Grand rounds in methodology: when are realist reviews useful, and what does a ‘good’ realist review look like?

Duddy, Claire; Wong, Geoff

doi:10.1136/bmjqs-2022-015236

Cited by 25 publications

(23 citation statements)

References 30 publications

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“…We used a flexible and adapted realist review approach that considered a wide variety of data sources and focused on contextual factors impacting screening. Indeed, the realist review approach is intended to be flexible, purposeful, contextual, iterative and theoretical and is guided by the question ‘what works for whom in what circumstances and in what respects?’ (Duddy & Wong, 2022; Pawson et al., 2005, p. 32). As such, this approach was used to understand how, when, why, for whom, and by whom FASD screening tools and/or strategies are used, as well as what specific indicators may aid in identifying people with FASD in criminal legal contexts.…”

Section: Methodsmentioning

confidence: 99%

“…As such, this approach was used to understand how, when, why, for whom, and by whom FASD screening tools and/or strategies are used, as well as what specific indicators may aid in identifying people with FASD in criminal legal contexts. As our research focused on multiple tools as well as an array of possible indicators, our approach did not use a context–mechanism–outcome configuration to describe results (Duddy & Wong, 2022). However, our approach does offer a discussion of important contextual factors that could have impacted the validity of screening instruments (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…In the current review, we aimed to synthesise the evidence regarding FASD screening in criminal legal contexts and to develop a conceptual framework for understanding which screening tools, items and/or indicators and characteristics, may be effective in accurately identifying individuals with FASD. A modified realist review approach (Duddy & Wong, 2022; Rycroft‐Malone et al., 2012) was used to delineate the characteristics of FASD screening tools, items, and/or indicators, that may prove to be effective in identifying FASD in criminal legal contexts. In addition, we considered potential implementation factors, with a focus on the populations and settings where screening may take place, points in the adjudicative process where screening may be most needed, and the professionals likely to conduct screening.…”

Section: Introductionmentioning

confidence: 99%

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Screening and identification of fetal alcohol spectrum disorder in criminal legal settings: A realist review

Jewell,

Dunleavy,

Faitakis

et al. 2024

Criminal Behav Ment Health

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BackgroundScreening for fetal alcohol spectrum disorder (FASD) has been identified as a promising approach to improve recognition, understanding and effective response to the unique needs of those with FASD in criminal legal settings. However, to date, there has been limited synthesis of relevant screening tools, indicators, or implementation considerations in this context.AimsThe present review aimed to synthesise evidence and develop a conceptual framework for understanding how, when, why, for whom and by whom FASD screening tools, items and/or indicators and characteristics serve to accurately identify people with FASD in criminal legal contexts, with consideration of individual and system needs relevant to effective implementation and response.MethodsA preregistered search was conducted using a modified realist review framework for both peer‐reviewed articles and grey literature. Included sources were available in English, which focused on individuals with prenatal alcohol exposure and/or FASD with criminal legal involvement and offered new empirical evidence. Sources were reviewed using the Quality Control Tool for Screening Titles and Abstracts by Second Reviewer framework, extracted using a structured coding form and narratively synthesised.ResultsThe search yielded 52 sources, 11 FASD screening tools designed for or applied in criminal legal settings and 38 potential FASD indicators or characteristics relevant to identifying people who may have FASD in criminal legal settings, organised into six conceptually related domains. There was limited evidence supporting the psychometric properties of screening tools across populations or settings, though growing evidence highlights the promise of some instruments. Although few studies characterised potential considerations to be made when implementing a screening tool or approach, both system and individual level needs related to recognising and effectively responding to FASD in criminal legal contexts were identified, and findings revealed strong support among legal and clinical professionals regarding the need for FASD screening in these settings.ConclusionsFindings of this review can be used to inform the development, selection, implementation and evaluation of FASD screening tools in criminal legal settings and underscore a continued need for enhanced resources, policy and cross‐sectoral response to better support the needs of people with FASD in the criminal legal contexts.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening and identification of fetal alcohol spectrum disorder in criminal legal settings: A realist review

Jewell,

Dunleavy,

Faitakis

et al. 2024

Criminal Behav Ment Health

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“…Realist approaches are grounded in the assumption that the same intervention will not work everywhere and for everyone 30. A realist review is a theory-driven interpretive type of literature review.…”

Section: Methodsmentioning

confidence: 99%

Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review

Hammond,

Mickleburgh,

Duddy

et al. 2023

BMJ Open

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ObjectivesLife Story Work (LSW) is used to promote the mental health and well-being of children and adolescents living in out-of-home care. LSW should be offered to all but is conventionally delivered in high-intensity ways. Low-intensity approaches are more accessible but there is significant variation and little guidance for supporting adolescents. We aimed to create guidance for Adolescent-Focused Low-Intensity LSW.DesignRealist review.Data sourcesMEDLINE, Embase, PsycINFO, Sociology Collection (ProQuest), CINAHL, CDAS, Web of Science (SCIE, SSCI), Social Care Online and grey literature sources. Searches were performed between December 2021 and March 2022.Eligibility criteriaDocuments on children and adolescents in care, LSW and/or low-intensity interventions to improve mental health were included. Documents focusing on parenting style and contact with birth family were excluded.AnalysisDocuments were analysed using a realist logic of analysis. In consultation with Content Expert Groups (comprising professionals and care leavers), we developed an initial programme theory. Data relating to and challenging the initial programme theory were extracted and context-mechanism-outcome-configurations developed, critiqued and refined in an iterative fashion. Interpretations were drawn from context-mechanism-outcome-configurations to enhance the programme theory.Results75 documents contributed to the analysis. Generally, studies were small-scale and lacked in-depth methods and evaluation descriptions. Findings indicated important factors contribute to the development of high-quality Adolescent-Focused Low-Intensity LSW. Adolescent-Focused Low-Intensity LSW should be person-centred, begin in the now, involve co-construction, record everyday positive life events and be supported by trained carer(s). Context-mechanism-outcome-configurations relating to these themes are reported.ConclusionsUsing this knowledge we developed initial practice guidance to support social care to deliver better quality Adolescent-Focused Low-Intensity LSW more consistently. To address gaps in our knowledge about the impact of Adolescent-Focused Low-Intensity LSW, further primary research is needed to strengthen understandings of how this intervention works (or not) in different contexts.PROSPERO registration numberCRD42021279816.

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“…Mechanisms may be found at different ‘levels’ (eg, organisation or individual level), but to make the claim that something is functioning as a mechanism, it is important to consider for which outcome this claim is being made. Importantly, mechanisms are not merely an intervention, an activity,or an intervention component 27 28. Hence, realist reviews will produce knowledge claims about causes of outcomes in certain contexts using the context–mechanism–outcome configuration (CMOC) heuristic, as this links the three main concepts of a realist analysis.…”

Section: Introductionmentioning

confidence: 99%

Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol

King

Gadsby

Bell³

et al. 2023

BMJ Open

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IntroductionHealth visiting services, providing support to under 5s and their families, are organised and delivered in very different ways in different parts of the UK. While there has been attention to the key components of health visiting practice and what works well and how, there is little research on how health visiting services are organised and delivered and how that affects their ability to meet their objectives. The COVID-19 pandemic rapidly disrupted service delivery from March 2020. This realist review aims to synthesise the evidence on changes during the pandemic to identify the potential for improving health visiting services and their delivery.Methods and analysisThis review will follow the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) quality standards and Pawson’s five iterative stages to locate existing theories, search for evidence, select literature, extract data, synthesise evidence and draw conclusions. It will be guided by stakeholder engagement with practitioners, commissioners, policymakers, policy advocates and people with lived experience. This approach will consider the emerging strategies and evolving contexts in which the services are delivered, and the varied outcomes for different groups. A realist logic of analysis will be used to make sense of what was happening to health visiting services during and following the pandemic response through the identification and testing of programme theories. Our refined programme theory will then be used to develop recommendations for improving the organisation, delivery and ongoing postpandemic recovery of health visiting services.Ethics and disseminationGeneral University Ethics Panel approval has been obtained from University of Stirling (reference 7662). Dissemination will build on links to policymakers, commissioners, providers, policy advocates and the public. A range of audiences will be targeted using outputs tailored to each. A final stakeholder event focused on knowledge mobilisation will aid development of recommendations.PROSPERO registration numberCRD42022343117.

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Grand rounds in methodology: when are realist reviews useful, and what does a ‘good’ realist review look like?

Cited by 25 publications

References 30 publications

Screening and identification of fetal alcohol spectrum disorder in criminal legal settings: A realist review

Screening and identification of fetal alcohol spectrum disorder in criminal legal settings: A realist review

Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review

Health visiting in the UK in light of the COVID-19 pandemic experience (RReHOPE): a realist review protocol

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