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Making implementation science more real.

Mitchell N Sarkies1, Emilie Francis-Auton2, Janet C Long2

  • 1Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, New South Wales, 2109, Australia. mitchell.sarkies@mq.edu.au.

BMC Medical Research Methodology
|June 25, 2022
PubMed
Summary
This summary is machine-generated.

Realist research helps understand how context affects healthcare implementation. This approach explains what works, for whom, and under what circumstances, improving evidence-based practice delivery.

Keywords:
ContextImplementation scienceMechanismOutcomeRealist evaluationRealist reviewRealist synthesisTheory

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Area of Science:

  • Healthcare implementation science
  • Realist research methodologies
  • Health services research

Background:

  • Implementation science seeks to bridge the gap between healthcare evidence and practice.
  • Replicating successful implementations across different settings is challenging due to contextual variations.
  • Contextual factors significantly influence the effectiveness of implementation strategies.

Purpose of the Study:

  • To propose realist research paradigms as a framework for understanding contextual influences on implementation strategies.
  • To explain how realist evaluations can elucidate the causal processes of implementation in healthcare.
  • To demonstrate the application of realist methods in a study of value-based healthcare initiatives.

Main Methods:

  • Utilizing realist research paradigms, which are theory-driven evaluations.
  • Focusing on understanding the interplay of context, mechanisms, and outcomes.
  • Analyzing conditional causality: identifying what works, for whom, and under what circumstances.
  • Applying these methods to a large-scale realist implementation study of value-based healthcare.

Main Results:

  • Realist studies provide a framework to express the effect of contextual factors on implementation strategy causal processes.
  • Preliminary findings from a value-based healthcare study illustrate the application of realist methods.
  • The approach helps in understanding how and why interventions work in different circumstances.

Conclusions:

  • Realist research paradigms offer a robust framework for analyzing implementation science challenges.
  • This approach can explain the conditional causality of implementation strategies in diverse healthcare contexts.
  • Judicious application of realist implementation studies can optimize the delivery of appropriate care at the right time and in the right setting.