���}�Ҷ�lU�~������n6�K���� Interviews with management team members and operational staff combined with quantitative data analysis allowed us to identify two distinct sets of practices according to their key mechanism: The first CMO can be summarised as follows: a hospital management team can attain higher organisational commitment if their management practices act upon economic exchange and social exchange. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data. ��D�@�������H �b���@M��a����ן-,І��OصP�3����R�y��Oȋm1�]JW?YY��cB(���W�jf]��TA� 0000008200 00000 n Evans and Killoran present the evaluation of a Health Education Authority’s Integrated Purchasing Programme and specifically of demonstration projects testing partnerships to tackle health inequalities. & Leeuw, F. (2010). 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. 0000008175 00000 n It describes five key ideas which frame realism and their implications for impact evaluation. Realist evaluation researchers orient their thinking to context-mechanism-outcome (CMO) pattern configurations. CMO configuration (sometimes In order to answer that question, realist evaluators aim to identify the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. Doing “hands-on” exercises in CMO configuring and theory building. Astbury, B. 0000004646 00000 n A realist diagnostic workshop. Evaluation 17: 21-36. Evaluation A range of approaches that engage stakeholders (especially intended beneficiaries) in conducting the evaluation and/or making decisions about the evaluation​. MRTs are specific enough to generate particular propositions to test and general enough to apply across different situations. (2010) present a realist case study of human resource management in Ghana and discuss the main methodological challenges of realist evaluation, Marchal et al. 'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+"://platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs"); Select a content type to filter search results: A special thanks to this page's contributors. Health Soc Care Community 14:375-383. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2006.00650.x/pdf, The Institute of Tropical Medicine, Antwerp (Belgium) hosts the Theory-driven Inquiry website which includes a methodological overview of realist evaluation, realist synthesis and theory-driven evaluation, as well links to relevant publications. 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. I'd like to second everything Alice said! (2012). Usually, both quantitative and qualitative data are collected in a realist evaluation, often with quantitative data being focused on context and outcomes and qualitative data on generative mechanisms. Investigate possible alternative explanations, 1. Once patterns of outcomes are identified, the mechanisms generating those outcomes can be analysed, provided the right kinds of data are available. In essence, “middle range” refers to the degree of abstraction and can refer to programme theory, generative mechanisms, CMOs, formal theories etc. 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 initial programme theory may be based on previous research, knowledge, experience, and the assumptions of the intervention designers about how the intervention will work. Pawson, R. (2013). The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. %PDF-1.5 %���� Tilley and Pawson (1997) developed a model of theory driven evaluation called 'realistic evaluation' that was centred on finding not only what outcomes were produced from interventions but also 'how they are produced, and what is significant about the varying conditions in the which the interventions take place' (Tilley, 2000). The mechanism generating different ‘reasoning’ by mothers and fathers may relate to dominant social norms about the roles and responsibilities of mothers and fathers. Realist evaluations are theory-driven evaluations that seek to understand how complex interventions work, ... (CMO) configuration. The evaluative process involves an iterative cycle of eliciting, testing and refining programme theory, constructed as Context-Mechanism-Outcome (CMO) configurations. In a next round of case studies, we tested the refined programme theory in other hospitals. In addition, we are developing Understanding the philosophical basis of Realist Evaluation (RE). [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … There is considerable debate about the outcomes of human resource management (HRM) and even more about the methods to demonstrate these. Collecting data to test realist programme theories. Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: A critical realist perspective. BMC Health Serv Res 8: 274. The Success Case Method (SCM) involves identifying the most and least successful cases in a program and examining them in detail. For example, a parenting skills programme may have achieved different outcomes for fathers and mothers. The difference between realist and other kinds of programme theory-based evaluation approaches is that a realist programme theory specifies what mechanisms will generate the outcomes and what features of the context will affect whether or not those mechanisms operate. These will then be linked according to the realist evaluation CMO formula in which findings on context and mechanisms will used to explain outcomes observed. Unpacking Black Boxes: Mechanisms and Theory Building in Evaluation. Taking a realist evaluation approach, ‘Context-Mechanism-Outcome’ configurations were used to explore how membership of a public forum might enhance public forum members’ personal development. The programme theory describes how the intervention is expected to lead to its effects and in which conditions it should do so. It explains when a realist impact evaluation may be most Results: Three CMO configurations were identified. Check the results are consistent with causal contribution, 3. Often the case study design is used, whereby case selection is typically purposive, as the cases should enable ‘testing’ of the initial programme theory in all its dimensions. h�b``�d``�����:�A��b�, Bs�30��4,�C�f`8��’zF6r�Ѣ��қ^$���u($�(� ���� a*�D�d�E iI ��+� ���x�ə����0�,�{�F�O���e��1x0��N�gx͞ ��A�!�����A�6��N ���U�ޟ � �w �~0o endstream endobj 38 0 obj <>>> endobj 39 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 40 0 obj <>stream Hypotheses generation † Generate hypotheses based on CMO configurations Rephrase CMO configurations into hypotheses Formulate hypotheses to be tested during stage three 3. The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. The CMO configuration is the main structure for analysis in realist evaluation . A realist evaluation of a safe medication administration education Programme. (2010) analyse how a hospital management team succeeded in reviving an ailing district hospital in Ghana using the realist evaluation approach, Image source: Mobius Transform of a regular circle packing, by fdecomite on Flickr. [ Updated 2018 10 07] A core concept in Realist Evaluation is the CMO configuration. Pawson and Tilley (1997) developed the first realist evaluation approach, although other interpretations have been developed since. Realist evaluation addresses these questions by developing context-mechanism-outcome (CMO) configurations. ww�{U~�iM����;L�l6PL#�JVRI�6���Zh��1� �����I�:@� �C������+6[]I�#���s��ن��6ф�"��PE���J>7���-]�'9��9"���k#U���2sX���������(y(����$�TM7/I�$|�������,!l����(�} i have been finding difficult sourcing for resources with explicit details. 0000003645 00000 n London: Sage. An approach designed to support ongoing learning and adaptation, which identifies the processes required to achieve desired results, and then observes whether those processes take place, and how. Realistic Evaluation. To construct CMOs, the researchers explored the coded data to identify instances where NCA feedback was reported to have been used by providers. Recommend content, collaborate, share, ask, tell us what you like, suggest an improvement, or just say hi! 0000032789 00000 n This study used realist evaluation methodology informed by a realist synthesis . (2010a) and Marchal et al. The content of this field is kept private and will not be shown publicly. Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. évaluation réaliste, santé rurale, santé mondiale, enfants dâge scolaire. 0000002763 00000 n They can be useful in understanding how a program or policy works, in which settings, and for whom. 0000003756 00000 n Their HRM bundles combine employment security, adequate compensation and training. In addition: I am based in Australia and am happy to reply to quick questions on methods and methodology. Critical Public Health 10:125-140. In general, proximal outcomes can be described in three categories: (1) improved staff availability; (2) improved staff attitudes and affects (commitment, job satisfaction) and (3) better staff behaviour (higher task performance and organisational citizenship behavior, lower absenteeism). (2000). A realist evaluation research starts from a middle range theory (MRT), which is understood as " theor [y] that lie [s] between the minor but necessary working hypotheses (...) and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change" [ 52] p. 39). REALIST . You can contact me at gill@communitymatters.com.au if you want to discuss this further. 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. For example, 'Randomized Controlled Trials' (RCTs) use a combination of the options random sampling, control group and standardised indicators and measures. A few potential CMO configurations will then be proposed and discussed (for validation purposes) through 2–3 focus group discussions comprising of 8–10 different stakeholders each. Marchal, B., Van Belle, S., Van Olmen, J., Hoerée, T. & Kegels, G. 2012. 0000093179 00000 n 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). An impact evaluation approach that compares results between a randomly assigned control group and experimental group or groups to produce an estimate of the mean net impact of an intervention. (2007). , and outlines how to design and conduct an impact evaluation based on a realist approach. An approach to decision-making in evaluation that involves identifying the primary intended users and uses of an evaluation and then making all decisions in terms of the evaluation design and plan with reference to these. Because the realist analysis uses mainly intra-programme comparisons (i.e., comparisons across different groups involved in the same programme) to test the initial theory, a realist evaluation design does not need to construct comparison groups. 0000069036 00000 n An participatory approach to value-for-money evaluation that identifies a broad range of social outcomes, not only the direct outcomes for the intended beneficiaries of an intervention. Various ways of doing evaluation in ways that support democratic decision making, accountability and/or capacity. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. Pawson and Tilley argued that in order to be useful for decision makers, evaluations need to identify ‘what works in which circumstances and for whom?’, rather than merely ‘does it work?. The second CMO configuration can be summarised as ‘keeping up standards of excellence through organisational culture’. 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. The contexts in which particular mechanisms did or did not ‘fire’ can then be determined. In a realist evaluation, the CMO configuration is used in different ways. http://www.itg.be/tdi, The RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) project which includes methodological guidance, publication standards and training resources. Rather, the refined programme theory will be tested subsequently in a different context in a next study. 0000069133 00000 n An impact evaluation approach without a control group that uses narrative causal statements elicited directly from intended project beneficiaries. Hence, we refer to the middle range theory (MRT) rather than the programme theory. It is a useful approach to document stories of impact and to develop an understanding of the factors that enhance or impede impact. A particular type of case study used  to create a narrative of how institutional arrangements have evolved over time and have created and contributed to more effective ways to achieve project or program goals. Approach primarily intended to clarify differences in values among stakeholders by collecting and collectively analysing personal accounts of change. A CMO configuration is a proposition stating what it is about an IS initiative which works for whom in what circumstances. An approach designed to support ongoing learning and adaptation, through iterative, embedded evaluation. ��=칃�)��Q�i�'�G� ��mצ?�IM��̳�GY�"�� 더⪝�E����>Z#����b��Mj[@��������$�3&�dg�.~=��:���V b���y&y��jE���(:0-6�Ϟm6}LꄽL�. Manzano-Santaella, A. (2008) applied realist evaluation principles to evaluate a mental health programme in the NHS. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. There are hundreds of members and they are very good about providing advice and support. 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 . Because of this, realist evaluations are appreciated by implementers and decision-makers who seek to understand how a program or policy works, and in which circumstances, when designing or funding programs. In a series of case studies of regional and district hospitals in Ghana, we assessed the role of hospital management practices on organisational performance. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ The evaluation of health and social care partnerships: an analysis of approaches and synthesis for the future. The last phase of the analysis consists of determining which CMO configuration(s) offers the most robust and plausible explanation of the observed pattern of outcomes. We formulated the initial MRT as follows: “Hospital managers of well-performing hospitals deploy organisational structures that allow decentralisation and self-managed teams and stimulate delegation of decision-making, good flows of information and transparency. Realist data analysis is driven by the principles of realism: realist evaluation explains change brought about by an intervention by referring to the actors who act and change (or not) a situation under specific conditions and under the influence of external events (including the intervention itself). It can be used to frame evaluation questions; to predict outcomes in different circumstances (and thus to select outcome indicators to look for), and as a framework for analysis. A stakeholder involvement approach designed to provide groups with the tools and knowledge they need to monitor and evaluate their own performance and accomplish their goals. Tackling health inequalities through partnership working: learning from a realist evaluation. Define ethical and quality evaluation standards, Document management processes and agreements, Develop planning documents for the evaluation or M&E system, Develop programme theory / theory of change, activities, outcomes, impacts and context, Combine qualitative and quantitative data, Check the results are consistent with causal contribution, Investigate possible alternative explanations, Sustained and emerging impacts evaluation (SEIE), Technology and evaluation in insecure settings, Evaluation practice in Aboriginal and Torres Straight Islander settings. Evaluation 18:176-191. http://dx.doi.org/10.1177/1356389012440912. Leone, L. (2008).Realistic evaluation of an illicit drug deterrence programme. Develop programme theory/theory of change, 5. Through developing and testing CMO configurations, realist evaluation demonstrates causality by providing an explanation of how and why a programme works. 0000008596 00000 n Realist evaluations are based on an assumption that projects and programmes work under certain conditions and are influenced by the way that different stakeholders respond to them. I suggest reviewing the international standards for realist review, which are available at www.ramesesproject.org. 0000001684 00000 n Realist evaluations attempt to answer questions such as what works, for whom, in which circumstances, and why. 0000003279 00000 n Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Consultant. Recommended reading on the philosophical background and the general development of this approach: Pawson, R. & Tilley, N. (1997). Evaluating complex public health interventions: theory, methods and scope of realist enquiry. These configurations or explanatory pathways describe how various contexts (C) work with underlying mechanisms (M) to produce particular outcomes (O). A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis. A particular type of case study used to jointly develop an agreed narrative of how an innovation was developed, including key contributors and processes, to inform future innovation efforts. POS refers to the perception of operational staff that they are effectively supported and recognised by the organisation. (2011). Allow sufficient time for assessing the interactions between intervention, actors and context. We present an example of a realist study of existing practices within the health care system in Ghana; it is not an evaluation of an intervention per se. (2010b). please can someone help me with difference and similarities between Realist Evaluation and Utilization Focused Evaluation. CMO stands for Context, Mechanism, Outcome. Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation. I heartily endorse Alice's suggestion of joining the Rameses discussion list. Larger scale or more complicated realist evaluations are ideally carried out by interdisciplinary teams as this usually allows for a braoder consideration of likely mechanisms. Easy Ice Cream Maker Recipes, Ge Dryer Model Number Lookup, Terminator Font Adobe, Woods Black Ops Voice Actor, Mold Resistant Paint Exterior, And I Want You To Know Baby Lyrics, Edible Basil Seeds, Duval County Texas Recorder Of Deeds, Cleveland Ohio Weather Forecast, Salter Ultimate Accuracy Kitchen Scales, Apache Words For Animals, " /> ���}�Ҷ�lU�~������n6�K���� Interviews with management team members and operational staff combined with quantitative data analysis allowed us to identify two distinct sets of practices according to their key mechanism: The first CMO can be summarised as follows: a hospital management team can attain higher organisational commitment if their management practices act upon economic exchange and social exchange. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data. ��D�@�������H �b���@M��a����ן-,І��OصP�3����R�y��Oȋm1�]JW?YY��cB(���W�jf]��TA� 0000008200 00000 n Evans and Killoran present the evaluation of a Health Education Authority’s Integrated Purchasing Programme and specifically of demonstration projects testing partnerships to tackle health inequalities. & Leeuw, F. (2010). 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. 0000008175 00000 n It describes five key ideas which frame realism and their implications for impact evaluation. Realist evaluation researchers orient their thinking to context-mechanism-outcome (CMO) pattern configurations. CMO configuration (sometimes In order to answer that question, realist evaluators aim to identify the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. Doing “hands-on” exercises in CMO configuring and theory building. Astbury, B. 0000004646 00000 n A realist diagnostic workshop. Evaluation 17: 21-36. Evaluation A range of approaches that engage stakeholders (especially intended beneficiaries) in conducting the evaluation and/or making decisions about the evaluation​. MRTs are specific enough to generate particular propositions to test and general enough to apply across different situations. (2010) present a realist case study of human resource management in Ghana and discuss the main methodological challenges of realist evaluation, Marchal et al. 'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+"://platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs"); Select a content type to filter search results: A special thanks to this page's contributors. Health Soc Care Community 14:375-383. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2006.00650.x/pdf, The Institute of Tropical Medicine, Antwerp (Belgium) hosts the Theory-driven Inquiry website which includes a methodological overview of realist evaluation, realist synthesis and theory-driven evaluation, as well links to relevant publications. 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. I'd like to second everything Alice said! (2012). Usually, both quantitative and qualitative data are collected in a realist evaluation, often with quantitative data being focused on context and outcomes and qualitative data on generative mechanisms. Investigate possible alternative explanations, 1. Once patterns of outcomes are identified, the mechanisms generating those outcomes can be analysed, provided the right kinds of data are available. In essence, “middle range” refers to the degree of abstraction and can refer to programme theory, generative mechanisms, CMOs, formal theories etc. 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 initial programme theory may be based on previous research, knowledge, experience, and the assumptions of the intervention designers about how the intervention will work. Pawson, R. (2013). The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. %PDF-1.5 %���� Tilley and Pawson (1997) developed a model of theory driven evaluation called 'realistic evaluation' that was centred on finding not only what outcomes were produced from interventions but also 'how they are produced, and what is significant about the varying conditions in the which the interventions take place' (Tilley, 2000). The mechanism generating different ‘reasoning’ by mothers and fathers may relate to dominant social norms about the roles and responsibilities of mothers and fathers. Realist evaluations are theory-driven evaluations that seek to understand how complex interventions work, ... (CMO) configuration. The evaluative process involves an iterative cycle of eliciting, testing and refining programme theory, constructed as Context-Mechanism-Outcome (CMO) configurations. In a next round of case studies, we tested the refined programme theory in other hospitals. In addition, we are developing Understanding the philosophical basis of Realist Evaluation (RE). [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … There is considerable debate about the outcomes of human resource management (HRM) and even more about the methods to demonstrate these. Collecting data to test realist programme theories. Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: A critical realist perspective. BMC Health Serv Res 8: 274. The Success Case Method (SCM) involves identifying the most and least successful cases in a program and examining them in detail. For example, a parenting skills programme may have achieved different outcomes for fathers and mothers. The difference between realist and other kinds of programme theory-based evaluation approaches is that a realist programme theory specifies what mechanisms will generate the outcomes and what features of the context will affect whether or not those mechanisms operate. These will then be linked according to the realist evaluation CMO formula in which findings on context and mechanisms will used to explain outcomes observed. Unpacking Black Boxes: Mechanisms and Theory Building in Evaluation. Taking a realist evaluation approach, ‘Context-Mechanism-Outcome’ configurations were used to explore how membership of a public forum might enhance public forum members’ personal development. The programme theory describes how the intervention is expected to lead to its effects and in which conditions it should do so. It explains when a realist impact evaluation may be most Results: Three CMO configurations were identified. Check the results are consistent with causal contribution, 3. Often the case study design is used, whereby case selection is typically purposive, as the cases should enable ‘testing’ of the initial programme theory in all its dimensions. h�b``�d``�����:�A��b�, Bs�30��4,�C�f`8��’zF6r�Ѣ��қ^$���u($�(� ���� a*�D�d�E iI ��+� ���x�ə����0�,�{�F�O���e��1x0��N�gx͞ ��A�!�����A�6��N ���U�ޟ � �w �~0o endstream endobj 38 0 obj <>>> endobj 39 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 40 0 obj <>stream Hypotheses generation † Generate hypotheses based on CMO configurations Rephrase CMO configurations into hypotheses Formulate hypotheses to be tested during stage three 3. The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. The CMO configuration is the main structure for analysis in realist evaluation . A realist evaluation of a safe medication administration education Programme. (2010) analyse how a hospital management team succeeded in reviving an ailing district hospital in Ghana using the realist evaluation approach, Image source: Mobius Transform of a regular circle packing, by fdecomite on Flickr. [ Updated 2018 10 07] A core concept in Realist Evaluation is the CMO configuration. Pawson and Tilley (1997) developed the first realist evaluation approach, although other interpretations have been developed since. Realist evaluation addresses these questions by developing context-mechanism-outcome (CMO) configurations. ww�{U~�iM����;L�l6PL#�JVRI�6���Zh��1� �����I�:@� �C������+6[]I�#���s��ن��6ф�"��PE���J>7���-]�'9��9"���k#U���2sX���������(y(����$�TM7/I�$|�������,!l����(�} i have been finding difficult sourcing for resources with explicit details. 0000003645 00000 n London: Sage. An approach designed to support ongoing learning and adaptation, which identifies the processes required to achieve desired results, and then observes whether those processes take place, and how. Realistic Evaluation. To construct CMOs, the researchers explored the coded data to identify instances where NCA feedback was reported to have been used by providers. Recommend content, collaborate, share, ask, tell us what you like, suggest an improvement, or just say hi! 0000032789 00000 n This study used realist evaluation methodology informed by a realist synthesis . (2010a) and Marchal et al. The content of this field is kept private and will not be shown publicly. Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. évaluation réaliste, santé rurale, santé mondiale, enfants dâge scolaire. 0000002763 00000 n They can be useful in understanding how a program or policy works, in which settings, and for whom. 0000003756 00000 n Their HRM bundles combine employment security, adequate compensation and training. In addition: I am based in Australia and am happy to reply to quick questions on methods and methodology. Critical Public Health 10:125-140. In general, proximal outcomes can be described in three categories: (1) improved staff availability; (2) improved staff attitudes and affects (commitment, job satisfaction) and (3) better staff behaviour (higher task performance and organisational citizenship behavior, lower absenteeism). (2000). A realist evaluation research starts from a middle range theory (MRT), which is understood as " theor [y] that lie [s] between the minor but necessary working hypotheses (...) and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change" [ 52] p. 39). REALIST . You can contact me at gill@communitymatters.com.au if you want to discuss this further. 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. For example, 'Randomized Controlled Trials' (RCTs) use a combination of the options random sampling, control group and standardised indicators and measures. A few potential CMO configurations will then be proposed and discussed (for validation purposes) through 2–3 focus group discussions comprising of 8–10 different stakeholders each. Marchal, B., Van Belle, S., Van Olmen, J., Hoerée, T. & Kegels, G. 2012. 0000093179 00000 n 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). An impact evaluation approach that compares results between a randomly assigned control group and experimental group or groups to produce an estimate of the mean net impact of an intervention. (2007). , and outlines how to design and conduct an impact evaluation based on a realist approach. An approach to decision-making in evaluation that involves identifying the primary intended users and uses of an evaluation and then making all decisions in terms of the evaluation design and plan with reference to these. Because the realist analysis uses mainly intra-programme comparisons (i.e., comparisons across different groups involved in the same programme) to test the initial theory, a realist evaluation design does not need to construct comparison groups. 0000069036 00000 n An participatory approach to value-for-money evaluation that identifies a broad range of social outcomes, not only the direct outcomes for the intended beneficiaries of an intervention. Various ways of doing evaluation in ways that support democratic decision making, accountability and/or capacity. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. Pawson and Tilley argued that in order to be useful for decision makers, evaluations need to identify ‘what works in which circumstances and for whom?’, rather than merely ‘does it work?. The second CMO configuration can be summarised as ‘keeping up standards of excellence through organisational culture’. 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. The contexts in which particular mechanisms did or did not ‘fire’ can then be determined. In a realist evaluation, the CMO configuration is used in different ways. http://www.itg.be/tdi, The RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) project which includes methodological guidance, publication standards and training resources. Rather, the refined programme theory will be tested subsequently in a different context in a next study. 0000069133 00000 n An impact evaluation approach without a control group that uses narrative causal statements elicited directly from intended project beneficiaries. Hence, we refer to the middle range theory (MRT) rather than the programme theory. It is a useful approach to document stories of impact and to develop an understanding of the factors that enhance or impede impact. A particular type of case study used  to create a narrative of how institutional arrangements have evolved over time and have created and contributed to more effective ways to achieve project or program goals. Approach primarily intended to clarify differences in values among stakeholders by collecting and collectively analysing personal accounts of change. A CMO configuration is a proposition stating what it is about an IS initiative which works for whom in what circumstances. An approach designed to support ongoing learning and adaptation, through iterative, embedded evaluation. ��=칃�)��Q�i�'�G� ��mצ?�IM��̳�GY�"�� 더⪝�E����>Z#����b��Mj[@��������$�3&�dg�.~=��:���V b���y&y��jE���(:0-6�Ϟm6}LꄽL�. Manzano-Santaella, A. (2008) applied realist evaluation principles to evaluate a mental health programme in the NHS. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. There are hundreds of members and they are very good about providing advice and support. 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 . Because of this, realist evaluations are appreciated by implementers and decision-makers who seek to understand how a program or policy works, and in which circumstances, when designing or funding programs. In a series of case studies of regional and district hospitals in Ghana, we assessed the role of hospital management practices on organisational performance. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ The evaluation of health and social care partnerships: an analysis of approaches and synthesis for the future. The last phase of the analysis consists of determining which CMO configuration(s) offers the most robust and plausible explanation of the observed pattern of outcomes. We formulated the initial MRT as follows: “Hospital managers of well-performing hospitals deploy organisational structures that allow decentralisation and self-managed teams and stimulate delegation of decision-making, good flows of information and transparency. Realist data analysis is driven by the principles of realism: realist evaluation explains change brought about by an intervention by referring to the actors who act and change (or not) a situation under specific conditions and under the influence of external events (including the intervention itself). It can be used to frame evaluation questions; to predict outcomes in different circumstances (and thus to select outcome indicators to look for), and as a framework for analysis. A stakeholder involvement approach designed to provide groups with the tools and knowledge they need to monitor and evaluate their own performance and accomplish their goals. Tackling health inequalities through partnership working: learning from a realist evaluation. Define ethical and quality evaluation standards, Document management processes and agreements, Develop planning documents for the evaluation or M&E system, Develop programme theory / theory of change, activities, outcomes, impacts and context, Combine qualitative and quantitative data, Check the results are consistent with causal contribution, Investigate possible alternative explanations, Sustained and emerging impacts evaluation (SEIE), Technology and evaluation in insecure settings, Evaluation practice in Aboriginal and Torres Straight Islander settings. Evaluation 18:176-191. http://dx.doi.org/10.1177/1356389012440912. Leone, L. (2008).Realistic evaluation of an illicit drug deterrence programme. Develop programme theory/theory of change, 5. Through developing and testing CMO configurations, realist evaluation demonstrates causality by providing an explanation of how and why a programme works. 0000008596 00000 n Realist evaluations are based on an assumption that projects and programmes work under certain conditions and are influenced by the way that different stakeholders respond to them. I suggest reviewing the international standards for realist review, which are available at www.ramesesproject.org. 0000001684 00000 n Realist evaluations attempt to answer questions such as what works, for whom, in which circumstances, and why. 0000003279 00000 n Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Consultant. Recommended reading on the philosophical background and the general development of this approach: Pawson, R. & Tilley, N. (1997). Evaluating complex public health interventions: theory, methods and scope of realist enquiry. These configurations or explanatory pathways describe how various contexts (C) work with underlying mechanisms (M) to produce particular outcomes (O). A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis. A particular type of case study used to jointly develop an agreed narrative of how an innovation was developed, including key contributors and processes, to inform future innovation efforts. POS refers to the perception of operational staff that they are effectively supported and recognised by the organisation. (2011). Allow sufficient time for assessing the interactions between intervention, actors and context. We present an example of a realist study of existing practices within the health care system in Ghana; it is not an evaluation of an intervention per se. (2010b). please can someone help me with difference and similarities between Realist Evaluation and Utilization Focused Evaluation. CMO stands for Context, Mechanism, Outcome. Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation. I heartily endorse Alice's suggestion of joining the Rameses discussion list. Larger scale or more complicated realist evaluations are ideally carried out by interdisciplinary teams as this usually allows for a braoder consideration of likely mechanisms. Easy Ice Cream Maker Recipes, Ge Dryer Model Number Lookup, Terminator Font Adobe, Woods Black Ops Voice Actor, Mold Resistant Paint Exterior, And I Want You To Know Baby Lyrics, Edible Basil Seeds, Duval County Texas Recorder Of Deeds, Cleveland Ohio Weather Forecast, Salter Ultimate Accuracy Kitchen Scales, Apache Words For Animals, ">

realist evaluation cmo configuration

argue that our attempt to pursue realist evaluation via a randomised trial will be 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. In a recent article in BMC Medicine, Wong and … H��W]s�H}�W�Gi��|5��TR�cg�5�L"���xk For more details, we refer to Marchal et al. 0000002159 00000 n Context matters: firstly, it influences ‘reasoning’ and, secondly, generative mechanisms can only work if the circumstances are right. Byng et al. This in turn could improve ownership and lead to more context-appropriate interventions. A realist evaluation yields information that indicates how the intervention works (i.e., generative mechanism) and the conditions that are needed for a particular mechanism to work (i.e., specification of contexts) and, thus, it is likely to be more useful to policymakers than other types of evaluation. Provide the theoretical basis for the realist evaluation 2. Evaluation,11, 69-93 and Byng, R., Norman, I., Redfern, S. and Jones, R. (2008). ��Z���=�G�Y�����d.�w�;�=������9�*Ϲs��y�\0��xx�02m6O����!����tz8��y�����L��M�x��Ah��Ah��Ah��Ah�� z�&�M؛�7�M`�-��@g�3������@s�9�`4���@s�9�`V�R�R�R�R�R�R�R�R�R�R�R�R�R�R�R�R��e�Q���F�k��Jѕ�+EWʮ])�Rte��Е�o����o����o����o����o�����j�sʂ甞��f��2,���T~ۖ���pSܽ���.�>���}�Ҷ�lU�~������n6�K���� Interviews with management team members and operational staff combined with quantitative data analysis allowed us to identify two distinct sets of practices according to their key mechanism: The first CMO can be summarised as follows: a hospital management team can attain higher organisational commitment if their management practices act upon economic exchange and social exchange. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data. ��D�@�������H �b���@M��a����ן-,І��OصP�3����R�y��Oȋm1�]JW?YY��cB(���W�jf]��TA� 0000008200 00000 n Evans and Killoran present the evaluation of a Health Education Authority’s Integrated Purchasing Programme and specifically of demonstration projects testing partnerships to tackle health inequalities. & Leeuw, F. (2010). 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. 0000008175 00000 n It describes five key ideas which frame realism and their implications for impact evaluation. Realist evaluation researchers orient their thinking to context-mechanism-outcome (CMO) pattern configurations. CMO configuration (sometimes In order to answer that question, realist evaluators aim to identify the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. Doing “hands-on” exercises in CMO configuring and theory building. Astbury, B. 0000004646 00000 n A realist diagnostic workshop. Evaluation 17: 21-36. Evaluation A range of approaches that engage stakeholders (especially intended beneficiaries) in conducting the evaluation and/or making decisions about the evaluation​. MRTs are specific enough to generate particular propositions to test and general enough to apply across different situations. (2010) present a realist case study of human resource management in Ghana and discuss the main methodological challenges of realist evaluation, Marchal et al. 'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+"://platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs"); Select a content type to filter search results: A special thanks to this page's contributors. Health Soc Care Community 14:375-383. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2006.00650.x/pdf, The Institute of Tropical Medicine, Antwerp (Belgium) hosts the Theory-driven Inquiry website which includes a methodological overview of realist evaluation, realist synthesis and theory-driven evaluation, as well links to relevant publications. 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. I'd like to second everything Alice said! (2012). Usually, both quantitative and qualitative data are collected in a realist evaluation, often with quantitative data being focused on context and outcomes and qualitative data on generative mechanisms. Investigate possible alternative explanations, 1. Once patterns of outcomes are identified, the mechanisms generating those outcomes can be analysed, provided the right kinds of data are available. In essence, “middle range” refers to the degree of abstraction and can refer to programme theory, generative mechanisms, CMOs, formal theories etc. 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 initial programme theory may be based on previous research, knowledge, experience, and the assumptions of the intervention designers about how the intervention will work. Pawson, R. (2013). The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. %PDF-1.5 %���� Tilley and Pawson (1997) developed a model of theory driven evaluation called 'realistic evaluation' that was centred on finding not only what outcomes were produced from interventions but also 'how they are produced, and what is significant about the varying conditions in the which the interventions take place' (Tilley, 2000). The mechanism generating different ‘reasoning’ by mothers and fathers may relate to dominant social norms about the roles and responsibilities of mothers and fathers. Realist evaluations are theory-driven evaluations that seek to understand how complex interventions work, ... (CMO) configuration. The evaluative process involves an iterative cycle of eliciting, testing and refining programme theory, constructed as Context-Mechanism-Outcome (CMO) configurations. In a next round of case studies, we tested the refined programme theory in other hospitals. In addition, we are developing Understanding the philosophical basis of Realist Evaluation (RE). [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … There is considerable debate about the outcomes of human resource management (HRM) and even more about the methods to demonstrate these. Collecting data to test realist programme theories. Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: A critical realist perspective. BMC Health Serv Res 8: 274. The Success Case Method (SCM) involves identifying the most and least successful cases in a program and examining them in detail. For example, a parenting skills programme may have achieved different outcomes for fathers and mothers. The difference between realist and other kinds of programme theory-based evaluation approaches is that a realist programme theory specifies what mechanisms will generate the outcomes and what features of the context will affect whether or not those mechanisms operate. These will then be linked according to the realist evaluation CMO formula in which findings on context and mechanisms will used to explain outcomes observed. Unpacking Black Boxes: Mechanisms and Theory Building in Evaluation. Taking a realist evaluation approach, ‘Context-Mechanism-Outcome’ configurations were used to explore how membership of a public forum might enhance public forum members’ personal development. The programme theory describes how the intervention is expected to lead to its effects and in which conditions it should do so. It explains when a realist impact evaluation may be most Results: Three CMO configurations were identified. Check the results are consistent with causal contribution, 3. Often the case study design is used, whereby case selection is typically purposive, as the cases should enable ‘testing’ of the initial programme theory in all its dimensions. h�b``�d``�����:�A��b�, Bs�30��4,�C�f`8��’zF6r�Ѣ��қ^$���u($�(� ���� a*�D�d�E iI ��+� ���x�ə����0�,�{�F�O���e��1x0��N�gx͞ ��A�!�����A�6��N ���U�ޟ � �w �~0o endstream endobj 38 0 obj <>>> endobj 39 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 40 0 obj <>stream Hypotheses generation † Generate hypotheses based on CMO configurations Rephrase CMO configurations into hypotheses Formulate hypotheses to be tested during stage three 3. The context-mechanism-outcome (CMO) configuration is used as the main structure for realist analysis. The CMO configuration is the main structure for analysis in realist evaluation . A realist evaluation of a safe medication administration education Programme. (2010) analyse how a hospital management team succeeded in reviving an ailing district hospital in Ghana using the realist evaluation approach, Image source: Mobius Transform of a regular circle packing, by fdecomite on Flickr. [ Updated 2018 10 07] A core concept in Realist Evaluation is the CMO configuration. Pawson and Tilley (1997) developed the first realist evaluation approach, although other interpretations have been developed since. Realist evaluation addresses these questions by developing context-mechanism-outcome (CMO) configurations. ww�{U~�iM����;L�l6PL#�JVRI�6���Zh��1� �����I�:@� �C������+6[]I�#���s��ن��6ф�"��PE���J>7���-]�'9��9"���k#U���2sX���������(y(����$�TM7/I�$|�������,!l����(�} i have been finding difficult sourcing for resources with explicit details. 0000003645 00000 n London: Sage. An approach designed to support ongoing learning and adaptation, which identifies the processes required to achieve desired results, and then observes whether those processes take place, and how. Realistic Evaluation. To construct CMOs, the researchers explored the coded data to identify instances where NCA feedback was reported to have been used by providers. Recommend content, collaborate, share, ask, tell us what you like, suggest an improvement, or just say hi! 0000032789 00000 n This study used realist evaluation methodology informed by a realist synthesis . (2010a) and Marchal et al. The content of this field is kept private and will not be shown publicly. Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. Realist evaluation offers a valuable methodology for researchers investigating interventions utilising simulation-based education. évaluation réaliste, santé rurale, santé mondiale, enfants dâge scolaire. 0000002763 00000 n They can be useful in understanding how a program or policy works, in which settings, and for whom. 0000003756 00000 n Their HRM bundles combine employment security, adequate compensation and training. In addition: I am based in Australia and am happy to reply to quick questions on methods and methodology. Critical Public Health 10:125-140. In general, proximal outcomes can be described in three categories: (1) improved staff availability; (2) improved staff attitudes and affects (commitment, job satisfaction) and (3) better staff behaviour (higher task performance and organisational citizenship behavior, lower absenteeism). (2000). A realist evaluation research starts from a middle range theory (MRT), which is understood as " theor [y] that lie [s] between the minor but necessary working hypotheses (...) and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change" [ 52] p. 39). REALIST . You can contact me at gill@communitymatters.com.au if you want to discuss this further. 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. For example, 'Randomized Controlled Trials' (RCTs) use a combination of the options random sampling, control group and standardised indicators and measures. A few potential CMO configurations will then be proposed and discussed (for validation purposes) through 2–3 focus group discussions comprising of 8–10 different stakeholders each. Marchal, B., Van Belle, S., Van Olmen, J., Hoerée, T. & Kegels, G. 2012. 0000093179 00000 n 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). An impact evaluation approach that compares results between a randomly assigned control group and experimental group or groups to produce an estimate of the mean net impact of an intervention. (2007). , and outlines how to design and conduct an impact evaluation based on a realist approach. An approach to decision-making in evaluation that involves identifying the primary intended users and uses of an evaluation and then making all decisions in terms of the evaluation design and plan with reference to these. Because the realist analysis uses mainly intra-programme comparisons (i.e., comparisons across different groups involved in the same programme) to test the initial theory, a realist evaluation design does not need to construct comparison groups. 0000069036 00000 n An participatory approach to value-for-money evaluation that identifies a broad range of social outcomes, not only the direct outcomes for the intended beneficiaries of an intervention. Various ways of doing evaluation in ways that support democratic decision making, accountability and/or capacity. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. Pawson and Tilley argued that in order to be useful for decision makers, evaluations need to identify ‘what works in which circumstances and for whom?’, rather than merely ‘does it work?. The second CMO configuration can be summarised as ‘keeping up standards of excellence through organisational culture’. 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. The contexts in which particular mechanisms did or did not ‘fire’ can then be determined. In a realist evaluation, the CMO configuration is used in different ways. http://www.itg.be/tdi, The RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) project which includes methodological guidance, publication standards and training resources. Rather, the refined programme theory will be tested subsequently in a different context in a next study. 0000069133 00000 n An impact evaluation approach without a control group that uses narrative causal statements elicited directly from intended project beneficiaries. Hence, we refer to the middle range theory (MRT) rather than the programme theory. It is a useful approach to document stories of impact and to develop an understanding of the factors that enhance or impede impact. A particular type of case study used  to create a narrative of how institutional arrangements have evolved over time and have created and contributed to more effective ways to achieve project or program goals. Approach primarily intended to clarify differences in values among stakeholders by collecting and collectively analysing personal accounts of change. A CMO configuration is a proposition stating what it is about an IS initiative which works for whom in what circumstances. An approach designed to support ongoing learning and adaptation, through iterative, embedded evaluation. ��=칃�)��Q�i�'�G� ��mצ?�IM��̳�GY�"�� 더⪝�E����>Z#����b��Mj[@��������$�3&�dg�.~=��:���V b���y&y��jE���(:0-6�Ϟm6}LꄽL�. Manzano-Santaella, A. (2008) applied realist evaluation principles to evaluate a mental health programme in the NHS. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. There are hundreds of members and they are very good about providing advice and support. 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 . Because of this, realist evaluations are appreciated by implementers and decision-makers who seek to understand how a program or policy works, and in which circumstances, when designing or funding programs. In a series of case studies of regional and district hospitals in Ghana, we assessed the role of hospital management practices on organisational performance. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ The evaluation of health and social care partnerships: an analysis of approaches and synthesis for the future. The last phase of the analysis consists of determining which CMO configuration(s) offers the most robust and plausible explanation of the observed pattern of outcomes. We formulated the initial MRT as follows: “Hospital managers of well-performing hospitals deploy organisational structures that allow decentralisation and self-managed teams and stimulate delegation of decision-making, good flows of information and transparency. Realist data analysis is driven by the principles of realism: realist evaluation explains change brought about by an intervention by referring to the actors who act and change (or not) a situation under specific conditions and under the influence of external events (including the intervention itself). It can be used to frame evaluation questions; to predict outcomes in different circumstances (and thus to select outcome indicators to look for), and as a framework for analysis. A stakeholder involvement approach designed to provide groups with the tools and knowledge they need to monitor and evaluate their own performance and accomplish their goals. Tackling health inequalities through partnership working: learning from a realist evaluation. Define ethical and quality evaluation standards, Document management processes and agreements, Develop planning documents for the evaluation or M&E system, Develop programme theory / theory of change, activities, outcomes, impacts and context, Combine qualitative and quantitative data, Check the results are consistent with causal contribution, Investigate possible alternative explanations, Sustained and emerging impacts evaluation (SEIE), Technology and evaluation in insecure settings, Evaluation practice in Aboriginal and Torres Straight Islander settings. Evaluation 18:176-191. http://dx.doi.org/10.1177/1356389012440912. Leone, L. (2008).Realistic evaluation of an illicit drug deterrence programme. Develop programme theory/theory of change, 5. Through developing and testing CMO configurations, realist evaluation demonstrates causality by providing an explanation of how and why a programme works. 0000008596 00000 n Realist evaluations are based on an assumption that projects and programmes work under certain conditions and are influenced by the way that different stakeholders respond to them. I suggest reviewing the international standards for realist review, which are available at www.ramesesproject.org. 0000001684 00000 n Realist evaluations attempt to answer questions such as what works, for whom, in which circumstances, and why. 0000003279 00000 n Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Consultant. Recommended reading on the philosophical background and the general development of this approach: Pawson, R. & Tilley, N. (1997). Evaluating complex public health interventions: theory, methods and scope of realist enquiry. These configurations or explanatory pathways describe how various contexts (C) work with underlying mechanisms (M) to produce particular outcomes (O). A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis. A particular type of case study used to jointly develop an agreed narrative of how an innovation was developed, including key contributors and processes, to inform future innovation efforts. POS refers to the perception of operational staff that they are effectively supported and recognised by the organisation. (2011). Allow sufficient time for assessing the interactions between intervention, actors and context. We present an example of a realist study of existing practices within the health care system in Ghana; it is not an evaluation of an intervention per se. (2010b). please can someone help me with difference and similarities between Realist Evaluation and Utilization Focused Evaluation. CMO stands for Context, Mechanism, Outcome. Realist research uses a mixed methods (qualitative and quantitative) approach to gathering data in order to test the proposed context-mechanism-outcome (CMO) configurations of the intervention under investigation. I heartily endorse Alice's suggestion of joining the Rameses discussion list. Larger scale or more complicated realist evaluations are ideally carried out by interdisciplinary teams as this usually allows for a braoder consideration of likely mechanisms.

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