The National Institute for Health Research Health Services and Delivery Research programme. Realist researchers then try to articulate the theories (termed ‘mechanisms’) that underpin the programme and explore how contexts influence the mechanisms to produce different programme outcomes. Intersectoral collaboration, recognized to result in more sustainable change in communities, is examined in the context of oral health promotion (OHP) interventions. Objectives 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). Realist and grounded theory approaches are used. The research question is: ‘What is it about IR in hospital wards that works, for whom and in what circumstances?’ We will investigate this at the three levels of the organisation and delivery of health services: national, service provider organisation and individual ward/unit. However, because these models consist of multiple components designed to provide individualized care, they should be adapted to best meet the needs of patients in diverse settings. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. In remote rural Andean communities, these interventions seem to have limited success. A Methods Lab Publication, ODI. It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). Conclusions An account is offered of the evolution of this persuasion, through the works of Chen and Rossi, Weiss, and Pawson and Tilley. It explores enablers and barriers associated with alcohol reduction following an ABI. Five key contextual factors enable the program mechanisms to work. ‘Bad' research may yield ‘good' evidence—but only if the reviewer follows an approach that involves analysis and appraisal. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a) used the Internet to support learning, (b) involved doctors or medical students; and (c) reported a formal evaluation. 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. Methods and analysis However, this shifting of the temporal frame for evaluation is in itself no guarantee of success. 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. 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. As with all secondary research methods, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency of studies. Prospective learners lack evidence-based guidance on how to choose between the options on offer. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. In Peru, the Ministry of Health implemented intersectoral OHP interventions to improve the oral health (OH) of schoolchildren. 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 … The results were combined and the five themes Background To determine the types of PPI in funded research, describe key processes, analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research for all those involved. Methods: An initial program theory was developed to identify potential contextual elements and mechanisms. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. 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 WAND T, WHITE K and PATCHING J. Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health 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. Realism research philosophy relies on the idea of independence of reality from the human mind. Realist impact evaluation is an approach to impact evaluation that emphasises the importance of context for programme outcomes. Theory-based evaluations have helped open the ‘black box’ of programmes. ... NRs map topic areas across different research traditions [4,14,66]. 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. 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 Direct realism, also known as naive realism, can be described as “what you see is what you get”[1]. Consider, in some detail, five principles of realist methodology, which may be applied to research practice including evaluation. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand-alone interventions. 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. In these settings, a relatively small number of carefully selected outcomes are assessed based on the anticipated effects of a limited number of variables controlling for the effects of identified confounders [11]. Qualitative data were entered into descriptive categories in N6 software (QSR; 2, 23 September 2020 | Journal of Medical Education and Curricular Development, Vol. Objectives Among these, the complexity of the environments in which SHPI are implemented, and intersectoral collaboration to promote more sustainable change, must be better addressed within evaluation processes. Respondents identified features of The Station's program, policies, atmosphere, connections and networks, stakeholder relationships, and staff and volunteers that are nurturing and empowering. Methods and analysis: This is a mixed methods study in three phases informed by realist evaluation methodology. 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 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. 1, 8 March 2017 | BMC Health Services Research, Vol. By analogy, research synthesis follows a disciplined, formalized, transparent and highly routinized sequence of steps in order that its findings can be considered trustworthy—before being launched on the policy community. We conducted interviews (n = 27), a survey (n = 279) and organization documentation review (n = 44). A critical interpretative synthesis was performed of elements of context and underlying situational and transformational mechanisms. In: Knuttson J, Conclusions Program mechanisms are categorised by descriptive themes referred to as 'nurturing' and 'empowering'. In knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. The Station obtains resources and connections to its rural community through key stakeholders and a peak organisation One Voice Network acts as an advocate. Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation. The problems we most often address in (evaluation) research are not simple, reality is complex. Keywords: Medical education; Palliative care; Scoping review; Narrative review; Knowledge syntheses. This introduction aims to explain realist impact evaluation for those unfamiliar with its principles. Evaluating Crime Reduction Initiatives. The 12 case studies represented what had happened. 78, No. What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? Narrative reviews (NRs) provide contextual knowledge critical to effective understanding of education processes yet remain plagued by concerns The most characteristic aspect of that schedule is the appraise‐then‐analyse sequence. We will describe ‘what works’, ‘for whom’ and ‘in what circumstances’ and develop conjectured programme theories using context, mechanism and outcome configurations. No 1. ESRC Research Methods Programme Methods Paper 2, Pawson R, Greenhalgh T, Harvey G, Walshe K (2004) The attainment of evidence-based practice is at the fore of the international practice development agenda. Together, these can facilitate accountability at the individual, community and system levels. This paper introduces the realist approach and explains why it is particularly suited to education research. Implementation fidelity refers to the degree to which an intervention is consistently delivered according to protocol. The first survey phase has university ethics approval and the second phase, Integrated Research Application System (IRAS) and Health Research Authority (HRA) approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Forty six papers employing a range of research methods are incorporated into the review. Introduction to Realist Evaluation and Synthesis Wednesday 25 th January 2017, 2pm-3.30pm Venue: Lecture Room G04, Cypress Building, Chatham Street, University of Liverpool, L69 7ZR 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. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round. We observe that all these approaches are grounded in critical realism. It is based on the epistemological foundations of critical realism.Based on specific theories, realist evaluation provides an alternative lens to empiricist evaluation techniques for the study and understanding of programmes and policies. The realist evaluation approach is a relatively new approach to evaluation, especially in some fields (such as health services research). Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or ‘evidence’ of care delivered, rather than as a means of increasing compassionate care. Patients were satisfied with adaptations designed to improve intervention fit for local contexts. It describes five key ideas which frame realism and their implications for impact evaluation. 1, 1 April 2016 | Health Services and Delivery Research, Vol. 12, 21 July 2015 | Journal of Advanced Nursing, Vol. Conclusion: This research project underlines the importance of the local stakeholders' leadership in OHP. Social mechanisms identified included social comparisons, camaraderie, and social capital. 10, No. 29, No. 2. 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. Mixed methods approaches are consequently being employed to capture the multidimensional characteristics of programmes that aim to address problematic situations affecting targeted populations. 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. Results Online communication has become the primary mode of communicating among many young adults; in fact it has taken the place of face to face communication. Collectively, these mechanisms had a positive effect on confidence that was perceived as being imperative to maintain health behaviour change. The results of this synthesis support a more comprehensive approach to evaluating SHPI, and improved consideration of intersectoral collaboration and the complexity associated with this type of intervention. 1, 9 February 2020 | BMJ Open, Vol. RAY PAWSON [continued]: It is the main sort of research that's funded and practiced in the UK. The study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances. ResultsParticipants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. This paper examines a new evaluation methodology developed by Pawson and Tilley (1997) that they term "realistic evaluation." The term ‘realist evaluation’ is drawn from Pawson and Tilley’s seminal work, Realistic Evaluation (1997). 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. The origins of services often lie in the need to provide options for people with mental illness and their carers when there is a lack of on-the-ground support. Working Paper Best Practices: Sacred Heart Hospital, Pensacola, Florida. Methods and analysis Setting 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). Unfavorable physical, social and political environment, negative past health experiences, feelings of disrespect, demotivation, mistrust and insufficient leadership are elements of negative configurations. There are few published examples of realist synthesis. 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. Six CMOC can explain these results: four having a negative influence and two having a positive influence. This philosophy is based on the assumption of a scientific approach to the development of knowledge. 2, 3 February 2020 | Translational Behavioral Medicine, Vol. A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. It explains when a realist impact evaluation may be most appropriate and outlines how to design and conduct an impact evaluation based on a realist approach. ESRC Research Methods Programme. Forty-seven participants with a formal diagnosis of coronary heart disease who had attended a programme of cardiac rehabilitation in Scotland 3 years previously were included in focus groups to discuss their perceptions and experiences (30 males and 17 females).