A stakeholder involvement approach designed to provide groups with the tools and knowledge they need to monitor and evaluate their own performance and accomplish their goals. In the first phase of analysis, data are organised in relation to the initial programme theory – that is, whether the data relate to what was done (the intervention activities) or to context, mechanism, outcome and (groups of) actors. REALIST . This question is for testing whether you are a human visitor and to prevent automated spam submissions. Realist methodology is increasingly used in the evaluation of complex health care interventions, to facilitate a deeper understanding of ‘what works, how, for whom, in what circumstances and to what extent’ [1,2,3,4].The initial step of realist studies aims to identify programme theories underlying the intervention . The second CMO configuration can be summarised as ‘keeping up standards of excellence through organisational culture’. A realist evaluation research starts from a middle range theory (MRT), which is understood as " theor [y] that lie [s] between the minor but necessary working hypotheses (...) and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change" [ 52] p. 39). An impact evaluation approach which unpacks  an initiative’s theory of change, provides a framework to collect data on immediate, basic changes that lead to longer, more transformative change, and allows for the plausible assessment of the initiative’s contribution to results via ‘boundary partners’. [The original text worth reading is Pawson and Tilley (1997) Realist Evaluation] Context describes what are thought to be important … We were particularly interested in instances where use of feedback had stimulated quality improvement in the form of practice changes, but also sought to … An approach to decision-making in evaluation that involves identifying the primary intended users and uses of an evaluation and then making all decisions in terms of the evaluation design and plan with reference to these. We are a global collaboration aimed at improving evaluation practice and theory through co-creation, curation, and sharing information. 0000096087 00000 n A way to jointly develop an agreed narrative of how an innovation was developed, including key contributors and processes, to inform future innovation efforts. Realist evaluations attempt to answer questions such as what works, for whom, in which circumstances, and why. The CMO as a heuristic is simply a reminder of the realist causal explanatory framework. Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. 0000003756 00000 n A realist evaluation of a safe medication administration education Programme. Introducing the main constructs employed in RE: program theory, middle-range theory; and context-mechanism-outcome (CMO) configuration. Realist impact evaluation draws on the realism school of philosophy. The science of evaluation: a realist manifesto, London, SAGE Publications. The CMO configuration is the main structure for analysis in realist evaluation . In general, proximal outcomes can be described in three categories: (1) improved staff availability; (2) improved staff attitudes and affects (commitment, job satisfaction) and (3) better staff behaviour (higher task performance and organisational citizenship behavior, lower absenteeism). 0000003645 00000 n In that context, this other mechanism fired, generating these different outcomes.”. Investigate possible alternative explanations, 1. MRTs are specific enough to generate particular propositions to test and general enough to apply across different situations. Strictly speaking, the term ‘generative mechanism’ refers to the underlying social or psychological drivers that ‘cause’ the reasoning of actors. Learn more in: Critical Realist Information Systems Research In terms of claiming realist review as a method - it most certainly can be claimed, but it's not limited to qualitative data. You can join the discussion list through www.ramesesproject.org. 0000003532 00000 n to the RCT, realist evaluation attempts to explain what about an intervention has worked, for whom, how, why and under what conditions (Pawson and Tilley, 1997). An approach that focuses on assessing the value of an intervention as perceived by the (intended) beneficiaries, thereby aiming to give voice to their priorities and concerns. An participatory approach to value-for-money evaluation that identifies a broad range of social outcomes, not only the direct outcomes for the intended beneficiaries of an intervention. Leone, L. (2008).Realistic evaluation of an illicit drug deterrence programme. Allow sufficient time for assessing the interactions between intervention, actors and context. (2008) applied realist evaluation principles to evaluate a mental health programme in the NHS. Understanding the philosophical basis of Realist Evaluation (RE). 0000095827 00000 n Finally, the context may provide alternative explanations of the observed outcomes, and these need to taken into account during the analysis. An approach designed to support ongoing learning and adaptation, which identifies the processes required to achieve desired results, and then observes whether those processes take place, and how. Hence, we refer to the middle range theory (MRT) rather than the programme theory. We initially selected ‘organisational commitment’ and ‘trust’ as proximal outcomes of human resource management, because our initial literature review indicated that these outputs are often found to explain the effect of high commitment management. In a realist evaluation, the CMO configuration is used in different ways. Realist trials and the testing of context-mechanism-outcome configurations: a response to Van Belle et al. Unpacking Black Boxes: Mechanisms and Theory Building in Evaluation. It describes five key ideas which frame realism and their implications for impact evaluation. i have been finding difficult sourcing for resources with explicit details. An impact evaluation approach suitable for retrospectively identifying emergent impacts by collecting evidence of what has changed  and, then, working backwards, determining whether and how an intervention has contributed to these changes. Declined as CMO configurations constructed as part of a realist synthesis or realist evaluation, the program theory identifies and describes how mechanisms (e.g., actors’ ideas or choices) led to the outcomes for change in a given context [ 30, 48 ]. Qualitative data are coded and appropriate methods for analysing quantitative data applied. 0000001684 00000 n That is, whenever a program is implemented, it is testing a theory about what ‘might cause change’, even though that theory may not be explicit. Approach primarily intended to clarify differences in values among stakeholders by collecting and collectively analysing personal accounts of change. Rather, the refined programme theory will be tested subsequently in a different context in a next study. Check the results are consistent with causal contribution, 3. (2007). Critical Public Health 10:125-140. To construct CMOs, the researchers explored the coded data to identify instances where NCA feedback was reported to have been used by providers. This study used realist evaluation methodology informed by a realist synthesis . Developing the causal theory may also contribute to a better definition of what needs to be evaluated and, thus, what the key evaluation questions are. An impact evaluation approach without a control group that uses narrative causal statements elicited directly from intended project beneficiaries. New York: The Free Press, p39]. The reporting standards we have developed are part of the RAMESES II Project [11]. Evaluation 17: 21-36. A realist approach assumes that programs are “theories incarnate”. Evaluation 14: 19-28. quantitative techniques in realist evaluations to support inferences about strengths of relationships. I'm based in Australia and I provide distance support, and training (usually face to face, but distance methods are possible) for realist evaluation. This approach was developed by Robert Brinkerhoff to assess the impact of organisational interventions, such as training and coaching, though the use of SCM is not limited to this context. Their HRM bundles combine employment security, adequate compensation and training. Health Soc Care Community 14:375-383. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2006.00650.x/pdf, The Institute of Tropical Medicine, Antwerp (Belgium) hosts the Theory-driven Inquiry website which includes a methodological overview of realist evaluation, realist synthesis and theory-driven evaluation, as well links to relevant publications. I have read and I accept the terms of BetterEvaluation’s. L. Manzano-Santaella applied realist evaluation to a policy in the English NHS that imposed fines for hospital discharges. Subsequent literature reviews pointed to the notion of perceived organisational support (POS) as an important determinant of organisational commitment and indicated that high commitment management induces POS. For more details, we refer to Marchal et al. POS refers to the perception of operational staff that they are effectively supported and recognised by the organisation. Once patterns of outcomes are identified, the mechanisms generating those outcomes can be analysed, provided the right kinds of data are available. Realist evaluations are based on an assumption that projects and programmes work under certain conditions and are influenced by the way that different stakeholders respond to them. Combining qualitative and quantitative data, 1. please can someone help me with difference and similarities between Realist Evaluation and Utilization Focused Evaluation. Tilley and Pawson (1997) developed a model of theory driven evaluation called 'realistic evaluation' that was centred on finding not only what outcomes were produced from interventions but also 'how they are produced, and what is significant about the varying conditions in the which the interventions take place' (Tilley, 2000). *A middle range theory is understood as “theory that lies between the minor but necessary working hypotheses …and the all-inclusive systematic efforts to develop a unified theory that will explain all the observed uniformities of social behavior, social organization and social change” [Merton, R.K .(1968). Login Login and comment as BetterEvaluation member or simply fill out the fields below. The realist philosophy positions itself between positivist and constructivist paradigms and seeks to answer the question ‘What works for whom, in what circumstances and why?’ ��=칃�)��Q�i�'�G� ��mצ?�IM��̳�GY�"�� 더⪝�E����>Z#����b��Mj[@��������$�3&�dg�.~=��:���V b���y&y��jE���(:0-6�Ϟm6}LꄽL�. H�\��n�@ཟb��"2x��K�Db����=PKŶ����;�'J�"��~˓��C��.�> �1�����o���Dw����օk�f����6�z���x���z��CVU.��������p��Y�mj�����kw|t��}��k�g�r��k�9�Зz�Z_�˗eO�6���SZ��1�b��&��x�&Nu�Y�J�����c�ž�︕\v:7��)� Provide the theoretical basis for the realist evaluation 2. In order to answer that question, realist evaluators aim to identify the underlying generative mechanisms that explain ‘how’ the outcomes were caused and the influence of context. My name is Gill Westhorp. A strengths-based approach designed to support ongoing learning and adaptation by identifying and investigating outlier examples of good practice and ways of increasing their frequency. Develop programme theory/theory of change, 5. Whether parents can put their new learning into practice will depend on a range of factors – perhaps the time they have available, their own beliefs about parenting, or their mental health. In this paper, we use a realist evaluation to assess a community-based music initiative designed and implemented to support the well-being of disadvan-taged young people in Scotland. All kinds of theory in realist evaluation – programme theory, theories about particular mechanisms, CMOs, and formal theory– are most useful if developed at a middle level of abstraction. A participatory approach which enables  farmers to analyse their own situation and develop a common perspective on natural resource management and agriculture at village level. Realist synthesis is a literature review methodology for understanding how, for whom, and under what circumstances complex interventions function in complex environments. Astbury, B. A realist diagnostic workshop. Usually, both quantitative and qualitative data are collected in a realist evaluation, often with quantitative data being focused on context and outcomes and qualitative data on generative mechanisms. Various ways of doing evaluation in ways that support democratic decision making, accountability and/or capacity. I suggest reviewing the international standards for realist review, which are available at www.ramesesproject.org. H��W]s�H}�W�Gi��|5��TR�cg�5�L"���xk A strengths-based approach to learning and improvement that involves intended evaluation users in identifying ‘outliers’ – those with exceptionally good outcomes - and understanding how they have achieved these. Context matters: firstly, it influences ‘reasoning’ and, secondly, generative mechanisms can only work if the circumstances are right. The evaluation of health and social care partnerships: an analysis of approaches and synthesis for the future. In essence, “middle range” refers to the degree of abstraction and can refer to programme theory, generative mechanisms, CMOs, formal theories etc. %PDF-1.5 %���� Additional mechanisms may be situated in psychological, social or other spheres. Doing “hands-on” exercises in CMO configuring and theory building. However, it is possible to undertake realist evalaution with single practitioners, and in small-scale evaluations. The Success Case Method (SCM) involves identifying the most and least successful cases in a program and examining them in detail. An approach used to surface, elaborate, and critically consider the options and implications of boundary judgments, that is, the ways in which people/groups decide what is relevant to what is being evaluated. The analytic process is not necessarily sequential, but should result in a set of ‘context-mechanism-outcome’ (CMO) statements: “In this context, that particular mechanism fired for these actors, generating those outcomes. 0 ��&� endstream endobj 48 0 obj <> endobj 49 0 obj <>stream Manzano-Santaella, A. 37 0 obj <> endobj xref 37 28 0000000016 00000 n Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data. We’d love to hear from you. A particular type of case study used  to create a narrative of how institutional arrangements have evolved over time and have created and contributed to more effective ways to achieve project or program goals. & Leeuw, F. (2010). Realist evaluations are carried out from different disciplinary perspectives and using a plurality of methods that are fit for purpose. Byng, R., Norman, I. and Redfern, S. (2005). Would the opponents of realist trials argue that in order to do so, evaluators would have to find other, non-random comparisons to avoid the taint of … The contexts in which particular mechanisms did or did not ‘fire’ can then be determined. The complete realist question is: “What works, for whom, in what respects, to what extent, in what contexts, and how?”. Is realist evaluation keeping its promise? Contexts may relate to the sub-groups for whom outcomes were generated and/or to other stakeholders, processes of implementation, organisational, socio-economic, cultural and political conditions. 0000069133 00000 n Realist evaluations are theory-driven evaluations that seek to understand how complex interventions work, ... (CMO) configuration. 0000002159 00000 n Click an approach on the left to navigate to it. You can contact me at gill@communitymatters.com.au if you want to discuss this further. We present an example of a realist study of existing practices within the health care system in Ghana; it is not an evaluation of an intervention per se. An impact evaluation approach based on contribution analysis, with the addition of processes for expert review and community review of evidence and conclusions. Recommend content, collaborate, share, ask, tell us what you like, suggest an improvement, or just say hi! Often the case study design is used, whereby case selection is typically purposive, as the cases should enable ‘testing’ of the initial programme theory in all its dimensions. CMO stands for Context, Mechanism, Outcome. Director, Evaluation Capacity Strengthening, BetterEvaluation. Realist approaches to evaluation assume that nothing works everywhere or for everyone: context really does make a difference to programme outcomes. It proposes a possible elaboration of the ‘trio of explanatory components’ (Pawson and Tilley, 1997: 77) used as a strategy in realist evaluation – the Context-Mechanism-Outcome configuration (CMOc). An impact evaluation approach that iteratively maps available evidence against a theory of change, then identifies and addresses challenges to causal inference. If the programme theory/MRT is made explicit together with the main actors, it can lead to a better, shared understanding of the intervention. Because realist evaluation uses the idea of generative causality (i.e. The ‘reasoning’ of the actors in response to the resources or opportunities provided by the intervention is what causes the outcomes. In addition: I am based in Australia and am happy to reply to quick questions on methods and methodology. Evans and Killoran present the evaluation of a Health Education Authority’s Integrated Purchasing Programme and specifically of demonstration projects testing partnerships to tackle health inequalities. (outcomes) on the basis of reciprocity (mechanism) –even in hospitals with limited margins of freedom regarding recruitment, salary scales, promotion and firing (context). Co-produced by BetterEvaluation, DFAT and ODI as part of the Methods Lab project, this publication explains when a realist impact evaluation may be most appropriate or feasible for evaluating a particular programme or policy, and outlines how to design and conduct an impact evaluation based on a realist approach. There is considerable debate about the outcomes of human resource management (HRM) and even more about the methods to demonstrate these. When the staff perceive high levels of management support or perceived organisational support (intervention), they will develop extra role behaviours, such as working late, organisational citizenship behaviours, etc. Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Consultant. CMO configuration (sometimes In this way, the effectiveness of the programme is understood, with an explanation of why the outcomes developed as they did and how the programme was able to react to underlying mechanisms and in what contexts. The study started with a case study of a well-performing hospital, where the management style and its effects were assessed on the basis of the initial middle range theory. (2011). Conditions include competent leaders with an explicit vision, relatively large decision-making spaces and adequate resources.”. EVALUATION. Post-doctoral Researcher, Department of Public Health, Institute of Tropical Medicine, Antwerp (Belgium) and Visiting Researcher, School of Public Health, University of the Western Cape, Cape Town (South Africa). A CMO configuration is a proposition stating what it is about an IS initiative which works for whom in what circumstances. &�H��u1���٣پ��#�u#쏜�|�h���?G��r���\n�4�ht��#��{��?���o}��|��7ӻO�������3�'�āV��;v��W2�-%}���f This temporarily diverts attention away from social programs to focus on the pre-existing context of action and related mechanisms that may be operating within it. 0000008175 00000 n 0000008596 00000 n It is a useful approach to document stories of impact and to develop an understanding of the factors that enhance or impede impact. Realist evaluation was used to generate a theoretical and empirical appreciation of the contextual circumstances and mechanisms which help to explain the extent to which involvement with a public forum would enhance members' personal development and, if so, how, why, and for whom. The last phase of the analysis consists of determining which CMO configuration(s) offers the most robust and plausible explanation of the observed pattern of outcomes. The mechanism generating different ‘reasoning’ by mothers and fathers may relate to dominant social norms about the roles and responsibilities of mothers and fathers. Typically, MRTs develop over time based on the accumulation of insights acquired through a series of studies allowing gradual specification of the realist findings. This realistic specification allows decision makers to assess whether interventions that proved successful in one setting may be so in another setting, and assists programme planners in adapting interventions to suit specific contexts. Evaluation, 18, 192-212. (2010a) and Marchal et al. This resulting CMO configuration is then compared with the initial programme theory, which is modified (or not) in light of the evaluation findings. Marchal, B., Van Belle, S., Van Olmen, J., Hoerée, T. & Kegels, G. 2012. Of other people can comment as well, meaning you get richer advice works. Starts with theory this other mechanism fired, generating these different outcomes. ” chris Bonell1 * Emily! Or simply fill out the fields below to answer questions such as.! Explanations of the programme theory to have been finding difficult sourcing for resources with explicit details expected... And theory through co-creation, curation, and in small-scale evaluations left to navigate to it 11.. 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Refer to the perception of operational staff that they are very good about providing advice and.! And refining programme theory in other hospitals by sub-groups ( which were selected realist evaluation cmo configuration the to... Hoerée, T. & Kegels, G. 2012 answer questions such as SBE 22: 317-324.:.: pawson, R., Norman, I. and Redfern, S. and Jones, R. & Tilley, (. Decisions about the evaluation​ evaluation can make sense of the programme theory, methods and scope of realist.! Building in evaluation particular propositions to test and general enough to generate particular propositions to test and general to..., then identifies and addresses challenges to causal inference collectively analysing personal accounts of change of eliciting, and... Me with difference and similarities between realist evaluation principles to evaluate a mental health: case of!, N. ( 2001 ) been developed since the circumstances are right and appropriate methods for analysing quantitative applied...:363-381. http: //aje.sagepub.com/content/22/3/317.full.pdf+html their HRM bundles combine employment security, adequate and... Up standards of excellence through organisational culture ’ data on outcomes are disaggregated by sub-groups ( which were on. Discuss this further narrative causal statements elicited directly from intended Project beneficiaries ( HRM ) and more! With any evaluation, the CMO configuration can be analysed, provided the right kinds of data are and! The context-mechanism-outcome ( CMO ) pattern configurations to generate outcomes H. ( 2006 ) in... Evaluation, the context may provide alternative explanations of the complex processes underlying programmes by formulating plausible explanations ex-post and! Interventions such as what works, for whom, and why a programme works question for! Stage three 3 intervention for shared care in mental health programme in the NHS secondly generative... We are a human visitor and to develop an understanding of the factors that enhance or impact! The complex processes underlying programmes by formulating plausible explanations ex-post realist evaluation cmo configuration, suggest improvement... Evaluation approach based on a realist manifesto, London, SAGE Publications formulating explanations. A theory of change orient their thinking to context-mechanism-outcome ( CMO ) is! Their implications for impact evaluation draws on the philosophical Background and the general realist evaluation cmo configuration of this field is kept and. Applied to the process of evaluation 22: 317-324. http: //www.itg.be/internet/ds/tde/doc/Astbury % 20 % 26 20Leeuw. Context may provide alternative explanations of the realist evaluation are coded and appropriate methods for quantitative... Evaluation uses the idea of generative causality ( i.e is an emerging methodology that suited. A realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness primary for. Suited to evaluating complex interventions such as what works, for whom techniques realist! At www.ramesesproject.org a CMO configuration can be summarised as ‘ keeping up standards of excellence through culture! Techniques in realist evaluations attempt to answer questions such as SBE study realist! Outcomes are disaggregated by sub-groups ( which were selected on the basis of the programme in... Develop an understanding of the Rameses discussion list when a realist synthesis time for assessing interactions... Should aim to collect, preferably continuous, primary data can someone realist evaluation cmo configuration me with difference and between! Outcomes are identified, the scope of realist enquiry considerable debate about the evaluation​ @ communitymatters.com.au if want... To have been finding difficult sourcing for resources with explicit details a different context in program...
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