Doing Realist Research

Emmel, Nick; Greenhalgh, Joanne; Manzano, Ana; Monaghan, Mark; Dalkin, Sonia

doi:10.4135/9781526451729

Cited by 127 publications

(156 citation statements)

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“…MEMORABLE aimed to explain medication management from this wider perspective. A realist approach was chosen because it enabled the researchers to work with complexity and understand how medication management works in the real world (38)(39)(40)(41)(42)(43)(44)(45). Systematic reviews examine an 'averaging' effect whereas realist reviews explore contexts where particular mechanisms are most likely and least likely to occur.…”

Section: Rationale For the Researchmentioning

confidence: 99%

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Preprint

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Background: More older people are living in the community with multiple diagnoses and medications. Managing multiple medications produces issues of unrivalled complexity for those involved. Despite increasing literature on the subject, gaps remain in understanding how, why and for whom complex medication management works, and therefore how best to improve practice and outcomes. MEMORABLE, MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation, aimed to address these gaps. Methods: MEMORABLE used realism to understand causal paths within medication management. Informed by RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines, MEMORABLE involved three overlapping work packages: 1) Realist Review of the literature (24 articles on medication management exploring causality); 2) Realist Evaluation (50 realist-informed interviews with older people, family carers and health and care practitioners, explaining their experiences); and 3) data synthesis and theorising from 1) and 2). Results: Medication management was viewed from the perspective of ‘implementation’ and structured into five stages: identifying a problem (Stage 1), getting a diagnosis and/or medications (Stage 2), starting, changing or stopping medications (Stage 3), continuing to take medications (Stage 4), and reviewing/reconciling medications (Stage 5). Three individual stages (1, 3 and 4) are conducted by the older person sometimes with family carer support when they balance routines, coping and risk. Stages 2 and 5 are interpersonal where the older person works with a practitioner-prescriber-reviewer, perhaps with carer involvement. Applying Normalisation Process Theory, four steps were identified within each stage: 1) sense making: information, clarification; 2) action: shared-decision-making; 3) reflection/monitoring; and 4) enduring relationships, based on collaboration and mutual trust. In a detailed analysis of Stage 5: Reviewing/reconciling medications, adopting the lens of ‘burden’, MEMORABLE identified five burdens amenable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Two initial improvement propositions were identified for further research: a risk screening tool and individualised information. Conclusions: Older people and family carers often find medication management challenging and burdensome particularly for complex regimens. Practitioners need to be aware of this potential challenge, and work with older people and their carers to minimise the burden associated with medication management.

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Section: Rationale For the Researchmentioning

confidence: 99%

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Preprint

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“…Scoping search and identi cation of a programme theory It is recognised that it is natural for a scoping search to be an iterative process and often challenging, due to the complexity of the intervention under study [40]. This may require re ning of the research question(s) for a length of time during the review [41]. EH will carry out the scoping search based on terms focussed on the intervention (informed consent).…”

Section: Multi-disciplinary Involvementmentioning

confidence: 99%

The Informed Consent Process in Health Research with Under-served Populations: A Realist Review Protocol.

Hoverd

Staniszewska

Dale

2020

Preprint

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BackgroundThe informed consent process aims to provide potential participants with information about health research that enables them to make an informed decision as to whether they choose to participate, or not. However, it remains unclear as to whether the process is effective for those whom are under-served in health research. It is a pivotal issue within health research that the diversity of people who participate is broadened. The National Institute for Health Research (NIHR) pledges to support equality, diversity and inclusion, actively creating opportunities for all citizens whom are eligible, to take part in health research. MethodsIn order to understand how the informed consent process for under-served populations in health research works, under what circumstances and in what respects, a realist review approach will be undertaken. Searches will be carried out using electronic databases (EMBASE, MEDLINE, Web of Science and PsychInfo), along with selected websites and grey literature. Development of initial rough programme theory (ies) will lead to a more refined programme theory that will provide an explanation of context, mechanism and outcomes. Stakeholder involvement by NIHR (Public) Research Champions, health professionals and clinical academics will provide expert opinion about concepts and programme theory.DiscussionFindings of this realist review will highlight how the informed consent process in health research affects the experience and decision-making process of potential participants from under-served populations. They will be written up in accordance with RAMESES guidelines and disseminated to patients and the public, health researchers, health professionals and policymakers through peer-reviewed publication, presentations and discussions. The review will contribute to our understanding of the mechanisms that trigger both positive and negative outcomes in the informed consent process for those whom are often under-represented in health research to inform policy, study design and delivery.

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“…[26][27][28][29][30] The purpose of realist evaluation is to find out why interventions work differently across different contexts, 28,31 moving beyond a descriptive account to uncover deeper causal factors. 32 The aim of this evaluation was to explore: "does it work, for whom, when and why?" where "it" refers to the implementation of a teamwork approach to patient oral health care that uses team members' full scope of practice.…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

Barnes

Bullock

Chestnutt

et al. 2019

Eur J Dental Education

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Introduction:In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied.Aims: Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. Materials and Methods:The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. Results:Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. Conclusion:Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice. K E Y W O R D S dental therapists, development, general practice, qualitative, realist evaluation, skill-mix, team-work, workforce development How to cite this article: Barnes E, Bullock A, Chestnutt IG, Cowpe J, Moons K, Warren W. Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances. Eur J Dent Educ. 2020;24:109-120. https ://doi.

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Doing Realist Research

Cited by 127 publications

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Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

The Informed Consent Process in Health Research with Under-served Populations: A Realist Review Protocol.

Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

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Doing Realist Research

Cited by 127 publications

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Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

The Informed Consent Process in Health Research with Under-served Populations:&nbsp;A Realist Review Protocol.

Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

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The Informed Consent Process in Health Research with Under-served Populations: A Realist Review Protocol.