2012), What's the "what" in "what works?" Issues to do with the age appropriateness of the evidence base in relation to the care of frail older people were also apparent. Limitations approach to directed content analysis to independently review identified articles from five bibliographic databases and seven medical education The realist evaluation approach is a relatively new approach to evaluation, especially in some fields (such as health services research). 29, No. The government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry . 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. The philosophical underpinnings of this approach propose that individuals are agents of change independent of their environment . Interprofessional team-work across stroke care pathways: outcomes and patient and carer experience. In the conceptual framework for implementation fidelity, adherence is the key. The study reported here was part of a mixed methods project investigating the impact of interprofessional teamwork on clinical outcomes and patient and carer experience after stroke . This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy. The use of realist Evaluates the research of Dr Mark Huselid of Rutgers Institute for Management and Labour Relations which suggests that companies with sophisticated HR practices are more profitable, have higher productivity and reduced turnover. There is growing interest in theory-driven, qualitative and mixed-method approaches to systematic review as an alternative to (or to extend and supplement) conventional Cochrane-style reviews. 2009, Rycroft-Malone et al. The term ‘realist evaluation’ is drawn from Pawson and Tilley’s seminal work, Realistic Evaluation (1997). Falls outcomes will be compared at five time intervals using negative binomial regression and logistic regression. 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 . In this review, we scrutinize the use of NRs in palliative medicine education (PME). However, the context exerts a strong influence on whether BSC is implemented, or not. 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. 27, No. All HAH services in England will be invited to participate in a telephone survey to enable the development of a typology of services. The national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. And believe me, it's only a beginning list of the different methods of doing evaluation research. The governance arrangements, policies, and administrative systems at The Station are well developed but flexibly implemented so that they support the nurturing and empowerment processes. Introduction: Realist evaluation is an increasingly popular methodology in health services research. Primary studies examining the application or implementation of knowledge translation interventions within healthcare settings and using RE were selected for inclusion. 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). Ethics and dissemination: The first survey phase has University ethics approval and the second phase, IRAS and HRA approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Informed by a realist approach, the model explained variation in (a) policy implementation (b) the breastfeeding outcomes, whereas the quantity of intervention delivered did not. 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. Five key contextual factors enable the program mechanisms to work. 3. MethodsA convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Organizational support, training and working in an environment where BSC is visible as standard care, positively influences implementation. 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. Future work Methods Many assumptions are made in healthcare literature and policy about how interprofessional teams function and about the outcomes of interprofessional teamwork. The community of practice will be supported to audit falls prevention activity and identify gaps in practice for intervention. Evaluation research is tortured by time constraints. Health, policing and crime prevention. Iterative analysis and a validation process resulted in the identification of a program theory involving Context-Mechanism-Outcome configuration (CMOC). These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Keywords: Medical education; Palliative care; Scoping review; Narrative review; Knowledge syntheses. This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? Realist approaches to scientific evaluation tend to be strong on theory and explanation, but lack adequate tests or means of validating theory. The 12 case studies represented what had happened. 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. 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. A recent Cochrane review found that school feeding programmes significantly improve the growth and cognitive performance of disadvantaged children. And the second thing is just to say, once more, the realist motto that evaluation is usually thought of asking a rather blunt question. Working Paper No 1, Pawson R (2003) Assessing the quality of evidence in evidence-based policy: why, how and when? Interviewees reported high levels of organisational commitment. Effect of Online Communication on Well-Being among Young Women: A Qualitative Analysis, Interprofessional teamwork in stroke care, Realist Evaluation - Oral Health Promotion Interventions, Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: A research protocol, What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? 9, 18 July 2018 | International Journal of Environmental Research and Public Health, Vol. Reviewed papers are interrogated to support, refute or develop these statements. 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. 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. / Dalkin, Sonia; Williams, Emma. 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. 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. The evaluation of a mental health nurse practitioner outpatient service based in the emergency department of a large teaching hospital in Sydney Australia is used to illustrate the application of a realist perspective to research in nursing practice. This paper introduces the realist approach and explains why it is particularly suited to education research. Forty six papers employing a range of research methods are incorporated into the review. However, the supporting evidence for individual learning was relatively weak, therefore there may be assumptions made about learning within healthcare literature and policy that are not founded upon strong empirical evidence. In: Knuttson J, 10, No. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. Stage 3 will test and refine these theories through individual stakeholder interviews. The Realist Research Design These were a clear purpose, role and structure for PPI; ensuring diversity; whole research team engagement with PPI; mutual understanding and trust between the researchers and lay representatives; ensuring opportunities for PPI throughout the research process; and reflecting on, appraising and evaluating PPI within a research study. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). Realist Evaluation is a theory-based approach that asks “How or why does this work, for whom and in what circumstances?” rather than just “what works?”The goal is to develop a detailed theory on how a program works and unpack the … We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses. The second section of the review introduces retroduction, a major methodological starting-point common to most realists. 12, 21 July 2015 | Journal of Advanced Nursing, Vol. Sixty-one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Conclusions Papers in English reporting aspects of the district nurse role in the provision of palliative care are included. In this article, we discuss how the epistemology of Soft Systems Methodology is compatible with realist approaches. Patients were interviewed and surveyed about their experiences in the care model and care coordinators were interviewed about their experiences implementing intervention components. 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. It does this by unpacking the mechanisms of an intervention, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes. Forming a community of practice could provide staff with the opportunity to share and develop their expertise in falls prevention and innovate change. The use and limitation of realistic evaluation as a tool for evidence-based practice: A critical realist perspective, Protocol - Realist and meta-narrative evidence synthesis: Evolving Standards (RAMESES), The Station Community Mental Health Centre Inc: Nurturing and Empowering, Internet-Based Medical Education: A Realist Review of What Works, for Whom and in What Circumstances, A realist evaluation of the management of well-performing regional hospital in Ghana, Community-Based Services for Homeless Adults Experiencing Concurrent Mental Health and Substance Use Disorders: A Realist Approach to Synthesizing Evidence, Diffusion Of Innovations In Service Organizations: Systematic Review And Recommendations, Realist review - A new method of systematic review designed for complex policy interventions, Realist Review to Understand the Efficacy of School Feeding Programmes, Evaluating 'realistic evaluation': Evidence from a study of CCTV, Evidence-Based Policy: In Search of a Method, Digging for Nuggets: How ‘Bad’ Research Can Yield ‘Good’ Evidence, Evidence-based Policy: The Promise of `Realist Synthesis', ‘Motor Magic’: Evaluation of a community capacity‐building approach to supporting the development of preschool children, Motor Magic: Evaluation of a community capacity-building approach to supporting the development of preschool children (Part 2), Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice, Implementation of Antiretroviral Therapy Adherence Interventions: A Realist Synthesis of Evidence, District nurses' role in palliative care provision: A realist review, Why do interventions work in some places and not others: A breastfeeding support group trial, Using Realistic Evaluation to Evaluate a Practice-Level Intervention to Improve Primary Health Care for Patients with Long-Term Mental Illness, How Do You Modernize a Health Service? An Introduction. Data from the stakeholder analysis were entered into Microsoft Excel. Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. 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. 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. Objectives Realist evaluation, using the mechanism, context and outcome pattern, acknowledges that interventions such as ABI do not necessarily work for everyone as participants are likely to be embedded in different contexts, ... Realist evaluation and realist syntheses are theory-driven methods (Greener and Mannion, 2009) that focus on explaining the mechanisms of action that underlie different complex programmes or interventions. Quality standards and methodological guidance for realist and meta-narrative reviews for use by researchers, research sponsors, students and supervisors2. Methods and analysis Findings from patient-centred case studies fed into realistic evaluation interviews with the management group. Ethics and dissemination They will also be presented at realist evaluation and health promotion international conferences. This website is intended for healthcare professionals, International Journal of Nursing Studies, Vol. 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 knowledge translation, complex interventions may be implemented in the attempt to improve uptake of research-based knowledge in practice. It seeks to understand ‘what works, for who, in what circumstances and why’ rather than providing one-off verdicts on programme … 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. The term ‘realist evaluation’ is drawn from Pawson and Tilley’s seminal work, Realistic Evaluation (1997). 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. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. 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. 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 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. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. Directing resources towards the improvement of existing communities is one way of improving health outcomes for all community residents. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change. Participants' accounts indicated that the didactic content of cardiac rehabilitation was not strongly linked to longer-term health behaviour change. 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. We advocate an ethnographic approach to the design and evaluation of complex intervention trials and illustrate how this can assist in developing an explanatory model. Sage, Both Soft Systems Methodology and realist approaches emphasize the necessity to engage stakeholders; through models, the description of contingencies and exploring the intricacies of how complex programmes really work. 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. Realist research approaches (realist evaluation or realist review) can help make sense of these types of interventions or programmes. This philosophy is based on the assumption of a scientific approach to the development of knowledge. 20:04 Design Assumptions about district nursing practice with palliative care patients are derived from a range of sources. The study used a realistic evaluation approach in a multi-method design to develop hypotheses about which aspects or features of teams and team-working are effective in improving patient clinical outcome and experience of care. Lists the evaluation criteria, cites companies with best prractices and draws common themes. Theories of change and realistic evaluation: peas in a pod or apples and oranges? 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 Patient and public involvement (PPI) is a prerequisite for many funding bodies and NHS research ethics approval. Six salient actions were required for effective PPI and were characterised by a shared understanding of moral and methodological purposes of PPI, a key individual co-ordinating PPI, ensuring diversity, a research team positive about PPI input and fully engaged with it, based on relationships that were established and maintained over time, and PPI being evaluated in a proactive and systematic approach. The evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. Conclusions Realist impact evaluation is an approach to impact evaluation that emphasises the importance of context for programme outcomes. Direct realism, also known as naive realism, can be described as “what you see is what you get”. What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working. These were identified based on the scientific literature published between 1997 and 2017 addressing intersectoral SHPI. 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. Main outcome measures It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. Findings from this research will assist residential aged-care providers to understand how to effectively translate evidence about falls prevention into clinical practice. Using the realist approach to evaluate public health policies with a health promotion perspective 1. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Content: This article introduces the reader to the realist approach and outlines its application in empirical evaluation studies and literature syntheses. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Results: A total of 66 schoolchildren (65.3%) had participated. Review methods 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. However, this shifting of the temporal frame for evaluation is in itself no guarantee of success. An analytical framework, derived from a realist synthesis of 13 ‘mechanisms’ (processes) of interprofessional teamwork, was used to identify positive and negative ‘indicators’ of teamwork. A rural primary care setting in Scotland. Consultations with community-based service providers in Toronto identified a lack of strong research evidence about successful community-based interventions that address the needs of homeless clients experiencing concurrent mental health and substance use disorders.
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