Realist Research, Design and Evaluation for Integrated Care Initiatives

Eastwood, John; Souza, Denise de; Mukumbang, Ferdinand C.

doi:10.1007/978-3-030-69262-9_37

Cited by 4 publications

(10 citation statements)

References 39 publications

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“…A Critical realist methodology enables the researcher to uncover the "hidden" causal mechanisms that are postulated to be contributing to the empirically observed phenomenon. Critical realism also examines the contribution of historical and current context within which integrated health and social care interventions are operating [14].…”

Section: Research Paradigmmentioning

confidence: 99%

Understanding for whom, how and why Sydney Local Health District’s Integrated Response was Effective in Addressing COVID-19: A Critical Realist Qualitative Study

Liu

Moore

et al. 2022

Int J Integr Care

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Introduction: Australia has been comparatively effective in preventing the transmission of COVID-19. The Sydney Local Health District [SLHD] used a "whole of health" integrated approach to respond to the pandemic. The aim of this study was to understand for whom, how and why this response worked, to inform a sustainable system transformation. Methods:A critical realist qualitative study was conducted with 20 purposively selected key informants. Data were collected through in-depth interviews and analysed using thematic analysis guided by abduction and retroduction. The five strategies of the WHO integrated people-centred health services framework was used to guide the overall study.Results: An enabling environment of a strong governance, emergency preparedness, a committed and adaptable workforce, and a strong core infrastructure underpinned SLHD's effective response. With a culture of embracing innovation, the district adapted virtual care to effectively quarantine people through their special health accommodation, and coordinate care across tertiary and community services. The established interagency relationships prior to the pandemic, enabled service directors to quickly integrate their services, which empowered and engaged the community [and staff], working across relevant sectors to provide care "where the people are"; reaching marginalised populations, and reducing community transmission. Discussion and Conclusion:The SLHD's progress towards a 'whole of health' approach, empowered and enabled the district to effectively work within and across sectors to address the pandemic in a people-centred manner. Sustaining the contextual conditions and mechanisms, that facilitated effective integration, will be beneficial beyond the pandemic.

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Section: Research Paradigmmentioning

confidence: 99%

Understanding for whom, how and why Sydney Local Health District’s Integrated Response was Effective in Addressing COVID-19: A Critical Realist Qualitative Study

Liu

Moore

et al. 2022

Int J Integr Care

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“…The task of conducting a realist synthesis is to mine and make explicit the underlying mechanisms that produce the ‘phenomenon and to understand the interplay between them and how they shape the outcome’. 14 The elicitation of our programme theories was informed by the critical realist causality framework proposed by Sayer 21 ( figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the identification of generative mechanisms and counteracting mechanisms requires the consideration of context elements, conditions required to determine how a mechanism empirically manifests. 14 The context or condition with causal tendencies may consist of aspects of structure, culture, agency and relations (eg, individual, organisational and environmental characteristics) and historical elements that can potentially (de)activate existing or introduced mechanisms. 18 22 23 …”

Section: Methodsmentioning

confidence: 99%

“…13 Critical realist approaches have value in improving evidencebased practice as they can be used to study the intricacies around the design, implementation and uptake by identifying and highlighting causal claims concerning these details while retaining the notion of complexity that exists in their practical implementation. 14 The dynamic learning process that can arise in conducting a realist synthesis may generate new ideas for programme development and innovation apart from what can be achieved in reviews providing a summary of quantified evidence. 15 In this critical realist synthesis, we aimed to identify the causal mechanisms provided and triggered by community-integrated care initiatives within various contextual conditions in relation to hospital presentation behaviours among people with complex health and social care requirements.…”

Section: Bmj Global Healthmentioning

confidence: 99%

“… 13 Critical realist approaches have value in improving evidence-based practice as they can be used to study the intricacies around the design, implementation and uptake by identifying and highlighting causal claims concerning these details while retaining the notion of complexity that exists in their practical implementation. 14 The dynamic learning process that can arise in conducting a realist synthesis may generate new ideas for programme development and innovation apart from what can be achieved in reviews providing a summary of quantified evidence. 15 …”

Section: Introductionmentioning

confidence: 99%

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Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

et al. 2022

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IntroductionCommunity-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not.Methods and analysisCritical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate.ResultsThree programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination.ConclusionWe systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions.PROSPERO registration numberCRD42020210442.

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Retroductive Theorizing: A Contribution of Critical Realism to Mixed Methods Research

Mukumbang

2021

Journal of Mixed Methods Research

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Mixed methods studies in social sciences are predominantly employed to explore broad, complex, and multifaceted issues and to evaluate policies and interventions. The integration of qualitative and quantitative methods in social sciences most often follows the Peircean pragmatic approach—abductive hypothesis formation followed by deductive and inductive testing/confirmation—with limited theorizing properties. This paper contributes to the field of mixed methods research in social sciences by explicating a two-way interaction process between mixed methods data and [social] theory in a pluralistic inferencing approach espoused by critical realism—retroductive theorizing. The paper further illustrates how through retroductive theorizing, critical realism offers a more epistemologically and ontologically grounded alternative for integrating qualitative and quantitative methods compared to pragmatism.

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Realist Research, Design and Evaluation for Integrated Care Initiatives

Cited by 4 publications

References 39 publications

Understanding for whom, how and why Sydney Local Health District’s Integrated Response was Effective in Addressing COVID-19: A Critical Realist Qualitative Study

Understanding for whom, how and why Sydney Local Health District’s Integrated Response was Effective in Addressing COVID-19: A Critical Realist Qualitative Study

Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis

Retroductive Theorizing: A Contribution of Critical Realism to Mixed Methods Research

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