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

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

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

BMJ Open ◽

10.1136/bmjopen-2016-015121 ◽

2017 ◽

Vol 7 (6) ◽

pp. e015121 ◽

Cited By ~ 3

Author(s):

Lisanne Hut-Mossel ◽

Gera Welker ◽

Kees Ahaus ◽

Rijk Gans

Keyword(s):

Hospital Care ◽

Evidence Synthesis ◽

Realist Review ◽

Local Context ◽

Quality Improvements ◽

Programme Theory ◽

Meta Review ◽

Ethical Approval ◽

Registration Number ◽

Improve Hospital

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

Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

BMJ Open ◽

10.1136/bmjopen-2018-024982 ◽

2019 ◽

Vol 9 (6) ◽

pp. e024982 ◽

Cited By ~ 4

Author(s):

Vicky Booth ◽

Rowan Harwood ◽

Jennie E Hancox ◽

Victoria Hood-Moore ◽

Tahir Masud ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Exercise Intervention ◽

Data Extraction ◽

Realist Review ◽

Falls Prevention ◽

Cochrane Library ◽

Programme Theory ◽

Eligibility Criteria ◽

Prevention Programmes

ObjectivesThis review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.DesignA realist review of the literature.Data sourcesEMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.Eligibility criteriaPublications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.Data extraction and synthesisA ‘rough programme theory’ (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.ResultsAn individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a ‘gate-keeper’, such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.ConclusionMotivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.PROSPERO registration numberCRD42015030169.

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

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

Community mobilisation approaches to preventing and reducing adolescent multiple risk behaviour: a realist review protocol

Systematic Reviews ◽

10.1186/s13643-021-01696-4 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Tinner Laura ◽

Caldwell Deborah ◽

Campbell Rona

Keyword(s):

Complex Interventions ◽

Realist Review ◽

Risk Behaviour ◽

Health Risk Behaviors ◽

Theory Model ◽

Family Influence ◽

Community Mobilisation ◽

Programme Theory ◽

Multiple Risk ◽

Multiple Risk Behaviour

Abstract Background Adolescent multiple risk behaviour (MRB) continues to be a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, rather than targeting the wider environmental or structural context. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. Despite this, there are gaps in the current literature, theory and implementation that would benefit from a realist approach due to the suitability of this methodology to analysing complex interventions. The objective of this study is to understand ‘how, why, for whom and in what circumstances and time periods’ do community mobilisation interventions work to prevent and/or reduce adolescent multiple risk behaviour. Methods This is a protocol for a realist review. The review will use a six-stage iterative process, guided by the RAMESES framework. We will systematically search PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies will be screened for relevance to the programme theory and included based on a priori eligibility criteria including (1) reporting a community mobilisation intervention (2) targeting two health risk behaviors (3) for adolescent populations. Two independent reviewers will select, screen and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome configurations that contribute to our programme theory. The findings will be synthesised to produce a refined programme theory model. Discussion The goal of this realist review is to identify and refine a programme theory for community mobilisation approaches to the prevention and/or reduction of adolescent multiple risk behaviour. Our aim is that the findings surrounding the programme theory refinement can be used to develop and implement adolescent multiple risk behaviour interventions and maintain collaboration between local policy makers, researchers and community members. Systematic review registration This realist review is registered on the PROSPERO database (registration number: CRD42020205342).

Download Full-text

Understanding factors critical to the implementation of ehealth in chronic disease management: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2020-048250 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048250

Author(s):

Nida Shahid ◽

Valeria E Rac ◽

Joanna Bielecki ◽

Whitney Berta

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Data Extraction ◽

Evidence Synthesis ◽

Grey Literature ◽

Complex Interventions ◽

Realist Review ◽

Chronic Obstructive ◽

Multiple Chronic Conditions

IntroductionCanadians are living longer, many with multiple chronic conditions. This population of older, frail Canadians continues to grow in size as do concurrent demands for community-based, outpatient and ambulatory models of care. Ideally, a multifaceted, proactive, planned and integrated care model includes ehealth. Although several factors are known to facilitate the implementation of ehealth in chronic disease management (CDM), for example, adequate support, usability, alignment of programme objectives, there is a growing body of inconclusive evidence on what is critical for implementation. We aim to achieve a fulsome understanding of factors critical to implementation by conducting a realist review—an approach suitable for understanding complex interventions. Our proposed review will identify factors critical to the implementation of ehealth in CDM (heart failure, chronic obstructive pulmonary disease, chronic kidney disease and/or diabetes (type 1 or 2)) without limitations to care setting, language, publication year or geography. Findings will be presented in configurations of contexts, mechanisms and outcomes (CMOs).Methods and analysisA search strategy will be iteratively developed based on the concepts of ‘implementation’ and ‘adoption’ of ‘ehealth’ interventions used within ‘CDM’ to identify the peer-reviewed and grey literature published before 31 March 2021 from five databases (Medline, Embase, Cochrane, CINAHL and PsychInfo) on ehealth interventions actively involving a healthcare provider for CDM among adults. Data extraction and synthesis will be guided by Realist and Meta-review Evidence Synthesis: Evolving Standards (RAMESES) guidelines informing core concepts of CMOs, and a study output will include a middle-range-theory describing the implementation of ehealth in CDM.Ethics and disseminationFindings will be published in an open-access peer-reviewed journal and presented at relevant conferences. A multistakeholder (patients, caregivers, healthcare providers and practitioners, decision-makers and policy-makers) perspective will be used in our dissemination approach. No formal ethics approval is required for this review.PROSPERO registration numberCRD42020208275.

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

Exploring how, why and in what contexts older adults are at risk of financial cybercrime victimisation: a realist review

10.31235/osf.io/qvdy3 ◽

2021 ◽

Author(s):

Alexandra Burton ◽

Claudia Cooper ◽

Ayesha Dar ◽

Lucy Mathews ◽

Kartikeya Tripathi

Keyword(s):

Older Adults ◽

Older People ◽

Cyber Security ◽

Mental Health Problems ◽

Realist Review ◽

Security Measures ◽

Physical And Mental Health ◽

Wealth Status ◽

Programme Theory ◽

Increased Risk

Although older people rarely report being victims of financial cybercrime, there is evidence that older online users are at increased risk. This realist review identified factors leading to older adults’ victimisation and reviewed the theory and evidence for interventions to reduce victimisation risks. We developed an initial programme theory from a scoping review and expert stakeholder consultations. We searched electronic databases, references and websites for literature meeting inclusion criteria. We analysed 52 primary and secondary data sources, seeking stakeholder views to develop and refine the programme theory and generate Context-Mechanism-Outcome Configurations (CMOCs) explaining how, why and in what circumstances older adults become financial cybercrime victims; and extrapolated this to consider rational intervention strategies. Our programme theory comprised 16 CMOCs describing how: social isolation, cognitive, physical and mental health problems; wealth status, limited cyber security skills or awareness, societal attitudes and content of scams led to victimisation. Only interventions to enhance older internet users’ awareness and skills have been trialled to date. Other theoretically plausible interventions include: offender management programmes, tailored security measures, society-wide stigma reduction and awareness-raising with groups who support older people. We recommend that the new UK Online Safety Bill is extended in scope to include online frauds.

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