Blurring the boundaries between synthesis and evaluation. A customized realist evaluative synthesis into adolescent risk behavior prevention

Abstract

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Highlights• Published reporting standards for realist review provide a set of guiding principles for conducting realist research. However, these are not

Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances

“…The importance of patient empowerment in the use of self-management apps has been explored in research around diabetes [ 86 ] but to our knowledge, this is the first review to apply a conceptual definition of empowerment to mobile app use in self-managing CLBP. In addition, the research drew on substantive theories and created programme theories in the middle range of abstraction which enhances the transferability of the findings Middle range theories can be used to explain patterns of causation across different programmes and settings [ 29 ]. As a result, the findings from this review can be used to inform research and development of similar mobile apps designed to help people self-manage other long-term pain conditions.…”

“…A realist synthesis typically relies on secondary sources however in this review — due to the lack of representation from people living with CLBP—realist interviews with stakeholders were also included. Although this is atypical, it is not without precedence [ 29 ]. The principal researcher (RH) came to the review with nascent research questions originating from their experience treating people with CLBP in the NHS.…”

Why patients in specialist palliative care in-patient settings are at high risk of falls and falls-related harm: A realist synthesis

“…Retroductive approaches require the researcher to not only use theory but also professional insights and hunches. 20 The Initial Programme Theories are described with a summary of the evidence obtained and an analysis of their implications for the proposed theory.…”