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the realist approach to evaluation research: an introduction

The evaluation was conducted as participatory action research with The Station members, volunteers, management committee members, and staff involved in all phases of the research process. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. Interprofessional teamwork in stroke care: Is it visible or important to patients and carers? 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 [32]. ... NRs map topic areas across different research traditions [4,14,66]. In research studies that were able to create reciprocal working relationships and to embed patient and public involvement this was contingent on: the purpose of patient and public involvement being clear; public contributors reflecting research end-beneficiaries; researchers understanding the value of patient and public involvement; patient and public involvement opportunities being provided throughout the research and ongoing evaluation of patient and public involvement. The published evidence focuses on evaluations of individual services, which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. School-based health promotion interventions (SHPI) have been introduced extensively over the last decades, but their implementation and evaluation still present challenges. A training module for researchers, including learning outcomes, outline course materials and assessment criteria. and RAC organisation (level iii.). 35, No. Introduction Direct realism, also known as naive realism, can be described as “what you see is what you get”[1]. This introduction will help evaluators and commissioners of evaluations to decide whether a realist approach is appropriate for evaluating the impact of a particular policy or programme. Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. Prospective learners lack evidence-based guidance on how to choose between the options on offer. 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. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate. RAY PAWSON [continued]: It is the main sort of research that's funded and practiced in the UK. 12, 21 July 2015 | Journal of Advanced Nursing, Vol. The good news is that I'm going to be talking about one. Ethics and dissemination the Studer Group protocol (Studer Group. The realist approach to evaluation research: an introduction By Gillian Hewitt, Sarah Sims, Ruth Harris and University of London Kingston University and St. George's Topics: alliedhealth, health, nursing Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. Intersectoral collaboration, recognized to result in more sustainable change in communities, is examined in the context of oral health promotion (OHP) interventions. In: Knuttson J, Methods: A realist evaluation approach was used, and two focus groups (one with parents and one with kindergarten staff) were held to identify program outcomes and to develop and refine key hypotheses about how these outcomes occurred. Interviews focused on The Station's role in assisting recovery from mental illness, the limitations and strengths of the program, and relationships with the mental health system. Tilley N (eds.) It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. Evidence, whether new or old, never speaks for itself. The study offers guide- lines to other researchers about potential pitfalls in conducting a realistic evaluation. Social mechanisms identified included social comparisons, camaraderie, and social capital. 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. Briefly consider a realist research design. Creators Pawson and Tilley propose that, in order to determine what works, for whom, in what circumstances, and why, researchers must identify and examine the intervention's underlying mechanisms, the contexts under which the mechanisms operate, and the patterns of outcomes triggered by interactions between actors and their environment [32][33]. A three-stage literature search and a stakeholder consultation event was completed. Methods Implementation fidelity refers to the degree to which an intervention is consistently delivered according to protocol. The paper provides a very brief introduction to the key ideas in realist evaluation and the implications of a realist approach for impact evaluation questions, evaluation design, programme theory, data collection, analysis and The research quality of the primary studies is checked out and only those deemed to be of high standard may enter the analysis, the remainder being discarded. Methods and analysis: Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. It is a generic approach that can be applied to many fields of research, including health and social care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience. The objectives of this study were to (1) identify pertinent scientific literature on the implementation processes for intersectoral SHPI and (2) develop a programme theory that maps potential elements of context and underlying mechanisms that may influence intersectoral SHPI. Cardiac rehabilitation programmes for the secondary prevention of coronary heart disease are common. A realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases. 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. 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. Best Practices: Sacred Heart Hospital, Pensacola, Florida. Methods Misapplications of NRs. Data sources The problems we most often address in (evaluation) research are not simple, reality is complex. The realist evaluation approach is a relatively new approach to evaluation, especially in some fields (such as health services research). The national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Funding In this article we defend the idea that theory-based evaluations—contribution analysis, logic analysis, and realist evaluation—are complementary components of a new theory in evaluation. 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. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. A realist evaluation protocol, ReseArch with Patient and Public invOlvement: a RealisT evaluation - the RAPPORT study, Improving performance and responsiveness of maternal health services through social accountability mechanisms in the Democratic Republic of the Congo: Strengthening the interface role in community participation, Brief smoking cessation in acute Welsh hospitals: a realist approach, How embedded is public involvement in mainstream health research in England a decade after policy implementation? Realism research philosophy relies on the idea of independence of reality from the human mind. As the use of realist approaches gains momentum, there is a growing interest in how systems approaches can complement realist thinking. Realism can be divided into two groups: direct and critical. District nurses clearly articulate what they consider to be important, but research in this area is limited and needs to undergo a renaissance to examine what is important: namely what district nurses do in practice; what patients and family carers' views are on what they do and do not do; and how district nurses can improve care outcomes. Intentional rounding (IR) is a structured process whereby nurses conduct one to two hourly checks with every patient using a standardised protocol. Information related to program contexts, elements, and successes and failures were extracted and further supplemented by key informant interviews and author communication regarding reviewed published studies. Working Paper Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Conclusions From the ten programs that we reviewed, we identified six important and promising program strategies that reduce mental health and, to a far lesser degree, substance use problems: client choice in treatment decision-making, positive interpersonal relationships between client and provider, assertive community treatment approaches, providing supportive housing, providing supports for instrumental needs, and nonrestrictive program approaches. Resources list on 'realist' evaluation . London: The Stationery Office; 2013. Realist evaluation using Normalization Process Theory as a programme theory to understand what enabled patient and public involvement to be embedded as normal 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. Falls outcomes will be compared at five time intervals using negative binomial regression and logistic regression. Background Study findings demonstrate that adapting components of an integrated care model can enhance patient satisfaction and engagement with behavioral interventions. Organizational support, training and working in an environment where BSC is visible as standard care, positively influences implementation. This paper introduces the realist approach and explains why it is particularly suited to education research. A third phase will synthesise and refine the results through consensus workshops. Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation. Together, these can facilitate accountability at the individual, community and system levels. Thematic Analysis also revealed that factors such as familiarity with the mode of communication, ease of access, relationship with the person they are communicating with, context of communication etc also have an effect on how online communication affects their sense of well-being. PORTER S and O’HALLORAN P. Nursing Inquiry 2012; 19: 18–28 The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective Objectives In the three localities where breastfeeding rates declined, negative aspects of place including deprivation, unsuitable premises and geographical barriers to inter-professional communication; personnel resources including staff shortages, high workload and low morale; and organisational change predominated (the base model tiers). Doing Realist Research combines the foundations of the realist methodology with the very latest thinking in the application, and development, of the approach.From understanding mechanisms, and the formulation of programme theories, to understanding the role of … This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Realist evaluation is a theory-driven approach to evaluating evidence from complex interventions. Theories of change and realistic evaluation: peas in a pod or apples and oranges? There were four super-ordinate themes providing details on a range of issues identified, focusing on 1) personal reflection, 2) ABI/hospital admission, 3) social and psychological cost-benefit analysis, 4) future challenges. The final explanatory model suggests that individuals with HIV will be more likely to enroll in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one-to-one relationship with the intervener. We offer a preliminary set of questions to aid course developers and learners consider these issues. This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. There is growing evidence on ABI’s use within various health care settings, although how they work and which components enhance success is largely unknown. 2016. Understand the implications of taking a realist approach on knowledge claims and realist research project design and processes; ... "I found the 5 days to be an excellent introduction and overview of realist evaluation and realist … This realist review focussed on mental health outcomes of families who moved, as well as the mechanisms through which moving influenced mental health. Ethics and dissemination:This research project has received approval from the Comité d’éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. There were a number of methodological challenges and a need to limit the depth of 'realistic unravelling'. Realist evaluation: an introduction. The University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. A 'RAMESES' (Realist and Meta-review Evidence Synthesis: Evolving Standards) statement (comparable to CONSORT or PRISMA) of publication standards for such reviews, published in an open-access academic journal.3. taff. The realist approach to evaluation research: an introduction By Gillian Hewitt, Sarah Sims, Ruth Harris and University of London Kingston University and St. George's Topics: alliedhealth, health, nursing Dissemination will be facilitated by project co-applicants with established connections to national policy making forums in addition to publications, conference presentations and reports targeted to service providers and commissioners. Results Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. 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. 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). From a preliminary study, we expected breastfeeding outcomes to vary and we prospectively used qualitative and quantitative methods to ask why. Evaluation research is tortured by time constraints. Participants The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice. Methods Realist evaluation is a valuable method for addressing the complexity of social programmes. 28 January 2020 09:30 - 16:30. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. Enter your email address below and we will send you the reset instructions. 1 A realist approach to the evaluation of complex mental health interventions Craig Duncan a*, Scott Weich b, Sarah-Jane Fenton c, Liz Twigg a, Graham Moon d, Jason Madan c, Swaran Singh c, David Crepaz-Keay e, Helen Parsons c, Kamaldeep Bhui f a Department of Geography University of Portsmouth Portsmouth PO1 3HE 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. Objectives Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mechanisms contributing to the routine incorporation of PPI in the research process were assessed, the impact of PPI on research processes and outcomes evaluated, and barriers and enablers to effective PPI identified. A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. It is a generic approach that can be applied to many fields of research, including health and social care. Similarities seen in their ontological, epistemological, and methodological positionings, as well as their complementarity in terms of the evaluative questions they address, suggest we may be observing the consolidation of a new theory in evaluation and the emergence of a fifth generation. 1, 8 March 2017 | BMC Health Services Research, Vol. 17, No. 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. These are not 'magic bullets' which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. ), the RAC facility (level ii.) Knowledge exchange activities through stakeholder engagement and online postings are embedded throughout the lifetime of the project. 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. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. Conclusions: Realist evaluation and realist synthesis are an advanced approach to evaluation research, but they offer an innovative and insightful means by which to further our understanding of complex social interventions. Its overall place in the toolkit of evaluation … Results Introduction A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. Background Realist review of literature. Introduction Past positive experiences of collaboration, a positive attitude towards OH, and the development of leadership and trust among stakeholders are present in configurations that influence positively the OH level of schoolchildren. Realist evaluation is a form of theory-driven evaluation, but is set apart by its explicit philosophical underpinnings. 05:37. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented. Studies highlight the value district nurses place on palliative care provision, the importance of developing a relationship with patients, and the emotional difficulties of providing such care. Integrated care models offer one approach to treat patients with chronic multimorbidity. Using an iterative approach to include the three data sets, a model was developed that identified important contextual factors that linked with two groups of program mechanisms that produced positive outcomes for members. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. Phase 3: case studies to explore how IR is implemented ‘on the ground’, including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. 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? The purpose of the present study was to understand the relationship between willingness to communicate, perceived interpersonal communication competence and online communication among young females and the ways in which it affects their well-being. to analyze the ontological, epistemological, and methodological foundations of various theory-based approaches in evaluation to appraise their similarities and differences. We aimed to examine adaptations made to a care coordinator-led behavioral intervention, and how patients responded to adaptations, through a secondary analysis of these data. A total of 129 case study participants included researchers and PPI representatives from 22 research studies, and representatives from funding bodies and PPI networks. The realist approach to evaluation research: an introduction.

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