Realist review

Hunter, Rebecca L.; Gorely, Trish; Beattie, Mary; Harris, Kevin

doi:10.1080/1750984x.2021.1969674

Cited by 51 publications

(83 citation statements)

References 61 publications

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“… 31 To this end, our study selection was purposive, meaning that the goal was not to represent the existing evidence base in its entirety, but rather only include what the authors deemed relevant for expanding, refuting or refining the initial theories. 32 Initial screening of studies based on title, abstract and keywords took place simultaneously with the searches. We also considered grey literature reporting on impact evaluations, process evaluations, action research, documentary analysis, administrative records, surveys, legislative analysis, conceptual critique, personal testimony thought pieces and commentaries.…”

Section: Methodsmentioning

confidence: 99%

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

et al. 2022

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IntroductionCommunity-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not.Methods and analysisCritical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate.ResultsThree programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination.ConclusionWe systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions.PROSPERO registration numberCRD42020210442.

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Section: Methodsmentioning

confidence: 99%

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

et al. 2022

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“…We followed the six-step framework recently published by Hunter et al [16] and the realist review methodological guidance provided by the RAMESES project [6]. Originally applied to a realist review of socially complex interventions in the domain of sports psychology, Hunter et al provide a clear overview of six stages of the review process.…”

Section: Methodsmentioning

confidence: 99%

“…Originally applied to a realist review of socially complex interventions in the domain of sports psychology, Hunter et al provide a clear overview of six stages of the review process. Their framework takes the RAMESES guidance into account and contributes to further clarifying methodological guidance and enhancing transparency of the application of the method [16].…”

Section: Methodsmentioning

confidence: 99%

A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being

2022

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The use of digital technologies for health has been rapidly gaining ground in the last decade, including as a strategy to empower adolescents living in urban resource-constrained settings. Nevertheless, unclarity and incoherence remain regarding which programme strategies generate which outcomes, as well as regarding the importance of context. We set out to answer the question “How do digital empowerment strategies work to improve adolescent health and well-being?”. We conducted a realist-informed review, the first on this subject matter to our knowledge. The realist methodology is geared towards the understanding of socially complex interventions, such as digital empowerment. We synthesized the data into a programme theory uncovering social mechanisms and context conditions underlying specific programme strategies. We found that digital technologies enlarge the space for adolescents to access information to health services on their own terms and provide anonymity, which leads to a sense of safety if access is not curbed by gatekeepers. If adolescents have access to information adapted to their needs, they will be able to make informed decisions, and this will contribute to improved health outcomes because their better understanding enlarges their sense of individual agency. We identified two main gaps in the literature on digital interventions for adolescents. Both are related to an under-theoretisation of the concepts the programmes rely on in implementation: (1) the urban environment the programme has to operate in and its meaning for the adolescents; (2) the socio-developmental stage of the adolescents the programmes work in.

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“…Their insights make a substantive contribution to health service innovation because, by taking context into account, they are potentially 'transferable'-producing insights relevant to a wide range of settings and geographical contexts. 70 Our proposed realist synthesis will be conducted in four iterative phases (see below). The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards (RAMESES) quality procedures 69 and, subsequently, will comply with RAMESES reporting guidance.…”

Section: Philosophy and Methodologymentioning

confidence: 99%

Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol

Evans

Timmons

et al. 2022

BMJ Open

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IntroductionOne of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts?Methods and analysisThe review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20–35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance.Ethics and disseminationEthical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426–1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences.PROSPERO registration numberCRD42021288702.

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Realist review

Cited by 51 publications

References 61 publications

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being

Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol

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