Understanding how and why audits work: protocol for a realist review of audit programmes to improve hospital care

IntroductionMany types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method.Methods and analysisThis review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the ‘Realist and Meta-Review Evidence Synthesis: Evolving Standards’ (RAMESES) publication standards.Ethics and disseminationThis review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences.PROSPERO registration numberCRD42016039882.

Download Full-text

Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2018-024876 ◽

2018 ◽

Vol 8 (11) ◽

pp. e024876 ◽

Cited By ~ 7

Author(s):

Ruth Abrams ◽

Geoffrey Wong ◽

Kamal Ram Mahtani ◽

Stephanie Tierney ◽

Anne-Marie Boylan ◽

...

Keyword(s):

Home Visiting ◽

Hospital Admissions ◽

Evidence Synthesis ◽

Realist Review ◽

Professional Associations ◽

Community Dwelling ◽

Mixed Method Research ◽

Programme Theory ◽

Registration Number ◽

The Impact

IntroductionIn western countries, early visiting services (EVS) have been proposed as a recent intervention to reduce both general practitioner workload and hospital admissions among housebound individuals experiencing a healthcare need within the community. EVS involves the delegation of the patient home visits to other staff groups such as paramedics or nursing staff. However, the principles of organising this care are unknown and it remains unclear how different contexts, such as patient conditions and the processes of organising EVS influence care outcomes. A review has been designed to understand how EVS are enacted and, specifically, who benefits, why, how and when in order to provide further insight into the design and delivery of EVS.Methods and analysisThe purpose of this review is to produce findings that provide explanations of how and why EVS contexts influence their associated outcomes. Evidence on EVS will be consolidated through realist review—a theory-driven approach to evidence synthesis. A realist approach is needed as EVS is a complex intervention. What EVS achieve is likely to vary for different individuals and contexts. We expect to synthesise a range of relevant data such as qualitative, quantitative and mixed-method research in the following stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesising and refining the programme theory.Ethics and disseminationA formal ethics review is not required as this study is secondary research. Findings will be disseminated in a peer-reviewed journal, at national and international conferences and to relevant professional associations.PROSPERO registration numberCRD42018096518.

Download Full-text

Understanding how to enhance efficacy and effectiveness of feedback via e-portfolio: a realist synthesis protocol

BMJ Open ◽

10.1136/bmjopen-2019-029173 ◽

2019 ◽

Vol 9 (5) ◽

pp. e029173 ◽

Cited By ~ 1

Author(s):

Mojca Babovič ◽

Ren-Huei Fu ◽

Lynn V Monrouxe

Keyword(s):

Course Design ◽

Evidence Synthesis ◽

Educational Practice ◽

Realist Synthesis ◽

Programme Theory ◽

Clinical Supervisors ◽

Context Sensitive ◽

Ethical Approval ◽

Registration Number ◽

Synthesis Report

IntroductionThe validity of feedback as one of the defining components for electronic portfolios (e-portfolios) to be effective and efficacious has yet to be demonstrated. While the literature has shown individual beneficial features of e-portfolios and feedback per se, evidence of feedback as mediated through technology directly resulting in improved educational practice is scarce. The explanation of how feedback via e-portfolio improves educational practice is particularly vague.Methods and analysisThe aim of this research is to unpack how and why feedback via e-portfolio is likely to flourish or wither in its path. Given the complexity of intervention, we will apply a theory-driven approach for evidence synthesis called realist synthesis. Informed by realist philosophy of science, it seems the most appropriate method because it explores observed outcomes (O) in terms of causal relationship between relevant contexts (C) and generating mechanisms (M). Initial programme theory will be developed through literature scoping. Later on it will be tested against purposively gathered evidence (through database and journal search), which simultaneously will be evaluated for rigour and relevance (whether method used are trustworthy and whether data contributes to theory building). We strive to (1) uncover ‘context sensitive’ mechanisms that generate feedback via e–portfolio to be (in) effective and (2) define in what circumstances is this mostly likely to occur.Ethics and disseminationThe synthesis report will be written according to the RAMESES guidelines and its findings will be published in peer reviewed articles and presented at relevant conferences. The aim is to inform: (1) policy and decision makers for future-course design; (2) medical educators/clinical supervisors and learners for improved educational use. No formal ethical approval is required.PROSPERO registration number120863.

Download Full-text

A realist review of community engagement with health research

Wellcome Open Research ◽

10.12688/wellcomeopenres.15298.1 ◽

2019 ◽

Vol 4 ◽

pp. 87 ◽

Cited By ~ 3

Author(s):

Bipin Adhikari ◽

Robin Vincent ◽

Geoff Wong ◽

Claire Duddy ◽

Emma Richardson ◽

...

Keyword(s):

Global Health ◽

Community Engagement ◽

Health Research ◽

Evidence Synthesis ◽

Realist Review ◽

Evidence Base ◽

Programme Theory ◽

Middle Income ◽

Middle Income Countries ◽

Registration Number

Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review – a theory driven approach to evidence synthesis – to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review. Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687

Download Full-text

Explaining variations in test ordering in primary care: protocol for a realist review

BMJ Open ◽

10.1136/bmjopen-2018-023117 ◽

2018 ◽

Vol 8 (9) ◽

pp. e023117 ◽

Cited By ~ 5

Author(s):

Claire Duddy ◽

Geoffrey Wong

Keyword(s):

Primary Care ◽

Realist Review ◽

Programme Theory ◽

Dissemination Strategy ◽

Care Protocol ◽

Ethical Approval ◽

Registration Number ◽

Primary Care Doctors ◽

Generative Mechanisms ◽

Test Ordering

IntroductionStudies have demonstrated the existence of significant variation in test-ordering patterns in both primary and secondary care, for a wide variety of tests and across many health systems. Inconsistent practice could be explained by differing degrees of underuse and overuse of tests for diagnosis or monitoring. Underuse of appropriate tests may result in delayed or missed diagnoses; overuse may be an early step that can trigger a cascade of unnecessary intervention, as well as being a source of harm in itself.Methods and analysisThis realist review will seek to improve our understanding of how and why variation in laboratory test ordering comes about. A realist review is a theory-driven systematic review informed by a realist philosophy of science, seeking to produce useful theory that explains observed outcomes, in terms of relationships between important contexts and generative mechanisms.An initial explanatory theory will be developed in consultation with a stakeholder group and this ‘programme theory’ will be tested and refined against available secondary evidence, gathered via an iterative and purposive search process. This data will be analysed and synthesised according to realist principles, to produce a refined ‘programme theory’, explaining the contexts in which primary care doctors fail to order ‘necessary’ tests and/or order ‘unnecessary’ tests, and the mechanisms underlying these decisions.Ethics and disseminationEthical approval is not required for this review. A complete and transparent report will be produced in line with the RAMESES standards. The theory developed will be used to inform recommendations for the development of interventions designed to minimise ‘inappropriate’ testing. Our dissemination strategy will be informed by our stakeholders. A variety of outputs will be tailored to ensure relevance to policy-makers, primary care and pathology practitioners, and patients.Prospero registration numberCRD42018091986

Download Full-text

Identifying conducive contexts and working mechanisms of sedentary behaviour interventions in older adults: a realist review protocol as part of the ‘Stand UP Seniors’ project

BMJ Open ◽

10.1136/bmjopen-2021-053942 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053942

Author(s):

Sofie Compernolle ◽

Delfien Van Dyck ◽

Kenneth Vanhove ◽

Sebastien F M Chastin ◽

Emelien Lauwerier ◽

...

Keyword(s):

Older Adults ◽

Sedentary Behaviour ◽

Evidence Synthesis ◽

Complex Interventions ◽

Realist Review ◽

Depth Information ◽

Programme Theory ◽

Age Related ◽

Modifiable Factors ◽

Ethical Approval

IntroductionLifestyle behaviours, including sedentary behaviour, have been listed as key modifiable factors to promote healthy ageing. Sedentary behaviour is ubiquitous in older adults and has a strong link with age-related functional declines and chronic health conditions. Although several interventions have been developed aimed at the reduction of sedentary behaviour in older adults, little in-depth information is available on how these complex interventions work in different contexts. Therefore, the aim of our study was to unpack the mechanisms of how existing interventions aimed at the reduction of older adults’ sedentary behaviour work or fail to work in particular contexts in order to optimise the development and implementation of future sedentary behaviour interventions.Methods and analysisA realist review will be conducted as a first part of the Stand UP Seniors (SUPS) project and will be structured as follows: (1) defining the scope of the review, (2) searching and appraising the evidence, (3) extracting data and synthesising the results, and (4) drawing conclusions and formulating recommendations. The result of this iterative process will be a final programme theory that can be used to identify which context triggers which mechanism, and in turn might elicit which outcome. The final programme theory will be used to inform the second and the third parts of the SUPS project, which are, respectively, the development and evaluation of a sedentary behaviour intervention in older adults.Ethics and disseminationEthical approval is not required for the review. Dissemination of the realist review results, including the final programme theory, will occur through peer-reviewed publications and presentations at relevant conferences. The peer-reviewed realist review will be prepared according to the Realist and Meta-narrative Evidence Synthesis: Evolving Standards publication standards for realist syntheses.PROSPERO registration numberCRD42021248795.

Download Full-text

A realist review of community engagement with health research

Wellcome Open Research ◽

10.12688/wellcomeopenres.15298.2 ◽

2019 ◽

Vol 4 ◽

pp. 87 ◽

Cited By ~ 1

Author(s):

Bipin Adhikari ◽

Robin Vincent ◽

Geoff Wong ◽

Claire Duddy ◽

Emma Richardson ◽

...

Keyword(s):

Global Health ◽

Community Engagement ◽

Health Research ◽

Evidence Synthesis ◽

Realist Review ◽

Evidence Base ◽

Programme Theory ◽

Middle Income ◽

Middle Income Countries ◽

Registration Number

Download Full-text

Psychological resilience during COVID-19: a meta-review protocol

BMJ Open ◽

10.1136/bmjopen-2021-051417 ◽

2021 ◽

Vol 11 (6) ◽

pp. e051417

Author(s):

Katie Seaborn ◽

Mark Chignell ◽

Jacek Gwizdka

Keyword(s):

Systematic Reviews ◽

Well Being ◽

Measurement Tool ◽

Psychological Resilience ◽

Key Points ◽

Meta Review ◽

Ethical Approval ◽

Registration Number ◽

Review Protocol

IntroductionThe global COVID-19 pandemic continues to have wide-ranging implications for health, including psychological well-being. A growing corpus of research reviews has emerged on the topic of psychological resilience in the context of the pandemic. However, this body of work has not been systematically reviewed for its quality, nor with respect to findings on the effectiveness of tools and strategies for psychological resilience. To this end, a meta-review protocol is proposed with the following objectives: (1) identify review work on the topic of psychological resilience during COVID-19; (2) assess the quality of this review work using A MeaSurement Tool to Assess systematic Reviews; (3) assess the risk of bias in this work; (4) generate a narrative summary of the key points, strengths and weaknesses; (5) identify the psychological resilience strategies that have been reviewed; (6) identify how these strategies have been evaluated for their effectiveness; (7) identify what outcomes were measured and (8) summarise the findings on strategies for psychological resilience so far, providing recommendations, if possible.Methods and analysisA systematic meta-review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews for Protocols and Joanna Briggs Institute umbrella review guidelines. Electronic searches of general databases, especially Web of Science, Scopus and PubMed, will be conducted. Only results from January 2020 onwards will be considered, coinciding with the COVID-19 pandemic. Only results in English will be included. Descriptive statistics, thematic analysis and narrative summaries describing the nature of the reviewed work and evaluation of psychological resilience strategies will be carried out.Ethics and disseminationEthical approval is not needed for systematic review protocols. The results of the meta-review will be published in an international peer-reviewed journal. The raw and summarised data will be shared in the journal or other open venues.PROSPERO registration numberCRD42021235288.

Download Full-text

Caregiver-mediated interventions to support self-regulation among infants and young children (0–5 years): a protocol for a realist review

BMJ Open ◽

10.1136/bmjopen-2020-046078 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046078

Author(s):

Amy Finlay-Jones ◽

Jetro Emanel Ang ◽

Elaine Bennett ◽

Jenny Downs ◽

Sally Kendall ◽

...

Keyword(s):

School Readiness ◽

Working Group ◽

Protective Factor ◽

Evidence Synthesis ◽

Grey Literature ◽

Self Regulation ◽

Realist Review ◽

Programme Theory ◽

Review Team ◽

The Impact

IntroductionSelf-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services.Methods and analysisRealist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines.Ethics and disseminationEthical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations.Review registration numberThe protocol is registered with Open Science Framework https://osf.io/5ce2z/registrations.

Download Full-text

Remediating doctors’ performance to restore patient safety: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025943 ◽

2018 ◽

Vol 8 (10) ◽

pp. e025943 ◽

Cited By ~ 2

Author(s):

Tristan Price ◽

Nicola Brennan ◽

Jennifer Cleland ◽

Linda Prescott-Clements ◽

Amanda Wanner ◽

...

Keyword(s):

Patient Safety ◽

Evidence Synthesis ◽

Grey Literature ◽

Realist Review ◽

Evidence Base ◽

Stakeholder Group ◽

Programme Theory ◽

Dissemination Strategy ◽

Knowledge To Action ◽

Patient Representatives

IntroductionUnderperformance by doctors poses a risk to patient safety. Remediation is an intervention designed to remedy underperformance and return a doctor to safe practice. Remediation is widely used across healthcare systems globally, and has clear implications for both patient safety and doctor retention. Yet, there is a poor evidence base to inform remediation programmes. In particular, there is a lack of understanding as to why and how a remedial intervention may work to change a doctor’s practice. The aim of this research is to identify why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to support patient safety.Methods and analysisRealist review is an approach to evidence synthesis that seeks to develop programme theories about how an intervention works to produce its effects. The initial search strategy will involve: database and grey literature searching, citation searching and contacting authors. The evidence search will be extended as the review progresses and becomes more focused on the development of specific aspects of the programme theory. The development of the programme theory will involve input from a stakeholder group consisting of professional experts in the remediation process and patient representatives. Evidence synthesis will use a realist logic of analysis to interrogate data in order to develop and refine the initial programme theory into a more definitive realist programme theory of how remediation works. The study will follow and be reported according to Realist And Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).Ethics and disseminationEthical approval is not required. Our dissemination strategy will include input from our stakeholder group. Customised outputs will be developed using the knowledge-to-action cycle framework, and will be targeted to: policy-makers; education providers and regulators, the National Health Service, doctors and academics.PROSPERO registration numberCRD42018088779.

Download Full-text

NHS Health Check programme: a protocol for a realist review

BMJ Open ◽

10.1136/bmjopen-2021-048937 ◽

2021 ◽

Vol 11 (4) ◽

pp. e048937

Author(s):

Claire Duddy ◽

Geoff Wong ◽

E W Gadsby ◽

Janet Krska ◽

Vivienne Hibberd

Keyword(s):

Public Health ◽

Adult Population ◽

Realist Review ◽

Health Check ◽

Design Strategies ◽

Cvd Risk ◽

Increased Risk ◽

Ethical Approval ◽

Registration Number ◽

Nhs Health Check

IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.Methods and analysisWe aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson’s five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes.Ethics and disseminationEthical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.PROSPERO registration numberCRD42020163822.

Download Full-text