Dealing With Complexity
						in a Realist Synthesis : Community Accountability and
							Empowerment Initiatives

Westhorp, G.; Walker, Bill; Rogers, Patricia

doi:10.4135/9781483399935.n20

Cited by 20 publications

(57 citation statements)

References 10 publications

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“…While it is a limitation, realist synthesis is less dependent on the inclusion of complete sets of studies than, for example, traditional systematic reviews 82. So, it may limit the scope of our findings but does not invalidate them.…”

Section: Discussionmentioning

confidence: 87%

“…‘Outcomes’, in realist terminology, can be short, medium and long terms 82. We have added a hierarchy of outcomes to our theoretical model.…”

Section: Resultsmentioning

confidence: 99%

“…So, it may limit the scope of our findings but does not invalidate them. While the backbone of meta-analysis and traditional systematic review is aggregation, realist synthesis refines theories by obtaining a rich (rather than necessarily complete) evidence base of reports of how interventions generate certain pattern of outcome 82. We also consider as a limitation the delay in preparing the review for publication after the end of the search in December 2014.…”

Section: Discussionmentioning

confidence: 99%

“…It is regarded as acceptable in realist synthesis to include part(s) or whole studies for analysis and synthesis, provided that the methods employed for collecting such data are robust 27. As recommended by Pawson,25 the appraisal of primary studies was informed by their relevance as well as their rigour 25.…”

Section: Methodsmentioning

confidence: 99%

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Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

et al. 2016

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ObjectiveTo determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work.DesignRealist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations.ResultsOver half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised.ConclusionsThese findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients’ health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it.

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Section: Discussionmentioning

confidence: 87%

“…‘Outcomes’, in realist terminology, can be short, medium and long terms 82. We have added a hierarchy of outcomes to our theoretical model.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

et al. 2016

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“…A realist synthesis has been selected because it is specifically designed for use in complex systems, such as health markets, and is ideal for investigating questions requiring depth of understanding. 13–15 The study is planned to be undertaken from November 2014 to March 2015.…”

Section: Introductionmentioning

confidence: 99%

Research protocol: a realist synthesis of cross-border patient mobility from low-income and middle-income countries

Durham

Blondell

2014

BMJ Open

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IntroductionPeople are increasingly mobile for numerous reasons, including healthcare. Patient mobility has vast implications for individuals, communities and whole populations and yet, to date, research on patient mobility has been quite limited. Only a small body of evidence exists on patient mobility between low-income and middle-income countries, instead having focused primarily on cross-border movement between high-income and low-income countries. In this paper, we present a protocol for examining this under-studied phenomenon.Methods and analysisWe propose to examine patient mobility between low-income and middle-income countries using a realist synthesis approach. Specifically, we aim to document why patients from low-income and middle-income countries cross international borders for healthcare, by identifying the mechanisms through which patients decide to cross-borders, and the contextual characteristics of domestic health markets that influence this choice. An underlying theory was established, based on the lead author's experience and a brief literature review, which will provide the basis to analyse search results in a subsequent paper. Search results will be obtained from databases (Ovid Medline, EMBASE, Scopus, EconLit, Web of Science) and the grey literature. An expert committee will be enlisted, prior to screening results, to review search results to ensure comprehensiveness. Based on this preliminary theory, we propose that, in some low-income and middle-income country markets, the interaction between demand-side and supply-side determinants results in market imperfections that, in turn, lead to patient movement across borders.Ethics and disseminationThe study does not involve primary research and, therefore, does not require formal ethical approval; we do, however, follow the relevant standards of utility, usefulness, feasibility, propriety, accuracy and accountability. The standards of realist and meta-narrative evidence synthesis (RAMESES) will be adhered to in reporting the findings of the review. Once completed, the findings of the resulting manuscript will be published in a peer-reviewed journal.Trial registration numberThis protocol has been registered with PROSPERO, registration number CRD42014014391.

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From favours to entitlements: community voice and action and health service quality in Zambia

Schaaf

Topp

Ngulube

2017

Health Policy and Planning

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Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collected between November 2013 and January 2014. It included in-depth interviews and focus group discussions with program stakeholders. Secondary data were used iteratively—to inform the process for primary data collection, to guide primary data analysis and to contextualize findings from the primary data. CVA positively impacted the state, society, state–society relations and development coordination at the local level. Specifically, sustained improvements in some aspects of health system responsiveness, empowered citizens, the improved provision of public goods (health services) and increased consensus on development issues appeared to flow from CVA. The central challenge described by interviewees and FGD participants was the inability of CVA to address problems that required central level input. The mechanisms that generated these outcomes included productive state–society communication, enhanced trust, and state–society co-production of priorities and the provision of services. These mechanisms were activated in the context of existing structures for state–society interaction, willing political leaders, buy-in by traditional leaders, and WV’s strong reputation and access to resources. Prospective observational research in multiple contexts would shed more light on the context, mechanisms and outcomes of CVA programs. In addition to findings that are intuitive and well supported in the literature we identified new areas that are promising areas for future research. These include (1) the context of organizational reputation by the organization(s) spearheading social accountability efforts; (2) the potential relationship between social accountability efforts and making ambitious national programs operational at the frontlines of the health system and (3) the feasibility of scale up for certain types of local level responsiveness.

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Dealing With Complexity in a Realist Synthesis : Community Accountability and Empowerment Initiatives

Cited by 20 publications

References 10 publications

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

Research protocol: a realist synthesis of cross-border patient mobility from low-income and middle-income countries

From favours to entitlements: community voice and action and health service quality in Zambia

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