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Realist methodologies informing the development, implementation, and scale-up of complex socio-medical interventions:
Md Koushik Ahmed1, Alejandro Argüelles Bullón2, Babatope O Adebiyi3
1Department of Global Health, University of Washington, Seattle, Washington, United States of America.
Plos One
|June 23, 2026
Summary
This scoping review maps how realist methodologies inform complex health interventions across development, implementation, and scale-up. It clarifies how realist inquiry enhances intervention design and effectiveness in diverse settings.
Area of Science:
- Implementation Science
- Public Health
- Health Services Research
Background:
- Understanding complex socio-medical interventions is crucial for health equity.
- Realist methodologies explain intervention success factors (what, who, context, why).
- Limited understanding exists on realist approaches across intervention lifecycle phases.
Purpose of the Study:
- To map the application of realist methodologies across the development, implementation, and scale-up of complex socio-medical interventions.
- To identify how realist inquiry informs explanatory program theories for intervention design and adaptation.
- To provide insights for implementation scientists and practitioners on effective intervention strategies.
Main Methods:
- Scoping review following Arksey & O'Malley, JBI, and PRISMA-ScR guidelines.
- Searches across PubMed, Web of Science, CINAHL, PsycINFO, supplemented by grey literature and citation tracking.
- Data charting and synthesis (descriptive, thematic, narrative) of realist-informed studies.
Main Results:
- Identification of how realist inquiry contributes to explanatory program theories.
- Mapping of realist methodology application across intervention lifecycle stages.
- Insights into context-mechanism-outcome configurations and methodological adaptations.
Conclusions:
- Realist methodologies enhance the development, implementation, and scale-up of complex socio-medical interventions.
- This review offers practical guidance for optimizing intervention design and adaptation.
- Understanding realist approach adoption improves intervention effectiveness in complex settings.
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