand access and utilization is 'candidacy' which has been used to explain access to, and utilization of, healthcare. The concept suggests that an individual's identification of his or her 'candidacy' for health services is structurally, culturally, organizationally and professionally constructed, and helps to explain why those in deprived circumstances make less use of services than the more affluent. In this article we assess the fit of candidacy to other public services using a Critical Interpretive Synthesis of three case studies literatures relating to: domestic abuse, higher education and environmental services. We find high levels of congruence between 'candidacy' and the sampled literatures on access/ utilization of services. We find, however, that the concept needs to be refined. In particular, we distinguish between micro, meso and macro factors that play into the identification, sustaining and resolution of candidacy, and demonstrate the plural nature of candidacies. We argue that this refined model of candidacy should be tested empirically beyond and within health. More specifically, in the current economic context, we suggest that it becomes imperative to better understand how access to public services is influenced by multiple factors including changing discourses of deservedness and fairness, and by stringent reductions in the public purse. levels of service uptake are inequitably distributed by socio-economic circumstances -the 'sharp elbowed middle classes' (or at least the relatively more advantaged) appear able to benefit disproportionately from provision across a range of public services including health, education, housing, leisure and cultural services (Le Grand 1982;Gal 1998). Indeed, across a range of services there is evidence that universal public provision, which often paradoxically operates with explicit goals to reduce inequalities, can exacerbate the existence and experience of such inequalities through a range of implicit mechanisms that advantage the most privileged. These mechanisms include those associated with both supply and demand factors.Supply factors include the extent to which services are sufficiently resourced to target need, the degree to which systems work to overcome barriers of accessibility and the ways in which individual workers practice inclusiveness (Meier and Stewart 1991;Gal 1998;Rummery and Glendinning 2000;Priestley et al. 2010). On the demand side, explanations focus on the different perceived relevance of services and differential capacity of the wealthiest and poorest groups in society to make the best use of services. This in turn can lead to a stigmatizing discourse about those who do not eng...

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BackgroundThere is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) >40 kg/m 2 . AimThis programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care. Design and settingFeasibility study in primary care. MethodPatients with a BMI ≥40 kg/m 2 commenced a micronutrient-replete 810-833 kcal/day lowenergy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. ResultsOf 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/ m 2 , age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. ConclusionA care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-monthmaintained weight loss of ≥15 kg for one-third of all patients entering the programme.

BackgroundSocial prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health.AimTo investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals.Design and settingQualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas.MethodAudiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically.ResultsParticipants identified some benefits of collaborative working, particularly the CLPs’ ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management.ConclusionAlthough the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as ‘magic bullets’. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care.

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Flame initiated (800 °C, 10 s) or bulk thermal (2 days, 1000 °C ) reactions of mixed powders of transition metal halides and CaC 2 or Al 4 C 3 produce transition metal carbides ( TiC, ZrC, HfC, V 8 C 7 , NbC, TaC, Cr 3 C 2 , Mo 2 C and WC ) in good yields. The carbides were characterised by X-ray powder diffraction, SEM/EDX, FTIR, microelemental analysis, TEM, electron diffraction and ELNES. bides exceeds 15000 tonnes annually.11 They are traditionally