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0000008596 00000 n Elicit-ing, refining and testing CMO configurations allows a deeper and more detailed understanding of for whom, in what circumstances and why the programme works. In terms of claiming realist review as a method - it most certainly can be claimed, but it's not limited to qualitative data. Building upon the ‘human capital’ within their staff and in a organisational context of relatively good resource availability and well-trained professionals (context), the managers developed a comprehensive set of both ‘hard’ and ‘soft’ management practices that responded to the needs of the staff and enabled them to maintain their professional standards (intervention). Strictly speaking, the term ‘generative mechanism’ refers to the underlying social or psychological drivers that ‘cause’ the reasoning of actors. An approach that focuses on assessing the value of an intervention as perceived by the (intended) beneficiaries, thereby aiming to give voice to their priorities and concerns. The analytic process is not necessarily sequential, but should result in a set of ‘context-mechanism-outcome’ (CMO) statements: “In this context, that particular mechanism fired for these actors, generating those outcomes. Central to realist evaluation is a recognition of the fundamental importance of context in shaping how and why programmes lead to (or fail to lead to) change. Rather, the refined programme theory will be tested subsequently in a different context in a next study. Realist methodology is increasingly used in the evaluation of complex health care interventions, to facilitate a deeper understanding of ‘what works, how, for whom, in what circumstances and to what extent’ [1,2,3,4].The initial step of realist studies aims to identify programme theories underlying the intervention . For more details, we refer to Marchal et al. These configurations or explanatory pathways describe how various contexts (C) work with underlying mechanisms (M) to produce particular outcomes (O). Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Visiting Researcher, School of Public Health, University of the Western Cape, Cape Town (South Africa). Introducing the main constructs employed in RE: program theory, middle-range theory; and context-mechanism-outcome (CMO) configuration. The data on outcomes are disaggregated by sub-groups (which were selected on the basis of the programme theory). (2007). CMO configuration (sometimes (2012). In the first phase of analysis, data are organised in relation to the initial programme theory – that is, whether the data relate to what was done (the intervention activities) or to context, mechanism, outcome and (groups of) actors. 0000069036 00000 n The content of this field is kept private and will not be shown publicly. Realist synthesis is a literature review methodology for understanding how, for whom, and under what circumstances complex interventions function in complex environments. Evaluation Define ethical and quality evaluation standards, 6. In other words, the purpose of a realist evaluation is as much to test and refine the programme theory as it is to determine whether and how the programme worked in a particular setting. [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … Manzano-Santaella, A. Chris Bonell1*, Emily Warren1, Adam Fletcher2 and Russell Viner3 Abstract Background: Van Belle et al. The study started with a case study of a well-performing hospital, where the management style and its effects were assessed on the basis of the initial middle range theory. A strengths-based approach to learning and improvement that involves intended evaluation users in identifying ‘outliers’ – those with exceptionally good outcomes - and understanding how they have achieved these. (2005) and Byng et al. ��v��ӑf�Vm��km�W�@��OS�! That is, whenever a program is implemented, it is testing a theory about what ‘might cause change’, even though that theory may not be explicit. 0000069202 00000 n 0000004399 00000 n i have been finding difficult sourcing for resources with explicit details. Because realist evaluation uses the idea of generative causality (i.e. If the programme theory/MRT is made explicit together with the main actors, it can lead to a better, shared understanding of the intervention. Recommended reading on the philosophical background and the general development of this approach: Pawson, R. & Tilley, N. (1997). Contexts may relate to the sub-groups for whom outcomes were generated and/or to other stakeholders, processes of implementation, organisational, socio-economic, cultural and political conditions. Check the results are consistent with causal contribution, 3.