Making implementation science more real

Abstract

Implementation science in healthcare aims to understand how to get evidence into practice. Once this is achieved in one setting, it becomes increasingly difficult to replicate elsewhere. The problem is often attributed to differences in context that influence how and whether implementation strategies work. We argue that realist research paradigms provide a useful framework to express the effect of contextual factors within implementation strategy causal processes. Realist studies are theory-driven evaluations that focus on understanding how and why interventions work under different circumstances. They consider the interaction between contextual circumstances, theoretical mechanisms of change and the outcomes they produce, to arrive at explanations of conditional causality (i.e., what tends to work, for whom, under what circumstances). This Commentary provides example applications using preliminary findings from a large realist implementation study of system-wide value-based healthcare initiatives in New South Wales, Australia. If applied judiciously, realist implementation studies may represent a sound approach to help optimise delivery of the right care in the right setting and at the right time.

How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE)

“…Rather than seeking to identify every contextual factor at play, the realist approach offered a framework for considering the role of context in relation to the intervention components and social processes that impact outcomes, affording a better understanding of conditional causality (i.e. what works for whom in what circumstances) [ 43 ]. The theory-informed approach and the application of the CMO heuristic facilitated the analysis of a very large and information-rich data set.…”

Community engagement in health services research on soil-transmitted helminthiasis in Asia Pacific region: Systematic review

“…However, details about how these “meetings” were organised, managed, and how results from the meetings were incorporated into the research were not discussed in these included studies. It has been hypothesised that increased CE in HSR studies may allow for greater sustainability of the intervention programme e.g., through sharing of resources among health sector and non-health sectors (DepEd in this case), community stakeholders (Aboriginal peoples, NGOs in this case) or promoting collective ownership [ 37 ]. In fact, CE in research has gained popularity as an approach for enhancing research, ensuring that community concerns are taken into consideration, and it also inform ethical decision-making when research is undertaken in the context of vulnerability [ 38 ].…”

How do stroke Early Supported Discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE).

“…what works for whom in what circumstances). 39 The analytical task of linking CMO chains is suggested to increase the explanatory power of ndings and improve the external validity of case studies. 19 Data were independently analysed by two researchers, reducing ambiguity and enhancing the trustworthiness of our ndings.…”