Using realist synthesis to understand the effectiveness and implementation of health programmes
Realist synthesis is an approach to systematic review which explicitly aims to identify and refine programme theory – that is, develop explanations of how and why programmes ‘work’. While realist methods have been successfully used to understand the effectiveness of policies and programmes, to inform intervention design and development, we believe the overall logic of realist explanation can also be used to better understand the implementation and effective delivery of complex health interventions and programmes. After introducing the fundamentals of realist inquiry, and the approach of realist synthesis, we will present our realist synthesis of the implementation of health promotion in schools. As well as presenting and discussing the findings of this synthesis, we will share our reflections on the value, limitations and conduct of realist synthesis; the separability of explanations of ‘effectiveness’ and ‘implementation’; and how such syntheses might better inform process evaluations and implementation science.
Mark Pearson is Senior Research Fellow in Implementation Science at the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula (‘PenCLAHRC’), University of Exeter Medical School. He has conducted realist research investigating the design and conduct of systematic reviews and guideline development at the National Institute for Health & Care Excellence (NICE) (PhD 2008), and (amongst other topics) conducted National Institute for Health Research (NIHR)-funded realist reviews to inform intervention development to improve offenders’ mental health, the design of intermediate care services, and the implementation of health promotion programmes in schools. He contributed to the development of the RAMESES publication standards for Realist Reviews and Realist Evaluation.
Rob Anderson is a health services researcher with a particular interest in the evaluation, economic evaluation and synthesis of evidence about complex health interventions, such as public health programmes and changes in service organisation and delivery. He is Associate Professor of Health Economics and Evaluation, and Director of the ESMI research group (Evidence Synthesis & Modelling for Health Improvement). As part of his interest in the evaluation of complex interventions he has become interested in the use of theory-driven methods of systematic review (in particular ‘realist synthesis’), and has applied these methods to issues of programme implementation, service change and evidence about the resource use and cost-effectiveness of interventions.
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