Cited by 476Evaluation and Performance AssessmentHealth Policy Implementation ScienceAdvanced Causal Inference Techniques

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Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research

Marchal, Bruno, van Belle, Sara, van Olmen, Josefien, Hoerée, Tom, Kegels, Guy·2012·Evaluation

DOI 10.1177/1356389012442444

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Abstract

This overview aims to stimulate conceptual and practical discussions to help unlock the full potential of realist evaluation in health systems research. Based on a structured literature search, this review maps how the concepts of realist evaluation are applied in health systems research and which methodological problems are encountered. We found a great diversity in the depth of application of the philosophical concepts, use of terminology and scope of application in the research process. Terms of theory-driven evaluation, theories of change and realist evaluation are often used interchangeably. Diverging views exist regarding the nature of ‘mechanism’ and the difference between mechanism and essential context condition. A lack of methodological guidance was highlighted by many authors. Realist evaluation is slowly gaining traction in health systems research, but more clarity is needed concerning the definitions of mechanisms and context and how the configuration of context, mechanism and intervention can be described and assessed.

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Additional file 2 of Non-dispensing pharmacists integrated into general practices as a new interprofessional model: a qualitative evaluation of general practitioners’ experiences and views
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“…premise on which the theory tests and the finding that cases combining systems thinking with participatory design score more evenly than cases operationalizing a single framework is a context– mechanism–outcome claim in its application, as well as in the rigor of its theoretical concept [41,43].”
Unpacking policy instruments through a mechanistic analysis: school desegregation policies in Barcelona
Zancajo, A., Jover, A., Quilabert, E., & Pagès, M. (2026) · Journal of Education Policy · doi:10.1080/02680939.2026.2743590
Building Initial Programme Theory With Global Stakeholders: Methodological Lessons From a Realist Evaluation on Community Participation in Quality Maternal and Newborn Care
Cocoman, O., Maliqi, B., Dsane-Aidoo, P. H., Dohlsten, M., Ruysen, H., Jackson, D. J., & Gilmore, B. (2026) · International Journal of Qualitative Methods · doi:10.1177/16094069261489339

Authors: Marchal, B., van Belle, S., van Olmen, J., Hoerée, T., & Kegels, G.
Affiliations: ITM-A, Belgium
BTC, Belgium
ORCID: Marchal, Bruno
Kegels, Guy
Venue: Evaluation
Publisher: SAGE Publications
Published: 2012-04
Volume: 18
Issue: 2
Pages: 192-212
ISSN: 1356-3890 (ISSN-L)
1461-7153
DOI: 10.1177/1356389012442444
OpenAlex: W2077589521
Cited by: 476
References: 92
Citations by year: 2026: 22 · 2025: 29 · 2024: 41 · 2023: 29 · 2022: 51 · 2021: 64 · 2020: 31 · 2019: 40 · 2018: 37 · 2017: 28 · 2016: 31 · 2015: 34 · 2014: 24 · 2013: 12 · 2012: 3
FWCI: 30.83
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Evaluation (publishedVersion)
Topics: Social Sciences › Public Administration › Evaluation and Performance Assessment
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
Keywords: realist evaluation, health systems research, mechanisms, context, intervention, theory of change, theory-based evaluation, methodological recommendations, conceptual clarity

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Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research

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