This book describes an innovative approach to the evaluation of complex health interventions, assessing what interventions work, how and for whom. Rejecting the stalemate between trials and realist evaluation, it draws on the best of both. Randomised controlled trials and systematic reviews offer the least biased means of assessing intervention effects but tell us little scientifically about how interventions work. Policy-makers and practitioners are also not supported to decide which interventions are likely to achieve most benefits in their local contexts. Realists use other forms of evaluation and evidence synthesis exploring how intervention mechanisms interact with context to generate outcomes. But these approaches lack rigour in assessing causality. This book proposes how realist evaluation methods may be incorporated within randomised controlled trials and systematic reviews. This enables evaluations and evidence synthesis to benefit from the more nuanced questions posed within realist enquiry while maintaining rigour in assessing causality.
Health and human services currently face a series of challenges – such as aging populations, chronic diseases and new endemics – that require highly complex responses, and take place in multiple care environments including acute medicine, chronic care facilities and the community. Accordingly, most modern health care interventions are now seen as ‘complex interventions’ – activities that contain a number of component parts with the potential for interactions between them which, when applied to the intended target population, produce a range of possible and variable outcomes. This in turn requires methodological developments that also take into account changing values and attitudes related to the situation of patients’ receiving health care. The first book to place complex interventions within a coherent system of research enquiry, this work is designed to help researchers understand the research processes involved at each stage of developing, testing, evaluating and implementing complex interventions, and assist them to integrate methodological activities to produce secure, evidence-based health care interventions. It begins with conceptual chapters which set out the complex interventions framework, discuss the interrelation between knowledge development and evidence, and explore how mixed methods research contributes to improved health. Structured around the influential UK Medical Research Council guidance for use of complex interventions, four sections, each comprised of bite-sized chapters written by multidisciplinary experts in the area, focus on: - Developing complex interventions - Assessing the feasibility of complex interventions and piloting them - Evaluating complex interventions - Implementing complex interventions. Accessible to students and researchers grappling with complex interventions, each substantive chapter includes an introduction, bulleted learning objectives, clinical examples, a summary and further reading. The perspectives of various stakeholders, including patients, families and professionals, are discussed throughout as are the economic and ethical implications of methods. A vital companion for health research, this book is suitable for readers from multidisciplinary disciplines such as medical, nursing, public health, health services research, human services and allied healthcare backgrounds.
Bringing together leading theorists, researchers and policy makers with expertise in using realist methods, this book is a definitive guide to putting realist methodologies into practice. Not just an overview of the field, this book looks to extend current debates and apply realist methods to new and practical challenges in social research. Featuring practical, worked examples of how to turn theory into evidence, it empowers readers not just to understand realist methods, but to use them. It will help readers: - Negotiate the complexity of relational systems - Understand the importance and relevance of cumulative theory - Address concerns over data sources and quality - Be flexible and creative in realist approaches - Produce useful evidence for policy. Sophisticated and globally minded, this book is the perfect addition to the ongoing development and application of realist methods across evaluation, synthesis, and social research.
Evaluation researchers are tasked with providing the evidence to guide programme building and to assess its outcomes. As such, they labour under the highest expectations - bringing independence and objectivity to policy making. They face huge challenges, given the complexity of modern interventions and the politicised backdrop to all of their investigations. They have responded with a huge portfolio of research techniques and, through their professional associations, have set up schemes to establish standards for evaluative inquiry and to accredit evaluation practitioners. A big question remains. Has this monumental effort produced a progressive, cumulative and authoritative body of knowledge that we might think of as evaluation science? This is the question addressed by Ray Pawson in this sequel to Realistic Evaluation and Evidence-based Policy. In answer, he provides a detailed blueprint for an evaluation science based on realist principles.
In this open access edited volume, international researchers of the field describe and discuss the systematic review method in its application to research in education. Alongside fundamental methodical considerations, reflections and practice examples are included and provide an introduction and overview on systematic reviews in education research.
This book focuses on two key ways to improve the literature surrounding policy analysis. Firstly, it explores the implications of new developments in policy process research, on the role of psychology in communication and the multi-centric nature of policymaking. This is particularly important since policy analysts engage with policymakers who operate in an environment over which they have limited understanding and even less control. Secondly, it incorporates insights from studies of power, co-production, feminism, and decolonisation, to redraw the boundaries of policy-relevant knowledge. These insights help raise new questions and change expectations about the role and impact of policy analysis.
Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.
