OP63 Clinical Videoconferencing - Critical-realist Review As Evidence?

2019 ◽  
Vol 35 (S1) ◽  
pp. 15-16
Author(s):  
Anne Ekeland
Keyword(s):  
Critical Review ◽  
Digital Health ◽  
Local Level ◽  
Real Life ◽  
Realist Review ◽  
Health Interventions ◽  
Decision Makers ◽  
Social Interventions ◽  
Critical Realist ◽  
What Works

IntroductionIt is not clear yet whether new digital health interventions can and should be assessed by using ‘conventional’ health technology assessment (HTA) methodology. In response to the question about how much and which type of evidence is needed for decisions on new digital health interventions, this presentation discusses complimentary evidence as generated through a critical-realist review and a qualitative meta-synthesis. This work follows from earlier work by AG Ekeland, AH Hansen and TS Bergmo.MethodsA realist review addresses complex social interventions investigated in real life settings. The review was conducted with the purpose of generating knowledge on what works, for whom and under which circumstances. The aim was to enable decision-makers to reach a deeper understanding of how the intervention can be made to work most effectively. A critical review goes beyond mere description of identified articles and includes analysis and conceptual innovation. An effective critical review synthesizes material from diverse sources, provides an opportunity to ‘take stock’ and evaluate what is of value related to a previous body of work.ResultsUser patterns of clinical videoconferencing turned out to be dependent on contextual factors like clinical condition, motivation, technological skills, professional and organizational arrangements, trust and the perceived value they add compared with “services as usual”. The pattern of what works, for whom and under which circumstances was heterogeneous and dynamic. The review types helped identify and conceptualize new user categories, and understand the complex patterns of use.ConclusionsThe in-depth accounts of different clinical use resulting from such a review provide decision makers with a highly practical understanding of complex social interventions which is likely to be of use when planning and implementing programs at a national, regional or local level. A critical-realist review of digital services can complement controlled studies and evidence summaries in HTA.

Realist review - a new method of systematic review designed for complex policy interventions

2005 ◽  
Vol 10 (1_suppl) ◽  
pp. 21-34 ◽  
Author(s):  
Ray Pawson ◽  
Trisha Greenhalgh ◽  
Gill Harvey ◽  
Kieran Walshe
Keyword(s):  
Empirical Evidence ◽  
Public Services ◽  
Local Level ◽  
Social Systems ◽  
Realist Review ◽  
Policy And Practice ◽  
Programme Theory ◽  
Theoretical Understanding ◽  
Social Interventions ◽  
Policy Interventions

Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems-things like league tables, performance measures, regulation and inspection, or funding reforms. These are not ‘magic bullets‘ which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging ‘realist’ approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories) - the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level.

scholarly journals Communicating evidence in icons and summary formats for policymakers: what works?

2021 ◽  
pp. 1-29
Author(s):  
Cameron Brick ◽  
Alexandra L.J. Freeman
Keyword(s):  
Decision Makers ◽  
Policy Options ◽  
Negative Consequences ◽  
Graphical Displays ◽  
What Works ◽  
Financial Costs ◽  
Two Samples ◽  
Evidence Quality ◽  
Color Cues ◽  
Expected Outcomes

Abstract Policy decisions have vast consequences, but there is little empirical research on how best to communicate underlying evidence to decision-makers. Groups in diverse fields (e.g., education, medicine, crime) use brief, graphical displays to list policy options, expected outcomes and evidence quality in order to make such evidence easy to assess. However, the understanding of these representations is rarely studied. We surveyed experts and non-experts on what information they wanted and tested their objective comprehension of commonly used graphics. A total of 252 UK residents from Prolific and 452 UK What Works Centre users interpreted the meaning of graphics shown without labels. Comprehension was low (often below 50%). The best-performing graphics combined unambiguous metaphorical shapes with color cues and indications of quantity. The participants also reported what types of evidence they wanted and in what detail (e.g., subgroups, different outcomes). Users particularly wanted to see intervention effectiveness and quality, and policymakers also wanted to know the financial costs and negative consequences. Comprehension and preferences were remarkably consistent between the two samples. Groups communicating evidence about policy options can use these results to design summaries, toolkits and reports for expert and non-expert audiences.

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia J. Lucas ◽  
Alastair D. Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract Background Type 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aims To gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups. Methods A purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically. Results A diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender. Conclusion This research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

Sign in / Sign up

Export Citation Format

Share Document