Realist Synthesis for Public Health: Building an Ontologically Deep Understanding of How Programs Work, For Whom, and In Which Contexts

Jagosh, Justin

doi:10.1146/annurev-publhealth-031816-044451

Cited by 173 publications

(202 citation statements)

References 48 publications

(53 reference statements)

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“…4), refining the refined interpretations of context that had emerged from review findings. Given the interpretive and subjective nature of the realist approach [72,73], this sense-checking exercise was invaluable. Revising the context map enabled progression beyond the data domains, towards an enhanced understanding and the identification of contextual factors and their influence and impact.…”

Section: Context Mappingmentioning

confidence: 99%

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

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Background: Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? Methods: A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. Results: Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. Conclusions: This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.

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Section: Context Mappingmentioning

confidence: 99%

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

et al. 2020

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“…The aim of this realist systematic review is to (a) identify and synthesise studies that explore oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level [57]. The DSM-5 Diagnostic Classification has been used to guide the disorders that will be considered [59].…”

Section: Aim and Review Questionsmentioning

confidence: 99%

“…Few reviews explore how the context, circumstances and stakeholders influence outcomes [1]. Realist systematic reviews explore the interconnectedness between context, mechanism, and outcomes (CMO) [55,57,58]. From this review, we will develop extensive understandings about oral health interventions for people with mental disorders.…”

Section: Introduction/backgroundmentioning

confidence: 99%

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

Kenny

Dickson‐Swift

Gussy

et al. 2020

Int J Ment Health Syst

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Background: The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. Methods:The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders.Discussion: This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders. Systematic review registrationThis review protocol is registered with PROSPERO (Number) 155969. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit l...

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“…According to the definition by Craig et al (2008 and [28,29], the practice approaches, SENSE and CVA that are planned to be implemented, can be defined as a complex intervention: (1) there are a number of interacting components, (2) there is a certain degree of difficulty of behaviours required by those delivering or receiving the intervention, (3) a high number of groups or organisational levels are targeted by the intervention, (4) there are a number of different outcomes, and (5) a degree of flexibility or tailoring of the intervention exists. It has been argued that complex interventions may unfold differently in different contexts [30] and replicating them in different jurisdictions without modifying according to context often leads to disappointing results [31]. Evidence from complexity and implementation science strongly suggests that external factors, governing practice within the service context, may be a major driver or barrier for successful implementation [32][33][34].…”

Section: Introductionmentioning

confidence: 99%

Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes

Zechmeister‐Koss

Goodyear

Tüchler

et al. 2020

BMC Health Serv Res

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Background: A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context. Methods: We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate. Results:We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children's needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs. Conclusions:The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.

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Realist Synthesis for Public Health: Building an Ontologically Deep Understanding of How Programs Work, For Whom, and In Which Contexts

Cited by 173 publications

References 48 publications

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes

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