Realist evaluation for programs and services in the health area: an integrative review of the theoretical and methodological literature

Abstract

Objective: to identify and analyze the concepts of the realist evaluation and the methodologies recommended for its development in the health area. Method: an integrative review, which included theoretical and methodological studies published in the following databases: COCHRANE Library, EVIPNet, Health Systems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for Change, and SciELO, in addition to Teses-CAPES and Google Scholar, for the gray literature. The mediation category underlay the analysis. Results: 19 references were included, published between 1997 and 2018. It is an innovative proposal to direct the process of evaluating health programs, interventions, and/or policies, with the democratic participation of the parties involved, such as users, workers, managers and researchers; it proposes to elaborate theories about what works, for whom, in what context, and how. The mediation category indicated the need for these theories not to be restricted to the micro-context, but to incorporate the elements of the social macro-structure to which they are connected. Conclusion: It is indicated that the realist evaluation is to be conducted in 21 stages. It takes into account qualitative and procedural methods, which makes it powerful for understanding human and social relationships in the context analyzed. Theories that come from evaluating the functioning of the programs analyzed have greater explanatory chances if they are built by reference to the social totality.

Application of a Realistic Evaluation Approach on Three Public Health Programs Aiming at Prevention of Obesity

“…e potential of critical realism is in line with the recent conclusions from Quintans et al [36] who, in their review of critical realism, described a guide of 21 stages that help the researcher to implement an evaluation of critical realism. is guide is informed by an integrative review of methodological and practical realistic evaluations, and it is regarded as overlapping substantially with the methodology followed in the current analysis of the three case studies on obesity and/or weight gain prevention.…”

Protocol of Process Evaluation of Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA)Trial

“…The SPRINT India trial PE is based on the Realist and RE-AIM evaluation models with a pragmatic approach. The realist model is established on realism-based hypothesis for the specific context involving both qualitative and quantitative components (Quintans et al, 2020). The characteristics of the environment and setting under which the treatments were implemented represent the context (Quintans et al, 2020).…”

“…There is an inherent element of evaluation in the SPRINT India RCT with the incorporation of the Case report form ‘Patient Feedback Questionnaire’ and the inclusion of patient diary in the workbook which has sections dedicated to all the 3 interventions for the patients to write and reflect on their learning experience and provide feedback. This method of critical realist evaluation is acquired out of critical realism (Quintans et al, 2020). The SPRINT India intervention is diverse and has complex interplaying components.…”

Whole of government and whole of society approaches: call for further research to improve population health and health equity

“…Conducting substantial implementation research and evaluation of countries’ experiences with WoG and WoS strategies to health is also essential to collect evidence, compare and contrast, and draw lessons. Complex health policies and interventions are usefully assessed by realist evaluation that aims to elucidate ‘what works, for whom, under what circumstances, and how’,4 42 and which necessarily employs a combination of qualitative and quantitative methods over the mid-term to long term.…”