Benefits of realist evaluation for rapidly changing health service delivery
Realist evaluation is a methodology that addresses the questions: ‘what works, for whom, in which circumstances, and how?’. In this approach, programme theories are developed and tested against available evidence. However, when complex interventions are implemented in rapidly changing environments,...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060347.full |
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| author | Paula Kersten Margaret Cupples Rachel Thomas Fiona Cramp Nicola E Walsh Justin Jagosh Hannah Stott Serena Halls Cathy Liddiard Dave Foster |
| author_facet | Paula Kersten Margaret Cupples Rachel Thomas Fiona Cramp Nicola E Walsh Justin Jagosh Hannah Stott Serena Halls Cathy Liddiard Dave Foster |
| author_sort | Paula Kersten |
| collection | DOAJ |
| description | Realist evaluation is a methodology that addresses the questions: ‘what works, for whom, in which circumstances, and how?’. In this approach, programme theories are developed and tested against available evidence. However, when complex interventions are implemented in rapidly changing environments, there are many unpredictable forces that determine the programme’s scope and architecture, as well as resultant outcome. These forces can be theorised, in real time, and included in realist evaluation outputs for current and future optimisation of programmes. Reflecting on a realist evaluation of first-contact physiotherapy in primary care (the FRONTIER Study), five important considerations are described for improving the quality of realist evaluation outputs when studying rapidly changing health service delivery. These are: (1) ensuring that initial programme theories are developed through creative thinking sessions, empirical and non-empirical literature, and stakeholder consultation; (2) testing the causal impact of formal and informal (eg, emergent) components of service delivery models; (3) contrasting initial programme theories with rival theory statements; (4) envisioning broad system impacts beyond the immediate implementation setting; and (5) incorporating rapidly evolving service developments and context changes into the theory testing process in real-time (eg, Additional Role Reimbursement Scheme, COVID-19). Through the reflections presented, the aim is to clarify the benefit of realist evaluation to assess emerging models of care and rapidly changing health service delivery. |
| format | Article |
| id | doaj-art-ef1765cf1417428685ff155beec4b26f |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ef1765cf1417428685ff155beec4b26f2025-01-31T14:15:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060347Benefits of realist evaluation for rapidly changing health service deliveryPaula Kersten0Margaret Cupples1Rachel Thomas2Fiona Cramp3Nicola E Walsh4Justin Jagosh5Hannah Stott6Serena Halls7Cathy Liddiard8Dave Foster9School of Health Sciences, Canterbury Christ Church University, Canterbury, UKDepartment of General Practice, Queens University, Belfast, UKNeurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA1 School of Health and Social Wellbeing, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKFaculty of Health and Applied Sciences, Glenside Campus, University of the West of England, Bristol, UKRealist evaluation is a methodology that addresses the questions: ‘what works, for whom, in which circumstances, and how?’. In this approach, programme theories are developed and tested against available evidence. However, when complex interventions are implemented in rapidly changing environments, there are many unpredictable forces that determine the programme’s scope and architecture, as well as resultant outcome. These forces can be theorised, in real time, and included in realist evaluation outputs for current and future optimisation of programmes. Reflecting on a realist evaluation of first-contact physiotherapy in primary care (the FRONTIER Study), five important considerations are described for improving the quality of realist evaluation outputs when studying rapidly changing health service delivery. These are: (1) ensuring that initial programme theories are developed through creative thinking sessions, empirical and non-empirical literature, and stakeholder consultation; (2) testing the causal impact of formal and informal (eg, emergent) components of service delivery models; (3) contrasting initial programme theories with rival theory statements; (4) envisioning broad system impacts beyond the immediate implementation setting; and (5) incorporating rapidly evolving service developments and context changes into the theory testing process in real-time (eg, Additional Role Reimbursement Scheme, COVID-19). Through the reflections presented, the aim is to clarify the benefit of realist evaluation to assess emerging models of care and rapidly changing health service delivery.https://bmjopen.bmj.com/content/12/7/e060347.full |
| spellingShingle | Paula Kersten Margaret Cupples Rachel Thomas Fiona Cramp Nicola E Walsh Justin Jagosh Hannah Stott Serena Halls Cathy Liddiard Dave Foster Benefits of realist evaluation for rapidly changing health service delivery BMJ Open |
| title | Benefits of realist evaluation for rapidly changing health service delivery |
| title_full | Benefits of realist evaluation for rapidly changing health service delivery |
| title_fullStr | Benefits of realist evaluation for rapidly changing health service delivery |
| title_full_unstemmed | Benefits of realist evaluation for rapidly changing health service delivery |
| title_short | Benefits of realist evaluation for rapidly changing health service delivery |
| title_sort | benefits of realist evaluation for rapidly changing health service delivery |
| url | https://bmjopen.bmj.com/content/12/7/e060347.full |
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