First Things First: How to Elicit the Initial Program Theory for a Realist Evaluation of Complex Integrated Care...

Area of Science:

• Health Services Research
• Evaluation Science
• Public Health Policy

Background:

• Integrated care programs present complex challenges for evaluation.
• Traditional evaluation methods may not fully capture the nuances of integrated care.
• A theory-driven approach is needed to understand program mechanisms and outcomes.

Purpose of the Study:

• To illustrate the process of eliciting an initial program theory (IPT) using realist evaluation (RE).
• To apply RE's first step to the TARGET program, a Dutch initiative for integrated care for chronically ill patients.
• To demonstrate how RE can systematically unravel a program's underlying theory.

Main Methods:

• Employed a phased IPT elicitation process informed by realist evaluation principles.
• Included identifying an abstract theory framework, formulating a preliminary IPT, and refining it through expert interviews.
• Utilized an RE heuristic tool (ICAMO) and retroductive reasoning to synthesize program theory.

Main Results:

• Identified distinct but related IPTs for primary care professionals (PCPs) and patients within the TARGET program.
• Proposed two key mechanisms: confidence (enhancing PCP skills and patient engagement) and mutual trust (between actors).
• Highlighted the crucial role of a supportive context, such as adequate resources, in activating these mechanisms.

Conclusions:

• Eliciting IPT through RE, though time-intensive, offers deeper insights into program functioning than experimental designs.
• The developed IPT can inform the design of realist-informed monitoring and evaluation processes for integrated care.
• RE provides a robust methodological asset for understanding complex healthcare interventions.