Part 1 - Looking Back and Looking Around: How Parents, Coaches and Athletes See Psychosocial Development in Adolescent Performance Sport.

Sport has the potential to support psychosocial development in young people. However, extant studies have tended to evaluate purpose-built interventions, leaving regular organised sport relatively overlooked. Moreover, previous work has tended to concentrated on a narrow range of outcomes. To address these gaps, we conducted a season-long ethnography of a youth performance sport club based on a novel Realist Evaluation approach [1]. We construed the club as a social intervention within a complex system of agents and structures. In this - Part 1 - account we detail the perceptions of former and current club parents, players and coaches, using them to build a set of programme theories. The resulting network of outcomes (i.e. self, emotional, social, moral and cognitive) and generative mechanisms (i.e., the attention factory, the greenhouse for growth, the personal boost, and the real-life simulator) spanning across multiple contextual layers provides a nuanced understanding of stakeholders’ views and experiences. This textured perspective of the multi-faceted process of development provides new insights for administrators, coaches and parents to maximise the developmental properties of youth sport, and signposts new avenues for research in this area.

Nurse-led projects for people experiencing homelessness and other inclusion health groups: a realist evaluation

Nursing service development or innovation projects, even small-scale ones, can be difficult to deliver and evaluate, due to a lack of resources and support. Results can also be difficult to disseminate, limiting transfer of learning. This paper presents findings from a realist evaluation of 10 small projects supported by the Queen's Nursing Institute Homeless and Inclusion Health Programme to deliver innovation in health care for people experiencing homelessness and other marginalised groups. These nurse-led projects were funded by the Queen's Nursing Institute and the Oak Foundation, and were largely successful in achieving outcomes to support the improved health of people experiencing homelessness and other marginalised groups. This realist evaluation explores the factors that contributed to the delivery of positive outcomes. All were impacted by the context and the response (mechanisms) of people experiencing homelessness and staff within these settings. It is hoped that the lessons learned will enable better support for nurse innovation projects in the future.

Using a Realist Framework to Overcome Evaluation Challenges in the Uncertain Landscape of Carbon Finance

In 2013, the United Kingdom Department for International Development and the Department of Business, Energy, and Industrial Strategy published a business case for the Carbon Market Finance Programme (CMFP). The core mandate: to build capacity and develop aids for least developed countries in sub-Saharan Africa to access finance via the carbon market. The chosen strategy involved signing emission reduction purchase agreements with private sector enterprises, using the United Nations Framework Convention for Climate Change’s Clean Development Mechanism (CDM) to verify generation of tradeable certified emissions reductions. The World Bank’s Carbon Initiative for Development (Ci-Dev) would implement the 12-year program. The team for the 2019 midterm evaluation found that program uncertainty—from sociopolitical challenges in pilot markets to global indecision on the future of Article 6 and carbon markets—would complicate assessing progress toward business case objectives. The collapse and failed recovery of the carbon market impacted underlying assumptions of the CMFP’s theory of change, and uncertainty about CDM’s future complicated evaluation of program sustainability. This chapter presents a practical approach to using realist evaluation to overcome the contextual uncertainties of the carbon market landscape, providing strengths and weaknesses of the approach applied and recommending a revised approach for future evaluations.

The role of contextual factors on participation in the life area of work and employment after rehabilitation: A qualitative study on the views of persons with chronic pain

BACKGROUND: A deeper understanding of how contextual factors affect the ability to participate in the life area of work and employment despite chronic musculoskeletal pain is needed as a basis for interprofessional rehabilitation programs. OBJECTIVE: To investigate which contextual factors influence rehabilitation program clients’ ability to participate in the life area of work and employment, and how they do this. METHODS: Nested case study using a realist evaluation framework of interprofessional interventions. Qualitative content analysis of problem-centered interviews to identify influential context-mechanism-outcome configurations. RESULTS: We identified several important context-mechanism-outcome configurations. In the pre-interventional phase, socioeconomic and environmental factors affected two mechanisms, “exhaustion” and “discrimination”. In the intra-interventional phase, the social skills of health professionals and opportunities for discussion with peers affected the ability of program participants to engage with program content. In the post-intervention phase, volitional competences of the social system affected the sustainable application of program content in everyday life. CONCLUSION: The identified context-mechanism-outcome configurations shows that the ability to participate in the life area of work is interdependent with the ability to participate in other areas of life. In practice and research, assessment and treatment should be carried out based on this understanding.

Cross-cultural realist interviews: An integration of the realist interview and cross-cultural qualitative research methods

Realist interviews are a data collection method used in realist evaluations. There is little available guidance for realist interviewing in cross-cultural contexts. Few published realist evaluations have included cross-cultural interviews, providing limited analyses of the cross-cultural application of realist methodology. This study integrated realist and cross-cultural qualitative methods in a realist evaluation of an Australian doula support program. The interviews were conducted with Arabic speaking clients of the program. The process included collaboration with a bicultural researcher, philosophically situating the study for methodologically coherent integration, bicultural review of the appropriateness of realist ‘how’ and ‘why’ questions, decisions about language translation and interpretation, pilot interviews, and co-facilitation of the interviews. Integration of the methods was feasible and valuable. This study may support other realist evaluators to give voice to people from culturally diverse groups, in a manner that is culturally safe, methodologically coherent and rigorous, and that produces trustworthy results.

Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation

ObjectivesGentamicin is the aminoglycoside antibiotic of choice in the UK. It has a narrow therapeutic index: underdosing results in inefficacy while overdosing is characterised by nephrotoxicity and ototoxicity. To improve patient safety, hospitals have protocols for the prescription of gentamicin, which vary in complexity and approach. This study aimed to explore two distinct protocols for prescribing gentamicin in hospital settings, in order to understand the mechanisms they trigger and the outcomes they achieve.SettingA mixed-methods realist evaluation explored gentamicin prescribing protocols in two hospital surgical admissions units in South West England between January and August 2018. Site 1 had a traditional, complex protocol, while site 2 took a simplified protocol.ParticipantsTesting the initial programme theory (IPT) involved semi-structured audio-recorded interviews of a volunteer sample of healthcare professionals (HCPs) involved in the prescribing and administering process, alongside a clinical audit reviewing accuracy of gentamicin prescribing.Outcome measuresThree sequential phases were used to identify factors in a successful protocol: IPT generation; testing; refinement of the IPT. The IPT was generated by literature search and analysis of existing protocols of sites 1 and 2. Refinement of the IPT synthesised the results of the quantitative and qualitative research to identify the key characteristics of a successful protocol.ResultsOne hundred gentamicin prescriptions were reviewed, with a mean accuracy of gentamicin prescribing at site 1 of 65.67% and at site 2 of 78.79% (p<0.01). Thirty HCPs were interviewed. Key contexts were identified including prescriptiveness, experience and availability of patient information. These triggered hidden mechanisms including uncertainty, fear, confidence and frustration leading to both intended outcomes but also unintended outcomes such as deviation from protocol and unnecessary gentamicin levels.ConclusionsA simplified prescribing protocol for gentamicin is better accepted by prescribers, leading to better adherence to protocol and more accurate prescribing.

Transforming social norms to improve girl-child health and well-being: a realist evaluation of the Girls’ Holistic Development program in rural Senegal

Background Early adolescence is a critical period where social norms, attitudes, and behaviors around gender equality form. Social norms influence adolescent choices and behaviors and are reinforced by caregivers and community members, affecting girls’ reproductive health and educational opportunities. Understanding how to shift these often-interconnected norms to delay child marriage, pregnancy and keep girls in school requires understanding of the structure and dynamics of family and community systems. The Senegalese and American non-governmental organization, the Grandmothers Project—Change through Culture, seeks to address these intertwined factors through innovative community change strategies that build on the specific structure and values of West African collectivist cultures. Methods The Girls’ Holistic Development approach in rural Vélingara, Senegal posits that by increasing recognition, knowledge and empowerment of elder community women and reinforcing intergenerational communication and decision-making, community members including girls will support and advocate on behalf of girls’ interests and desires. We assessed the Girls Holistic Development approach using Realist Evaluation with a mixed-method, quasi-experimental design with a comparison population. We examined differences in intergenerational communication, decision-making and descriptive and injunctive norms related to early marriage, pregnancy and schooling. Results After 18 months, intergenerational communication was more likely, grandmothers felt more valued in their communities, adolescent girls felt more supported with improved agency, and norms were shifting to support delayed marriage and pregnancy and keeping girls in school. Grandmothers in intervention villages were statistically significantly more likely to be perceived as influential decision-makers by both VYA girls and caregivers for marriage and schooling decisions compared to girls and caregivers in comparison villages. Conclusions This realist evaluation demonstrated shift in social norms, particularly for VYA girls, in intervention villages favoring delaying girls’ marriage, preventing early pregnancy and keeping girls in school along with increased support for and action by grandmothers to support girls and their well-being related to these same outcomes. These shifts represent greater community social cohesion on girl-child issues. This research helps explain the linkage between social norms and girls’ reproductive health and education outcomes and demonstrates that normative shifts can lead to behavior change via collective community action mechanisms.