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Cited by 742Health Policy Implementation ScienceMeta-analysis and systematic reviewsEvaluation and Performance Assessment

The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index.

Realist synthesis: illustrating the method for implementation research

Open access
Rycroft-Malone, Jo, McCormack, Brendan, Hutchinson, Alison M, DeCorby, Kara, Bucknall, Tracey K, Kent, Bridie, Schultz, Alyce, Snelgrove-Clarke, Erna, Stetler, Cheryl B, Titler, Marita, Wallin, Lars, Wilson, Val·2012·Implementation Science
DOI 10.1186/1748-5908-7-33PMC PMC3514310
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Abstract

BACKGROUND: Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered. METHODS: The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. RESULTS: Based on key terms and concepts related to various interventions to promote evidence-informed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. CONCLUSIONS: Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.

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Figure 1 Review framework.
Figure 1 Review framework.CC BY · PubMed Central
Figure 2 Screening process.
Figure 2 Screening process.CC BY · PubMed Central

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Research works printed but not linked: 1

  1. Pawson R, Tilley N: Realistic Evaluation. 1997, London, England: Sage

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Authors
Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., DeCorby, K., Bucknall, T. K., Kent, B., Schultz, A., Snelgrove-Clarke, E., Stetler, C. B., Titler, M., Wallin, L., & Wilson, V.
Affiliations
  • University of Ulster (GB)
  • Deakin University (AU)
  • McMaster University (CA)
  • Boston University (US)
  • University of Michigan (US)
  • Karolinska Institutet (SE)
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2012-04-19
Volume
7
Issue
1
Pages
33-33
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-7-33
PMC
PMC3514310
OpenAlex
W2097730860
Cited by
742
References
32
Citations by year
2026: 54 · 2025: 71 · 2024: 92 · 2023: 66 · 2022: 84 · 2021: 82 · 2020: 55 · 2019: 46 · 2018: 48 · 2017: 49 · 2016: 29 · 2015: 27 · 2014: 19 · 2013: 14 · 2012: 1
FWCI
34.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Queen Margaret University Publications Repository (Queen Margaret University) (acceptedVersion)
  • PEARL (University of Plymouth) (submittedVersion)
  • Research Online (University of Wollongong) (submittedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • UTS ePRESS (University of Technology Sydney) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
Keywords
realist synthesis, realist review, causal mechanisms, change agency, implementation research, complex interventions, theoretical framework, data extraction, hypothesis generation
MeSH terms
Health Services Research, Humans, Review Literature as Topic, Evidence-Based Medicine

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