In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders' belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders' belief-motive explanations ('we believe the program works') in realist evaluation is clarified and discussed.
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http://dx.doi.org/10.1016/j.evalprogplan.2020.101800 | DOI Listing |
PLoS One
January 2025
Department for Educational Development, Aga Khan University, Karachi, Pakistan.
Background & Objectives: The context, mechanism, and outcome (CMO) framework is meant to identify specific contextual factors (C) related to organizational and program structure that trigger certain mechanisms (M) involving the unique characteristics of a program, leading to specific outcomes (O). The purpose of this study was to explore the contextual underpinnings, operational processes, and resultant effects of the faculty mentorship program at AKU-SONAM. This exploration involved the context in terms of organizational culture, mechanisms examining processes such as communication between mentors and mentees, quality of relationships, the challenges encountered, and the program's adaptability to cope up while, outcomes encompassed improvements in interpersonal relationships, career advancement, and skill development.
View Article and Find Full Text PDFPain
January 2025
Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia Adelaide, SA, Australia.
Guideline-based care for chronic pain is challenging to deliver in rural settings. Evaluations of programs that increase access to pain care services in rural areas report variable outcomes. We conducted a realist review to gain a deep understanding of how and why such programs may, or may not, work.
View Article and Find Full Text PDFBMC Med
January 2025
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Background: In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce.
View Article and Find Full Text PDFGlob Health Promot
January 2025
Formerly with Georgetown University, Medical Center Research Development Unit, Washington, DC, USA.
Social norms, the informal rules that influence behavior, play essential roles in shaping people's behavior. Community-based norms-shifting interventions (NSIs) identify gender and other social norms linked to unhealthy behaviors and implement activities to promote collective change by encouraging communities to reflect on and question these norms. Though NSIs are gaining international traction in social and behavior change programming for health promotion, how change occurs needs to be clearly understood in African and other contexts.
View Article and Find Full Text PDFArch Public Health
January 2025
Section of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Background: Breastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. A Danish intervention included a home visit by a health visitor during pregnancy to prolong breastfeeding and reduce social inequality in its rates.
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