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Benefits of realist evaluation for rapidly changing health service delivery

Jagosh, Justin; Stott, Hannah; Halls, Serena; Thomas, Rachel; Liddiard, Cathy; Cupples, Margaret; Cramp, Fiona; Kersten, Paula; Foster, Dave; Walsh, Nicola E

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Justin Jagosh

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Dr Hannah Stott
Occasional Associate Lecturer - HAS AHP

Cathy Liddiard

Margaret Cupples

Fiona Cramp
Professor in Long Term Conditions

Paula Kersten

Dave Foster

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Nicola Walsh
Professor in Knowledge Mobilisation & Muscul


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.

Journal Article Type Article
Acceptance Date Jul 5, 2022
Online Publication Date Jul 27, 2022
Publication Date Jul 27, 2022
Deposit Date Jul 29, 2022
Publicly Available Date Jul 29, 2022
Journal BMJ open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 12
Issue 7
Pages e060347
Keywords realist evaluation; health service delivery; health service; health initiatives; FRONTIER study; treatment; FCP services; service delivery
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