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Will it work here? A realist approach to local decisions about implementing interventions evaluated as effective
Chris Bonell1, Audrey Prost2, G J Melendez-Torres3
1Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK chris.bonell@lshtm.ac.uk.
Journal of Epidemiology and Community Health
|September 10, 2020
Summary
Local decision-makers need comprehensive evidence beyond effectiveness when transporting interventions. Assessing implementation, context, mechanisms, and local capacity ensures successful adoption and tailored solutions for new settings.
Area of Science:
- Implementation Science
- Public Health
- Educational Psychology
Background:
- Growing interest in evidence required for transporting effective interventions to new settings.
- Limited attention on how local decision-makers choose between immediate implementation and further evaluation.
- School-based social and emotional learning (SEL) interventions serve as a case study.
Purpose of the Study:
- To inform decisions regarding the implementation of evidence-based interventions in new contexts.
- To guide local needs assessments for intervention adoption.
- To refine criteria for deciding between immediate implementation, piloting, or new trials.
Main Methods:
- Utilized realist evaluation principles to analyze decision-making processes.
- Examined evidence from process evaluations, mediation, moderation, and qualitative comparative analyses.
- Focused on assessing intervention effectiveness, implementation fidelity, contextual factors, and underlying mechanisms.
Main Results:
- Decisions require evaluating not just effectiveness, but also implementation processes, contextual influences, and mechanisms of action (for whom and why).
- Local needs assessments should consider the potential, capability, capacity, and contribution of the new setting.
- Assessing for similar 'aetiological mechanisms' underlying local adverse outcomes is crucial.
Conclusions:
- Uncertainty in feasibility necessitates implementation piloting.
- Uncertainty in triggering intended mechanisms warrants a new effectiveness trial.
- Uncertainty in mechanisms generating intended outcomes may require alternative interventions.
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