The Utility of a Realist Evaluation Approach in Implementing and Evaluating Health Equity Policy

2014 ◽  
Vol 29 (2) ◽  
pp. 87
Author(s):  
Sanjeev Sridharan ◽  
Tim Warren
Keyword(s):  
Health Equity ◽  
Realist Evaluation ◽  
Evaluation Approach ◽  
Equity Policy

scholarly journals Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol

2019 ◽  
Vol 4 ◽  
pp. 202 ◽  
Author(s):  
Prashanth Nuggehalli Srinivas ◽  
Tanya Seshadri ◽  
Nandini Velho ◽  
Giridhara R Babu ◽  
C Madegowda ◽  
...  
Keyword(s):  
Health Equity ◽  
Population Level ◽  
Realist Evaluation ◽  
Theoretical Explanation ◽  
Evaluation Approach ◽  
Systems Research ◽  
Tribal Health ◽  
Transformative Action ◽  
Tribal Populations ◽  
The Individual

Background: In India, heterogenous tribal populations are grouped together under a common category, Scheduled Tribe, for affirmative action. Many tribal communities are closely associated with forests and difficult-to-reach areas and have worse-off health and nutrition indicators. However, poor population health outcomes cannot be explained by geography alone. Social determinants of health, especially various social disadvantages, compound the problem of access and utilisation of health services and undermine their health and nutritional status. The Towards Health Equity and Transformative Action on tribal health (THETA) study has three objectives: (1) describe and analyse extent and patterns of health inequalities, (2) generate theoretical explanations, and (3) pilot an intervention to validate the explanation.     Methods: For objective 1, we will conduct household surveys in seven forest areas covering 2722 households in five states across India, along a gradient of socio-geographic disadvantage. For objective 2, we will purposefully select case studies illustrating processes through which socio-geographic disadvantages act at the individual, household/neighbourhood, village or population level, paying careful attention to the interactions across various known axes of inequity. We will use a realist evaluation approach with context-mechanism-outcome configurations generated from the wider literature on tribal health and results of objective 1. For objective 3, we will partner with willing stakeholders to design and pilot an equity-enhancing intervention, drawing on the theoretical explanation generated and evaluate it to further refine our final explanatory theory. Discussion: THETA project seeks to generate site-specific evidence to guide public health policy and programs to better contribute to equitable health in tribal populations. It fulfills the current gap in generating and testing explanatory social theories on the persistent and unfair accumulation of geographical and social disadvantage among tribal populations and finally examines if such approaches could help design equity-enhancing interventions to improve tribal health.

scholarly journals The contribution of realist evaluation to critical analysis of the effectiveness of entrepreneurship education competitions

2018 ◽  
Vol 32 (6) ◽  
pp. 405-417 ◽  
Author(s):  
Catherine Brentnall ◽  
Iván Diego Rodríguez ◽  
Nigel Culkin
Keyword(s):  
Knowledge Production ◽  
Meta Analysis ◽  
Entrepreneurship Education ◽  
Realist Evaluation ◽  
Professional Experience ◽  
Scientific Evaluation ◽  
Randomized Controlled ◽  
Evaluation Approach ◽  
Evidenced Based ◽  
Evaluation Approaches

The purpose of this article is to explore the effectiveness of entrepreneurship education (EE) programmes through the lens of realist evaluation (RE). The interest of the authoring team – a practitioner–academic mix with professional experience including developing EE in primary and secondary schools – lies with EE competitions, a type of intervention recommended for and delivered to students and pupils of all ages. RE is a theory-driven philosophy, methodology and adaptable logic of enquiry with which to conceptualize and analyse such programmes. In this study, we undertake an act of ‘organized scepticism’, as described by evidenced-based policy academic Ray Pawson, to identify and question the declared outcomes of EE competitions in European policy over a 10-year period. However, our contribution goes beyond the application of an evaluation approach, novel to EE. We argue that, while education generally, and EE specifically, appears committed to emulating ‘gold standard’ scientific evaluation approaches (e.g. randomized controlled trials, systematic review and meta-analysis), the field of evidenced-based policymaking has moved on. Now, alternative methodological strategies are being embraced and RE in particular has evolved as an approach which better aligns knowledge production with the reality of complex, socially contingent programmes. By using this approach, we not only establish that education and psychology theories challenge the outcomes of EE competitions declared in policy, but also demonstrate the wider relevance of RE to the appraisal and refinement of the theorizing and practice of entrepreneurship programmes and interventions.

scholarly journals A systematic approach to equity assessment for digital health interventions: case example of mobile personal health records

2019 ◽  
Vol 26 (8-9) ◽  
pp. 884-890 ◽  
Author(s):  
Martin C Were ◽  
Chaitali Sinha ◽  
Caricia Catalani
Keyword(s):  
Health Equity ◽  
Systematic Approach ◽  
Digital Health ◽  
Personal Health Record ◽  
Health Interventions ◽  
Personal Health ◽  
Term Care ◽  
Middle Income ◽  
Evaluation Approach ◽  
Assessment Approach

Abstract Despite the increasing number of digital health interventions in low- and middle-income countries and other low-resource settings, little attention has been paid to systematically evaluating impacts of these interventions on health equity. In this article, we present a systematic approach for assessing equity impacts of digital health interventions modeled after the Health Equity Impact Assessment of the Ontario Ministry of Health and Long-Term Care. The assessment approach has 4 steps that address (1) scope, (2) potential equity impacts, (3) mitigation, (4) monitoring, and (5) dissemination strategies. The approach examines impacts on vulnerable and marginalized populations and considers various social determinants of health. Equity principles outlined by Whitehead and Dahlgren are used to ensure systematic considerations of all potential equity impacts. The digital health evaluation approach that is presented is applied to a case example of mobile personal health record application in Kenya.

scholarly journals Youth Access to Cigarettes Across Seven European Countries: A Mixed-Methods Study

2019 ◽  
Vol 22 (11) ◽  
pp. 1989-1996 ◽  
Author(s):  
Paulien A W Nuyts ◽  
Rebecca M F Hewer ◽  
Mirte A G Kuipers ◽  
Vincent Lorant ◽  
Adeline Grard ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Young People ◽  
Realist Evaluation ◽  
Mixed Methods Study ◽  
European Countries ◽  
Programme Theory ◽  
Vending Machines ◽  
Evaluation Approach ◽  
Policy Interventions ◽  
Minimum Age

Abstract Background Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts. Methods A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14–19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions. Results While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale. Conclusions Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people’s access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement. Implications Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people’s access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms—for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale.

scholarly journals Policymakers and institutional structures affecting health inequality in Ethiopia: a Qualitative Study

2020 ◽  
Author(s):  
Kassa Mohammed Abbe ◽  
Bethabile L Dolamo
Keyword(s):  
Health Policy ◽  
Interest Groups ◽  
Health Equity ◽  
Rural Areas ◽  
Structured Interviews ◽  
Policy Documents ◽  
Level Of Knowledge ◽  
Institutional Relations ◽  
Equity Policy ◽  
The Right

Abstract Background : Ethiopia generally provides a story of progress in child health, but unevenly distributed. The attitude, knowledge, political drives, interest groups and institutional dynamics in health equity policy setting and execution has not been explored in Ethiopia. Without addressing these issues, the right kind of policy choice and implementation cannot be attained. Methods : This study was conducted between 2015 and 2017 in Ethiopia. The study utilized a qualitative framework, grounded in social determinants for health and health policy. Semi-structured interviews; executed policy analysis; and reviewed the literature. In-depth interviews were conducted among twenty-one policymakers and reviewed 23 policy documents and over 350 literatures, Transcribed data, policy extracts and articles were synthesised and analysed by ATLAS.ti 7.1.4. Results: Ethiopia is in an early state of recognizing and intervening against health inequalities. The quality and level of knowledge is mixed and gets reduced as one goes to the rural areas. Consensus is slowly developing on the major underlying causes of inequality. The contents of health policy documents are neither comprehensive nor strongly supported by evidence. There are multiple interest groups with varying level of knowledge and power. Complex political and institutional relations affect policy making process negatively. Participants demonstrated denialism; blaming of victims; misconceptions; and one size fits all attitudes. Conclusions : Any future work for improving health equity needs to be build more on evidence and embrace more participatory processes to address all types of interest groups.

scholarly journals Facebook as a Medium for the Support and Enhancement of Ambulatory Care for People With Diabetes: Qualitative Realist Evaluation of a Real-World Trial

JMIR Diabetes ◽  
10.2196/18146 ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. e18146
Author(s):  
Bryan Cleal ◽  
Ingrid Willaing ◽  
Mette T Hoybye ◽  
Henrik H Thomsen
Keyword(s):  
Social Media ◽  
Data Gathering ◽  
Realist Evaluation ◽  
Program Theory ◽  
Primary Data ◽  
Provider Communication ◽  
New Developments ◽  
Evaluation Approach ◽  
Diabetes Technology ◽  
Patient Provider Communication

Background There is a growing focus on the potential uses, benefits, and limitations of social media in the context of health care communication. In this study, we have sought to evaluate an initiative pioneered at a hospital in Denmark that uses Facebook to support and enhance patient-provider communication about diabetes. Objective This paper aims to evaluate the success of the trial according to its initial objectives and to assess its potential scalability. Methods The study was undertaken in a clinic for diabetes and hormonal diseases at a large regional hospital in Denmark. Using a realist evaluation approach, we identified 4 key components in the program theory of the initiative, which we formulated as context-mechanism-outcome configurations (eg, complex and iterative chains of causality). These configurations informed data gathering and analysis. Primary data sources were the activity and content in the Facebook group, in the form of posts, likes, and comments, and interviews with patients (n=26) and staff (n=6) at the clinic. Results New developments in diabetes technology were the most popular posts in the forum, judged by number of likes and comments. Otherwise, information specific to the clinic received the most attention. All 4 components of the program theory were compromised to varying degrees, either as a result of failings in the anticipated mechanisms of change or contextual factors derived from the mode of implementation. Conclusions Social media serves well as a conduit for imagining positive change, but this can be a strength and weakness when attempting to enact change via concrete interventions, where stakeholder expectations may be unreasonably high or incompatible. Nonetheless, such initiatives may possess intangible benefits difficult to measure in terms of cost-effectiveness.

scholarly journals Team interventions in acute hospital contexts: protocol for the evaluation of an initial programme theory using realist methods

2021 ◽  
Vol 4 ◽  
pp. 32
Author(s):  
Una Cunningham ◽  
Aoife De Brún ◽  
Mayumi Willgerodt ◽  
Erin Blakeney ◽  
Eilish McAuliffe
Keyword(s):  
Secondary Analysis ◽  
Realist Evaluation ◽  
Acute Hospital ◽  
Healthcare Team ◽  
Programme Theory ◽  
Evaluation Approach ◽  
Middle Range ◽  
Team Interventions ◽  
Structured Approach

Introduction: Literature on multi-disciplinary healthcare team interventions to improve quality and safety of care in acute hospital contexts tends to focus on evaluating the success of the intervention by assessing patient outcomes. In contrast, there is little focus on the team who delivered the intervention, how the team worked to deliver the intervention or the context in which it was delivered. In practice, there is therefore a poor understanding of why some interventions work and are sustained and why others fail. There is little emphasis in the literature on how the team delivering the intervention might impact success or failure. Given that team is the vehicle through which these interventions are introduced, it is important to understand interventions from their perspectives. This research seeks to deepen understanding of enablers and barriers for effective team interventions. Using two case studies, we will evaluate previously developed initial programme theories to understand, what worked for whom, in what conditions, why, to what extent and how? Methods and analysis: A realist evaluation approach will be employed to test the previously formed set of initial programme theories. Two multi-disciplinary acute hospital team interventions in two different geographical and organisational contexts will be identified. In case study 1, a theory based approach to interviewing will be used. In case study 2, interview transcripts obtained using a semi- structured approach for primary research purposes will undergo secondary analysis. This will enable a more sensitive look at patterns and variations in patterns of multi-disciplinary team interventions. Researchers will first iteratively interrogate each respective dataset to identify the characteristics or resources present within the specific context that influenced how the team intervention worked to produce particular outcomes. Data will then be synthesised across contexts in order to produce middle range theories and thereby more generalisable insights.

scholarly journals Schools’ engagement with the Get Set London 2012 Olympic education programme: Empirical insights from schools in a non-hosting region

2017 ◽  
Vol 25 (1) ◽  
pp. 254-272 ◽  
Author(s):  
Shushu Chen ◽  
Ian Henry
Keyword(s):  
Education Programme ◽  
Realist Evaluation ◽  
Programme Implementation ◽  
Programme Theory ◽  
Local Schools ◽  
Evaluation Approach ◽  
London 2012 ◽  
Individual School ◽  
Olympic Education ◽  
The Government

During the Olympiad, an Olympic host country is required to organise and deliver an education programme to schools nationwide. Schools’ experiences of engagement with such programmes are often reported on by the government rather than being rigorously examined by academics. Moreover, there is little scientific understanding of how individual schools facilitate the programmes and why different schools engage with the same programme in different ways and to varying degrees, and generate different levels of impact. Looking at the London 2012 Olympic education programme called Get Set, this original qualitative research was undertaken to explore local schools’ experiences of involvement with the programme in a non-hosting region, Leicestershire. The paper advocates the use of programme-theory-driven evaluations (in particular a realist evaluation approach) to assess programme implementation. The results provide explanations of how and why case study schools engage more effectively or less effectively with the programme. The results identify the missing links in the programme theory, highlighting the significance of contextual factors at individual school levels, and arguing for the adoption of tailored strategies for effective programme implementation.

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