Realist Evaluation of System of Care Trial
What is a realist evaluation?
A realist evaluation is a theory driven approach to evaluation. It aims to test the efficacy of the intervention theories by exploring how the intervention components induce a change in practice (known as mechanisms), the environmental factors that impact on these mechanisms (known as contexts) and how combinations of both link to the outcomes observed. Explanations are produced through the development of context, mechanism, outcome, configurations (CMOCs) or put more simply through describing ‘what works for whom and in what circumstances’.
Steps in conducting a realist evaluation:
Study Aim
To understand how the LoTS care stroke system of care works to improve patient outcomes.
Objectives
- Describe how the intervention is being delivered.
- Explore contextual factors that affect implementation.
- Refine the intervention theories using the data collected to produce CMOCs.
- Provide an explanatory framework to help interpret trial outcomes.
Methods
It is hoped that the study objectives will be achieved through applying the following methods:
- Semi structured interviews (conducted via telephone) with all Stroke Care Coordinators (SCCs) delivering the LoTS care intervention.
- Observations of practice at two SCC services chosen as case study sites.
- Semi structured interviews with SCCs at case study sites.
- Semi structured interviews with a sub-sample of patients at case study sites.
Current Status
- Telephone interviews with all SCCs have been completed.
- Observations and interviews with SCCs and patients have been carried out at the two case study sites.
- Analysis of the data is ongoing.