The construction of context-mechanisms-outcomes in realistic evaluation

Linsley, Paul; Howard, David; Owen, Sara

doi:10.7748/nr.22.3.28.e1306

Cited by 36 publications

(44 citation statements)

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“…Linsley, Howard, and Owen suggest that the explanation should consist of propositions about how the interplay between structure and agency in a social action constituted the regularity [37]. …”

Section: Discussionmentioning

confidence: 99%

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

et al. 2016

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BackgroundThe antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not).MethodsWe adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective.ResultsWe classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase.ConclusionThe perspectives of the programme designers and managers provided an important step towards developing an initial programme theory, which will guide our realist evaluation of the adherence club programme in South Africa.

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Section: Discussionmentioning

confidence: 99%

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

et al. 2016

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“…The analysis followed the RE process of knowledge accumulation in evaluation research. Evaluation research is applied research that addresses how and why and attempts to penetrate the surface of observable practices 29,31,32 . We used analytic induction, as suggested by Pawson and Tilley, 29 to begin the analysis with specifics and move to abstract elements (ie, from the participant observations in the OR to identifying CMOs) (Figure 2).…”

Section: Methodsmentioning

confidence: 99%

“…The research framework for this study was inspired by the Pawson and Tilley 29 realistic evaluation (RE) process. Realistic evaluation is based on realist principles, and its key feature is its emphasis on the mechanics of explanation 29‐32 . Researchers engaging in RE explore the configuration of context, mechanism, and outcome (CMO).…”

Section: Statement Of Purposementioning

confidence: 99%

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Danish Perioperative Nurses’ Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership

Søndergaard

Lorentzen

Sørensen³

et al. 2017

AORN Journal

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Researchers have described the documentation practices of perioperative nurses as flawed and characterized by subjectivity and poor quality, which is often related to both the documentation tool and the nurses' level of commitment. Studies suggest that documentation of nursing care in the OR places special demands on electronic health records (EHRs). The purpose of this study was to explore how the use of an EHR tailored to perioperative practice affects Danish perioperative nurses' documentation practices. This study was a follow-up to a baseline study from 2014. For three months in the winter of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative nurses' documentation practices and that a tailored EHR may improve documentation practices.

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“…Whilst historical use and examination of the critical realist perspective have largely been absent in human and health sciences research (Clark et al ., ; Linsley et al ., ), we consider that the dialogue about its contribution is becoming more evident in recent times (McEvoy & Richards, ; Bergin et al ., ; Clark et al ., ; Angus, ). There are several reasons for this.…”

Section: Scope Of Critical Realismmentioning

confidence: 99%

Bringing critical realism to nursing practice: Roy Bhaskar's contribution

2016

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In the context of modern nursing practice that is embedded within complex social situations, critical discussions about the contribution of major philosophers are relevant and important. Whilst nurse theorists have advanced and shaped nursing as a discipline, other major philosophers can offer much to advance nursing enquiry. In this paper, we focus on philosopher Roy Bhaskar who, amongst others, developed critical realism, a philosophy for social science which connects with how many of us think about the world. Bhaskar's work focuses our attention on the interplay between structure and agency and on the search for the causative or generative mechanisms that explain the social world. Bhaskar was interested in human emancipation, and we suggest his work is of great importance to advance understanding of complex social situations. Critical realism has already been endorsed by a range of disciplines, especially in research which focuses on real problems and acknowledges the complexities of the social world. In recent evidence from healthcare literature, there has been a surge in research using realist methodology (realist evaluation and realist synthesis), which is underpinned by the philosophy of critical realism and which offers a different perspective to understanding nursing and healthcare problems through the realist lens. However, we suggest that sufficient attention is not always paid to the philosophical roots of this methodology. In this paper, we provide insight into Bhaskar's work and demonstrate how research positioned within critical realism and realist methodology can advance nursing and healthcare-related knowledge. Through shining a light on Bhaskar, we illustrate how critical realism philosophy is a natural fit with human and health science enquiry, including nursing.

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The construction of context-mechanisms-outcomes in realistic evaluation

Cited by 36 publications

References 0 publications

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

Danish Perioperative Nurses’ Documentation: A Complex, Multifaceted Practice Connected With Unit Culture and Nursing Leadership

Bringing critical realism to nursing practice: Roy Bhaskar's contribution

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