Background: The medical and health sciences were described by Joan Eakin as “a land in which the randomized controlled trial (RCT) is considered the apex of the methodological food chain”. However, integrated care (IC) interventions may in themselves call for the prioritisation of comprehensive, qualitative and multimethod research instead of traditional quantitative, single-method evaluations of program effectiveness. Therefore, rather than focusing only on whether certain IC interventions contribute to better outcomes, it should be explored when, why and how some do, while others do not. This requires a focus on the implementation of an intervention, including which type of intervention was implemented, how the setting in which it was implemented affected its implementation, and which outcomes were achieved.
This idea was formulated most comprehensively by Pawson and Tilley in their Context-Mechanism-Outcomes (CMO) Model and realist evaluation (RE) approach. In short, RE focusses on “what works for whom in which circumstances?” instead of only on “what works?”. While RE is up and coming in health services research and policy, there are still considerable pitfalls and difficulties in the funding, conducting, reporting and publishing of RE research. Moreover, there is still relative ambiguity with regard to what the components the CMO Model actually mean and how the model can be applied to the realities of researching complex interventions. This includes the challenge of breaking down a multifaceted problem in its myriad parts and then to put these parts back into a concise, clear and value-adding narrative in the form of an academic publication.
Aims and Objectives:
Topics to be discussed include the following:
How to conduct case studies using RE;
How to conduct research that transcends case study research to develop theories with more general applicability to health services research;
How to define and operationalise the concepts: context, mechanisms and outcomes;
How to use RE in quantitative, mixed, multi method, and longitudinal research
Using realist methods by practitioners and others in non-scientific settings;
Patient involvement in RE;
Practical experiences with conducting, reporting and publishing RE research.
15 min presentation (LB): introduction to RE and integrated care research
30 min of interactive discussion with workshop attendees (sub-group work depending on attendees’ previous experience with RE)
Target audience: We propose this workshop to discuss and consolidate researchers’, practitioners’ and services users’ experiences with RE in IC research, and thereby provide an educational seminar to those who have not conducted RE as of yet.
Take away: Attendees will receive an introduction to RE as well as an update on the most recent applications of RE methodologies to IC research, including the currently most salient challenges. This workshop is conducted in parallel to a planned Special Issue on Realist Evaluation in the International Journal of Care Coordination to be published in 2018 for which workshop attendees are invited to submit papers. The proposed workshop could serve as an initial step to be extended within the framework of IFIC’s Special Interest Group on Evaluation.