Blog
About

0
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Data Analysis and Synthesis Within a Realist Evaluation: Toward More Transparent Methodological Approaches

      1 , 2 , 3 , 1 , 2 , 4 , 1

      International Journal of Qualitative Methods

      SAGE Publications

      Read this article at

      ScienceOpenPublisher
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Realist evaluations are increasingly used in the study of complex health interventions. The methodological procedures applied within realist evaluations however are often inexplicit, prompting scholars to call for increased transparency and more detailed description within realist studies. This publication details the data analysis and synthesis process used within two realist evaluation studies of community health interventions taking place across Uganda, Tanzania, and Kenya. Using data from several case studies across all three countries and the data analysis software NVivo, we describe in detail how data were analyzed and subsequently synthesized to refine middle-range theories. We conclude by discussing the strengths and weaknesses of the approach taken, providing novel methodological recommendations. The aim of providing this detailed descriptive account of the analysis and synthesis in these two studies is to promote transparency and contribute to the advancement of realist evaluation methodologies.

          Related collections

          Most cited references 17

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

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

          Background In 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. Methods Multiple 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. Results A 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. Conclusions The 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.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            A realistic evaluation: the case of protocol-based care

            Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Using Realistic Evaluation to Evaluate a Practice-level Intervention to Improve Primary Healthcare for Patients with Long-term Mental Illness

               R. Byng (2005)
                Bookmark

                Author and article information

                Journal
                International Journal of Qualitative Methods
                International Journal of Qualitative Methods
                SAGE Publications
                1609-4069
                1609-4069
                July 03 2019
                January 2019
                July 03 2019
                January 2019
                : 18
                : 160940691985975
                Affiliations
                [1 ]Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
                [2 ]Trinity Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
                [3 ]School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
                [4 ]Health Research Board Trials Methodology Research Network, Ireland
                Article
                10.1177/1609406919859754
                © 2019

                Comments

                Comment on this article