The realist approach to evaluation research: an introduction

Hewitt, Gillian; Sims, Sarah; Harris, Ruth

doi:10.12968/ijtr.2012.19.5.250

Cited by 70 publications

(77 citation statements)

References 23 publications

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“…Program mechanisms may be described as the underlying processes that describe how an intervention or program produces change [4]. Mechanisms explain the impact of the program of intervention resource(s) on the individual's reasoning and their choices [9],[15].…”

Section: Resultsmentioning

confidence: 99%

“…In order to address feasibility of RE, all information reported with regard to challenges associated with its application [4],[13] and the ways in which authors have attempted to address the challenges they encountered was also abstracted from each source document.…”

Section: Methodsmentioning

confidence: 99%

“…[9],[15],[19]. This is accomplished through the identification and examination of underlying generative mechanisms (M) associated with the intervention or program, the conditions or contexts (C) under which the mechanisms operate, and the pattern of outcomes (O) produced [4],[9],[17]. Program or intervention mechanisms are not viewed as equivalent to program components; rather, they are an attempt to represent how program resources are received, interpreted and acted upon by the participant to produce an outcome or pattern of outcomes [6],[9],[15].…”

Section: Introductionmentioning

confidence: 99%

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Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

2014

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BackgroundIn knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. Traditional evaluation efforts that focus on aggregate effectiveness represent an oversimplification of both the environment and the interventions themselves. However, theory-based approaches to evaluation, such as realist evaluation (RE), may be better-suited to examination of complex knowledge translation interventions with a view to understanding what works, for whom, and under what conditions. It is the aim of the present state-of-the-art review to examine current literature with regard to the use of RE in the assessment of knowledge translation interventions implemented within healthcare environments.MethodsMultiple online databases were searched from 1997 through June 2013. Primary studies examining the application or implementation of knowledge translation interventions within healthcare settings and using RE were selected for inclusion. Varying applications of RE across studies were examined in terms of a) reporting of core elements of RE, and b) potential feasibility of this evaluation method.ResultsA total of 14 studies (6 study protocols), published between 2007 and 2013, were identified for inclusion. Projects were initiated in a variety of healthcare settings and represented a range of interventions. While a majority of authors mentioned context (C), mechanism (M) and outcome (O), a minority reported the development of C-M-O configurations or testable hypotheses based on these configurations. Four completed studies reported results that included refinement of proposed C-M-O configurations and offered explanations within the RE framework. In the few studies offering insight regarding challenges associated with the use of RE, difficulties were expressed regarding the definition of both mechanisms and contextual factors. Overall, RE was perceived as time-consuming and resource intensive.ConclusionsThe use of RE in knowledge translation is relatively new; however, theory-building approaches to the examination of complex interventions in this area may be increasing as researchers attempt to identify what works, for whom and under what circumstances. Completion of the RE cycle may be challenging, particularly in the development of C-M-O configurations; however, as researchers approach challenges and explore innovations in its application, rich and detailed accounts may improve feasibility.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0115-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

2014

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“…It seeks to explain why interventions work or don't work in particular settings by unpacking the ''mechanisms'' or underlying theories of how a complex intervention works, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes (Pawson et al, 2004). The aim of realist synthesis is to help policy makers and practitioners ''make sense'' of a complex intervention and to help resolve unexplained variation in intervention effectiveness (Clark, Whelan, Barbour, & MacIntyre, 2005;Hewitt, Sims, & Harris, 2012;Pawson et al, 2004). This is the second in a series of four papers (Hewitt, Sims, & Harris, in press a, b; Sims, Hewitt, & Harris, in press) reporting a realist synthesis of interprofessional teamworking which addressed the question: Through what mechanisms does teamworking affect outcomes and experience (patient, carer, staff and service) and how does context influence those mechanisms and outcomes?…”

Section: Introductionmentioning

confidence: 99%

Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis

Sims

Hewitt

Harris

2014

Journal of Interprofessional Care

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138

101

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Interprofessional teamwork has become an integral feature of healthcare delivery in a wide range of conditions and services in many countries. Many assumptions are made in healthcare literature and policy about how interprofessional teams function and about the outcomes of interprofessional teamwork. Realist synthesis is an approach to reviewing research evidence on complex interventions which seeks to explore these assumptions. It does this by unpacking the mechanisms of an intervention, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes. This is the second in a series of four papers reporting a realist synthesis of interprofessional teamworking. The paper discusses four of the 13 mechanisms identified in the synthesis: collaboration and coordination; pooling of resources; individual learning; and role blurring. These mechanisms together capture the day-to-day functioning of teams and the dependence of that on members' understanding each others' skills and knowledge and learning from them. This synthesis found empirical evidence to support all four mechanisms, which tentatively suggests that collaboration, pooling, learning, and role blurring are all underlying processes of interprofessional teamwork. However, the supporting evidence for individual learning was relatively weak, therefore there may be assumptions made about learning within healthcare literature and policy that are not founded upon strong empirical evidence. There is a need for more robust research on individual learning to further understand its relationship with interprofessional teamworking in healthcare.

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“…Realist reviews explore complex social programmes and seek out mid-range theories that explain observable patterns of outcomes (demi-regularities), including why interventions are successful in some settings but not in others 28 29. Strong stakeholder engagement strategies are used to ensure interpretive depth and the policy relevance of synthesis findings, and require the consideration of a much broader and heterogeneous evidence base than traditional Cochrane reviews of effectiveness 30 31.…”

Section: Review Question and Aimsmentioning

confidence: 99%

Improving skills and care standards in the support workforce for older people: a realist review

et al. 2014

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IntroductionIn the context of a population that is growing older, and a number of high-profile scandals about care standards in hospital and community settings, having a skilled and knowledgeable workforce caring for older people is an ethical and policy imperative. Support workers make up the majority of the workforce in health and social care services for older people (aged 65 years and over), and yet little is known about the best way to facilitate their development. Given this gap, this review will draw on evidence to address the question: how can workforce development interventions improve the skills and the care standards of support workers within older people's health and social care services?Methods and analysisAs we are interested in how and why workforce development interventions might work, in what circumstances and with whom, we will conduct a realist review, sourcing evidence from health, social care, policing and education. The review will be conducted in four steps over 18 months to (1) construct a theoretical framework, that is, the review’s programme theories; (2) retrieve, review and synthesise evidence relating to interventions designed to develop the support workforce guided by the programme theories; (3) ‘test out’ our synthesis findings and refine the programme theories, establish their practical relevance/potential for implementation and (4) formulate recommendations about improvements to current workforce development interventions to contribute to the improvement of care standards in older people's health and social care services, potentially transferrable to other services.Ethics and disseminationEthical approval is not required to undertake this review. Knowledge exchange activities through stakeholder engagement and online postings are embedded throughout the lifetime of the project. The main output from this review will be a new theory driven framework for skill development for the support workforce in health and social care for older people.Trial registration numberCRD42013006283.

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The realist approach to evaluation research: an introduction

Cited by 70 publications

References 23 publications

Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis

Improving skills and care standards in the support workforce for older people: a realist review

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