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Background: Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together.
Methods: Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley's Realist Evaluation or Pawson's Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken.
Results: Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors' reflections on the integration of NPT and Realist approaches were limited.
Conclusions: Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research.
Systematic Review Registration: Not registered.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234627 | PMC |
http://dx.doi.org/10.1186/s43058-021-00172-3 | DOI Listing |
Implement Sci
December 2024
Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
Background: A central goal of implementation science is to generate insights that allow evidence-based practices to be successfully applied across diverse settings. However, challenges often arise in preserving programs' effectiveness outside the context of their intervention development. We propose that qualitative data can inform generalizability via elucidating mechanisms of an intervention.
View Article and Find Full Text PDFN Am Spine Soc J
December 2024
Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Background: Spine surgical training faces increasing challenges due to restricted working hours and greater sub specialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods.
View Article and Find Full Text PDFPublic Health Res (Southampt)
September 2024
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Background: Sex workers' risk of violence and ill-health is shaped by their work environments, community and structural factors, including criminalisation.
Aim: We evaluated the impact of removing police enforcement on sex workers' safety, health and access to services.
Design: Mixed-methods participatory study comprising qualitative research, a prospective cohort study, mathematical modelling and routine data collation.
Disabil Rehabil
December 2024
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Purpose: Chronic pain is prevalent among breast cancer survivors. Bio-psychosocial factors interplay in its exacerbation and maintenance. Therefore, prevention and treatment require an interdisciplinary response and the integration of various approaches.
View Article and Find Full Text PDFHealth Soc Care Deliv Res
December 2024
Centre for Advancement in Realist Evaluation and Synthesis, Vancouver, Canada.
Background: First-contact physiotherapists assess and diagnose patients with musculoskeletal disorders, determining the best course of management without prior general practitioner consultation.
Objectives: The primary aim was to determine the clinical and cost-effectiveness of first-contact physiotherapists compared with general practitioner-led models of care.
Design: Mixed-method realist evaluation of effectiveness and costs, comprising three main phases: A United Kingdom-wide survey of first contact physiotherapists.
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