How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

Abstract

BackgroundDespite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services.MethodsThis study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management.DiscussionEvaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

“…Articles retrieved for inclusion were published in the years between 2007 and 2013. Of the 14 studies identified, 6 were protocols that contained descriptions of proposed rather than completed research [28],[33]-[37]. In general, there did not appear to be any specific preference in terms of healthcare setting or type of knowledge translation intervention studied.…”

“…Nine of the included studies made reference to C-M-O configurations in reporting the application of realist evaluations [28],[32],[33],[36]-[38],[40],[41],[43]. Four of these were study protocols that provided detailed descriptions of initial investigations that included searches of existing literature, interviews and document analysis intended to inform identification of contextual factors, possible underlying mechanisms and outcome patterns that could be used to develop C-M-O configurations from which to generate study hypotheses [28],[33],[36],[37].…”

“…Four of these were study protocols that provided detailed descriptions of initial investigations that included searches of existing literature, interviews and document analysis intended to inform identification of contextual factors, possible underlying mechanisms and outcome patterns that could be used to develop C-M-O configurations from which to generate study hypotheses [28],[33],[36],[37]. The report provided by Mackenzie and colleagues [28] presented the results of this first stage of evaluation and also provided examples of proposed C-M-O configurations.…”

Transformation of health visiting services in England using an Online Community of Practice

“…A realist evaluation technique (RET henceforth) starts with the formulation of a middle range theory that connects contexts, mechanisms and outcomes to create what is termed a potential CMO (Context, Mechanism, Outcome) configuration [26]. RETs do not set out to make a judgement about whether or not an intervention is effective.…”

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

“…For instance, an early application of realist inquiry into intervention in health care was research undertaken by Greenhalgh et al into a major reorganisation of four inner-London health-care organisations 176,261,270 They present an inclusive analysis of the interwoven components of an intervention, together with a postulated theory for each facet. 176,261,270,271 Similarly holistic approaches are illustrated in Byng et al's evaluation of a complex health services intervention targeted towards people with long-term mental illness, 264,272 Manzano-Santaella's realist evaluation of financial incentives in English hospital discharge policy, 273 and other causal explanations of interventions targeted at various stakeholder groups, including (i) patients; [274][275][276] (ii) specific groups of health-care and aligned workers, [277][278][279][280][281][282][283][284] and (iii) the standardisation of evidence-based practice through protocol-based care. [285][286][287] Alongside realist approaches that have been applied to consider 'whole interventions', more selective analyses of the discrete components of an intervention are depicted in studies such as Leone's evaluation of an illicit drug deterrence programme.…”