This is followed by a discussion of tensions related its application encountered in two studies carried out by the authors. Interprofessional teamwork in stroke care: Is it visible or important to patients and carers? The findings describe six themes that emerged from the data analyses: (a) awareness of scholarships; (b) perceptions of institutional scholarships; (c) motivations for pursuing scholarships; (d) barriers to pursuing scholarships; Developmental evaluation (DE), essentially conceptualized by Patton over the past 30 years, is a promising evaluative approach intended to support social innovation and the deployment of complex interventions. ... NRs map topic areas across different research traditions [4,14,66]. The realist approach is a form of theory-driven evaluation developed to strengthen the explanatory power of evaluation studies and contribute to evidence-based policy and practice. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. 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. Working Paper A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Accordingly, there is debate about the best strategy of marshalling bygone research results into the policy process. They will also be presented at realist evaluation and health promotion international conferences. This philosophy is based on the assumption of a scientific approach to the development of knowledge. Results Content: This article introduces the reader to the realist approach and outlines its application in empirical evaluation studies and literature syntheses. HCPs make nuanced judgements on whether to implement BSC based on their assessment of the patient's responses, the patient's condition and other acute care demands. Investigating the impact of a falls prevention community of practice in a residential aged-care setting: A mixed methods study protocol, Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: A qualitative enquiry, Exploring the use of Soft Systems Methodology with realist approaches: A novel way to map programme complexity and develop and refine programme theory, Realist synthesis of intentional rounding in hospital wards: Exploring the evidence of what works, for whom, in what circumstances and why, Evident and Effective? Using co-production to improve patient carer and staff experiences in health care organizations: a multi-centre, mixed methods evaluation in inpatient stroke units (CREATE). 7, 5 March 2019 | Health Education Journal, Vol. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. The good news is that I'm going to be talking about one. 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). In some case studies, lack of coherence in defining PPI persisted, with evidence of a dual role of PPI representative/study participant. 10, No. A Realist Evaluation of Whole-Scale Transformation in London, Does moving from a high-poverty to lower-poverty neighborhood improve mental health? The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. More support is required to promote health behaviour change after the completion of cardiac rehabilitation. Quality standards and methodological guidance for realist and meta-narrative reviews for use by researchers, research sponsors, students and supervisors2. This paper provides an overview of critical realism, a modern philosophical perspective that seeks contextualised causal understandings of social phenomena. Findings will be submitted to academic journals and presented at conferences. Realist evaluation is a theory-driven approach to evaluating evidence from complex interventions. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. An appreciation of the complex social reality inherent in the different programmes under investigation is required in order to seek the theories that explain why interventions are successful in some instances but not in others, ... 16 17 Realist synthesis seeks to understand for whom the intervention works and does not work, how, why and in what circumstances. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. 12, 1 September 2015 | Health Services and Delivery Research, Vol. Elements for data extraction (as depicted in Figure 2 and Table 1) were derived a priori from definitions of elements of context and the mechanisms proposed by several authors who have utilised a realist evaluation design (Astbury and Leeuw, 2010;De Souza, 2013; ... All identified elements were manually extracted from selected papers and incorporated into an analysis grid. A pre-post design using a range of standardized measures supported by audits, surveys, focus groups and interviews will determine its effect on falls prevention practice. Realist evaluation is a valuable method for addressing the complexity of social programmes. This is the second in a series of four papers reporting a realist synthesis of interprofessional teamworking. At the completion of cardiac rehabilitation programmes, patients should be referred to safe and appropriate community-based exercise services. 7, 1 October 2019 | Health Services and Delivery Research, Vol. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. It uncovers underlying implicit or explanatory theory leading to the program and its multiple components, and it identifies contextual factors that spearhead pathways of change to produce expected outcomes (Jagosh et al., 2015;Pawson, 2002;Pawson andTilley, 1997, 2004;Ridde et al., 2012;Salter and Kothari, 2014). This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. The key issues are related to the links between academic and evaluative objectives, the dual role of researcher and consultant, and the temporality of the process. This paper introduces the realist approach and explains why it is particularly suited to education research. It highlights the point that an apparent failure to affect crime levels (using statistical measures) may still generate other benefits if the research is designed within the realistic evaluation framework. Intentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. The Challenges, Potentials and Limitations of Evaluation Research on Preventing Violent Extremism, Optimum hospice at home services for end-of-life care: Protocol of a mixed-methods study employing realist evaluation, Project SoL—A Community-Based, Multi-Component Health Promotion Intervention to Improve Healthy Eating and Physical Activity Practices among Danish Families with Young Children Part 2: Evaluation, Connecting cash with care for better child well-being A nine-month post intervention follow-up evaluation of a Family and Community Strengthening Programme for beneficiaries of the Child Support Grant, The delivery of compassionate nursing care in a tick-box culture: Qualitative perspectives from a realist evaluation of intentional rounding, ‘Function First—Be Active, Stay Independent’—promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design, Adaptations and patient responses to behavioral intervention components in a depression-focused chronic disease care model implemented in India, The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. Key contested areas included: whether to measure patient and public involvement impact; seeking public contributors to maintain a balance between being research-aware and an outsider standpoint seen as ‘authentically’ lay; scaling-up patient and public involvement embedded within a research infrastructure rather than risk token presence and whether patient and public involvement can have a place within basic science. The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). Searches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence. / Dalkin, Sonia; Williams, Emma. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management. An adaptation of Pawson's realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. Four completed studies reported results that included refinement of proposed C-M-O configurations and offered explanations within the RE framework. Participants A realist evaluation, Improving skills and care standards in the support workforce for older people: A realist review, Theory-Based Evaluation and Types of Complexity. At each stage, steps were taken to identify the context, mechanisms and outcomes associated with the version of the model under scrutiny. This paper reflects on the merits and challenges of realistic evaluation design in the establishment of a new managed clinical network (MCN) approach to implementing a guideline concerned with the care of individuals with cancer-related pain. More attention should be given to the complex systems within which policies and interventions occur, to identify and understand the favourable conditions necessary for a successful intervention. The aim of this review is to construct a detailed account of the role of the district nurse (generalist registered nurse providing nursing care in primarily home settings) in providing palliative care, to determine if and how district nursing care provides effective care to such patients at home, and to examine the utility of a realist review for the above purpose. A realist review of `Moving to Opportunity', A realist study of the mechanisms of cardiac rehabilitation, Developing a managed clinical network in palliative care: A realistic evaluation. In contrast, where breastfeeding rates increased the base tiers of the model were less problematic, there was more evidence of leadership, focus on the policy, multi-disciplinary partnership working and reflective action cycles (the higher model tiers). Identifies some unique strategies and agrees with the hypotheses. ResultsParticipants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. Realist impact evaluation is an approach to impact evaluation that emphasises the importance of context for programme outcomes. Objectives It is therefore imperative that robust evaluation methodologies are available to scrutinise new approaches to service development. 18, No. 1. It formed part of a larger project to evaluate the impact of a falls prevention CoP on falls outcomes (including falls rates and injurious falls rates) in a RAC setting . Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. Briefly consider a realist research design. Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3–8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Evaluators, researchers, and policy makers can have greater confidence in the outcome assessments which are made when a high level of implementation fidelity is achieved. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. HCPs are less likely to implement BSC in dynamic and uncertain environments, as they are concerned about adversely impacting on the clinician-patient relationship and prioritize other acute care requirements. Organizations should actively promote BSC as a core function of the acute hospital setting and improve professional practice through leadership, training, feedback and visible indicators of organizational commitment. Multiple mechanisms may be activated within each intervention, each representing a 'pathway from resource to reasoning and response'. 2009, Rycroft-Malone et al. Background and Aims: There is a lack of literature on the evaluation of programmes addressing the motor and sensory development of preschool children. The quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience. RAY PAWSON [continued]: That's is realist evaluation. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This review provides the background for Part II of the article (to be published in the next issue, Evaluation 8), which considers the merits of a new model for evidence-based policy, namely `realist synthesis'. A critical realist approach can help us to answer research questions about how and why interventions and programs work within the complexities of primary care. Using the realist approach to evaluate public health policies with a health promotion perspective Concepts and keys to initiate a realist evaluation IUHPE conference| Curitiba | 2016 Emilie Robert, Valéry Ridde, Ketan Shankardass, Anthony Lacouture, Emilie Renahy © Crown copyright 2013. Results Twenty-five in-depth interviews were conducted with participants who were randomly selected from within the groups identified above. Falls outcomes will be compared at five time intervals using negative binomial regression and logistic regression. Patients’ expressed needs were consistent with what care coordinators perceived. The realist approach to evaluation has been used previously in health services research where a comprehensive understanding of complex interventions is required (Greenhalgh et al. 20:04 A three-stage literature search and a stakeholder consultation event was completed. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate. The impact of the community of practice will be evaluated at three levels: individual member level, facility level and organizational level. We will describe ‘what works’, ‘for whom’ and ‘in what circumstances’ and develop conjectured programme theories using context, mechanism and outcome configurations. 29, No. Knowledge exchange activities through stakeholder engagement and online postings are embedded throughout the lifetime of the project. An Aboriginal and Torres Strait Islander Advisory Group guides this research. , ... Its creators, the sociologists Ray Pawson and Nicholas Tilley, see it as an obligation of the social sciences to do their part in solving social problems by producing knowledge about the impacts of social programs. Thus realism does involve being realistic. This process informs the coding framework, develops theory and is in line with a realist evaluation perspective. 78, No. A purposive sample of 62 patients and 3 care coordinators were recruited based on their involvement with the INDEPENDENT care model across two clinics. The second section of the review introduces retroduction, a major methodological starting-point common to most realists. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. ... Realist evaluation is a theory-driven approach designed for evaluating complex social interventions, such as IR. ... 18,19 It does not seek to answer the question 'does this intervention work?' Participants Introduction to Realist Approaches. 35, No. 1, 8 March 2017 | BMC Health Services Research, Vol. A three-staged realist evaluation drawing on Normalisation Process Theory to understand how far PPI was embedded within health-care research in six areas: diabetes mellitus, arthritis, cystic fibrosis, dementia, public health and learning disabilities. You can request the full-text of this article directly from the authors on ResearchGate. Abstract Interprofessional teamwork has become an integral feature of healthcare delivery in a wide range of conditions and services in many countries. 4, No. London However, as a formative approach, in the messy world of interdisciplinary practice development, realistic evaluation proved a worthy design. For realist evaluations (RE) this project aims to: develop quality and reporting standards and training materials; build capacity for undertaking and critically evaluating them; produce resources and training materials for lay participants, and those seeking to involve them. We also identified a number of practical difficulties and priorities for further methodological development. Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. 1. Evaluation utilizes many of the same methodologies used in traditional social research, but because evaluation takes place within a political and organizational context, it requires group skills, management ability, political dexterity, sensitivity to multiple stakeholders and other skills that social research in general does not rely on as much. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i. The third stage consisted of case studies tracked over 18 months through interviews and document analysis. Sage, London Pawson R, Tilley N (2004) Realist evaluation, Pawson R, Tilley N (1997) Realistic Evaluation. Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently ‘intentional rounding’ was incorporated into nursing practice in the United Kingdom. In the second phase, case study sites representing the different service types will collect patient data and recruit carers, service managers and commissioners to gather quantitative and qualitative data about service provision and outcomes. The approaches are theory driven – developing structurally coherent explanations of interventions and test these against empirical data. Hourly Rounding Supplement . Trial registration number WAND T, WHITE K and PATCHING J. Interview data were coded for reported modifications in intervention content, tools, and delivery; then, these adaptations were categorized by how they served to enhance implementation in the Indian context. This study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. A realist evaluation, Exploring the use of Soft Systems Methodology with realist approaches: A novel way to map programme complexity and develop and refine programme theory, Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry, Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions, Investigating the impact of a falls prevention community of practice in a residential aged-care setting: a mixed methods study protocol, ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study. Ethics and dissemination The evidence, therefore, does not provide generalisable information, so the question ‘What are the features of hospice at home service models that work, for whom, and under what circumstances?’ remains unanswered. The realist evaluation approach was first developed by Pawson and Tilley (1997) and has since been adapted in many different ways. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). There are few published examples of realist synthesis. – based on a realist philosophy of science (ontology) – looks for mechanisms and middle-range theories. PPI models included a ‘one-off’ model with limited PPI, a fully intertwined model in which PPI was fully embedded and an outreach model with lay representatives linking to broader communities. And the second thing is just to say, once more, the realist motto that evaluation is usually thought of asking a rather blunt question. Future work These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. (accessed 16 April 2012), Realistic Evaluation. 10, No. Despite widespread use of IR, this paper highlights the paradox that there is ambiguity surrounding its purpose and limited evidence of how it works in practice. Direct realism, also known as naive realism, can be described as “what you see is what you get”. The focus of this article is the potential for randomisation and experimentation to provide evidence for transfactual (i.e. Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. There were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components. 2012), What's the "what" in "what works?" Introduction. The second section of the review introduces retroduction, a major methodological starting-point common to most realists.
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