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Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why?  cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  !Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l !  #%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  $ Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y %Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? 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Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#" PowerPoint Document(</DocumentSummaryInformation8Dܖ"DArial Black0TT*ܖ 0ܖ" DArial (W1)0TT*ܖ 0ܖ0DSymbolW1)0TT*ܖ 0ܖ B .  @n?" dd@  @@`` ph   $?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4?d?d|& 0ppp@ <4dddd k 0T*h___PPT2001D<4XDe___PPT10E .$ hss401.6? %1jReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline [ Background & methodology Searching & retrieval Extraction & synthesis Emerging findings :ZX([  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why?  cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  !Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l !  #%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  $ Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y %Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? 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What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? 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What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  ,+Theory Area1: Impact of Change Agents on KU,,$4 *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"}  0 @$(  r  S H)   r  S X3)`   H  0޽h ? 3f33f___PPT10i."Ƶ+D='  = @B +$  0 0$(  r  S >    r  S  `   H  0޽h ? 3f33f80___PPT10.!0rF+ aF>,1I( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` zu  $ !"#$%&'?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *D h___PPT2001D<4XDe___PPT10E .$ hss401.6? %?jReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  ,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"$  0 0$(  r  S >    r  S   `   H  0޽h ? 3f33f80___PPT10.!0  0 P(  r  S `   H  0޽h ? 3f33f___PPT10i.#P+D=' = @B +}  0 `$(  r  S :   r  S `  H  0޽h ? 3f33f___PPT10i.#2t+D=' = @B +  0 p(  r  S $`0   H  0޽h ? 3f33f80___PPT10.#kr~,@/[fZ/1P( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` }~   $ !"#$%&'()*?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *D h___PPT2001D<4XDe___PPT10E .$ hss401.6? %FjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  0!What worked wellCommunication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O1"What challenges were overcome$Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  2,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:!Refine data extraction templates N  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"6  0 6(  ~  s *    x  c $   H  0޽h ? 3380___PPT10.!0sL<  0 <(  ~  s *U   ~  s *h.   H  0޽h ? 3380___PPT10.!`'3$  0 $(  r  S _   r  S 0`  H  0޽h ? 3f33f80___PPT10.$8Ór00,/T1321 Q( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` 4, ~   $ !"#$%&'(-.?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *>2001<4XD\___PPT10< .$ hss401.? %FjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  3%What worked wellCommunication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O4&What challenges were overcome$Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  2,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:!Refine data extraction templates N  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"6  0 6(  ~  s *`c    x  c $H 0 `    H  0޽h ? 3380___PPT10.!0sL<  0 <(  ~  s *<    ~  s *஢ `   H  0޽h ? 3380___PPT10.!`'3r33 ք3X41d( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` |p0(  $ !"#$%&'(-.1234567:?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *&(h___PPT2001D<4XDe___PPT10E .$ hss401.6? %YjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  5. Title SlideNames? Dates? purpose statement theoretical model terms of reference telemtng dates focus on theory area 1 development of TM, TR, & DE toolF?6'/Searching, Relevance Testing, & Data Extraction00$Zsearch strategy relevance, 2 stream approach data extraction, final relevant papers Z[7(Search Strategiesbroad, not discipline-specific, corresponding to healthcare in general approx 39 lines of search text used with Boolean operators 8)Search Results6 online databases (1997-2007): (Medline, CINAHL, Embase, PsycInfo, Sociological Abstracts, Web of Science) Health Sciences Librarians (Dalhousie University, McMaster University) consulted on search strategies run March 5, 2007 in OVIDF"N"Ne,59*Search Results24,021 electronic references Medline 4,530 Embase 8,482 CINAHL 5,683 PsycInfo 4,993 Sociological Abstracts 248 Web of Science 130 196 potentially-relevant papers based on title and abstract (return rate of 0.8%)PPfP<PPfS,+:+Inclusion Criteria $Urelate to purpose statement: What are the interventions and strategies that are effective in enabling evidence-informed health care? published in the last 10 years english-language healthcare related all disciplines not limited by research focus or design (e.g. papers addressing intervention application in addition to effectiveness)lPlP~POPi~O;,Data Extraction papers divided among 5 work groups further papers eliminated based on full versions data extraction of each paper by 2 reviewers final data extraction resulted in BLANK relevant papers &<-)RES-IS WORKING GROUP DATA EXTRACTION FORM**) FULL REFERENCE, APA format: THEORY AREA 1  PROPERTIES OF CHANGE AGENCY IN KU What impact do the characteristics of the change agent have on KU? What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? IS THE EVIDENCE PROVIDED IN THIS THEORY AREA GOOD AND RELEVANT ENOUGH TO BE INCLUDED IN THE SYNTHESIS (CONSIDER ISSUES OF SAMPLE SIZE, DATA COLLECTION, DATA ANALYSIS AND CLAIMS MADE) Overarching questions: IS THERE EVIDENCE OF PARTICULAR THEORETICAL PERSPECTIVE(S) IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF CONTEXTUAL FACTORS IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF THE LEVEL OF THE INTERVENTION IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF THE INTERVENTION DOSE IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? TNPPcPP 3%!Overall Process: What worked well"" Communication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O4&.Overall Process: What challenges were overcome// Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  2,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:!Refine data extraction templates N  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /" 0 06(  0~ 0 s *2  s 2  x 0 c $`2   2  H 0 0޽h ? v`___PPT10i.7P:+D='  = @B +  0  <(   ~   s *̎   ~   s *ώ`  H   0޽h ? v`___PPT10i.7Y+D='  = @B +  0  <(  ~  s *P9   ~  s *LJ`  H  0޽h ? v`___PPT10i.7Y+D='  = @B +  0 0<(  ~  s *U   ~  s *`Z`  H  0޽h ? v`___PPT10i.7Y+D='  = @B +  0 @<(  ~  s *m   ~  s *q`  H  0޽h ? v`___PPT10i.ov+D='  = @B +  0 P6(  ~  s *@   x  c $`3sJ  H  0޽h ? v`___PPT10i.P9.u+D='  = @B +  0 ` <(   ~   s *2   ~   s *D`  H   0޽h ? v`___PPT10i.D+D='  = @B +  0 p$6(  $~ $ s *   x $ c $<m  H $ 0޽h ? v`___PPT10i.v^ +D='  = @B +  0 6(  ~  s *`c @   x  c $H 0 `    H  0޽h ? 33___PPT10i.!0sL+D='  = @B +  0 <(  ~  s *<    ~  s *஢    H  0޽h ? 33___PPT10i.!`'3+D='  = @B +r43(R)].t<1d( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" small Bildrubriker#X 8@ _TemplateIDTC010721201033 _TemplateIDTC010721201033      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~dd@  @@`` |p0(  $ !"#$%&'(-.1234567:?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *&(h___PPT2001D<4XDe___PPT10E .$ hss401.6? %YjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  5. Title SlideNames? Dates? purpose statement theoretical model terms of reference telemtng dates focus on theory area 1 development of TM, TR, & DE toolF?6'/Searching, Relevance Testing, & Data Extraction00$Zsearch strategy relevance, 2 stream approach data extraction, final relevant papers Z[7(Search Strategiesbroad, not discipline-specific, corresponding to healthcare in general approx 39 lines of search text used with Boolean operators 8)Search Results6 online databases (1997-2007): (Medline, CINAHL, Embase, PsycInfo, Sociological Abstracts, Web of Science) Health Sciences Librarians (Dalhousie University, McMaster University) consulted on search strategies run March 5, 2007 in OVIDF"N"Ne,59*Search Results24,021 electronic references Medline 4,530 Embase 8,482 CINAHL 5,683 PsycInfo 4,993 Sociological Abstracts 248 Web of Science 130 196 potentially-relevant papers based on title and abstract (return rate of 0.8%)PPfP<PPfS,+:+Inclusion Criteria $Urelate to purpose statement: What are the interventions and strategies that are effective in enabling evidence-informed health care? published in the last 10 years english-language healthcare related all disciplines not limited by research focus or design (e.g. papers addressing intervention application in addition to effectiveness)lPlP~POPi~O;,Data Extraction papers divided among 5 work groups further papers eliminated based on full versions data extraction of each paper by 2 reviewers final data extraction resulted in BLANK relevant papers &<-)RES-IS WORKING GROUP DATA EXTRACTION FORM**) FULL REFERENCE, APA format: THEORY AREA 1  PROPERTIES OF CHANGE AGENCY IN KU What impact do the characteristics of the change agent have on KU? What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? IS THE EVIDENCE PROVIDED IN THIS THEORY AREA GOOD AND RELEVANT ENOUGH TO BE INCLUDED IN THE SYNTHESIS (CONSIDER ISSUES OF SAMPLE SIZE, DATA COLLECTION, DATA ANALYSIS AND CLAIMS MADE) Overarching questions: IS THERE EVIDENCE OF PARTICULAR THEORETICAL PERSPECTIVE(S) IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF CONTEXTUAL FACTORS IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF THE LEVEL OF THE INTERVENTION IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? IS THERE EVIDENCE OF THE INTERVENTION DOSE IMPACTING ON THE EFFECTIVENESS OF THE INTERVENTION? TNPPcPP 3%!Overall Process: What worked well"" Communication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O4&.Overall Process: What challenges were overcome// Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  2,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:!Refine data extraction templates N  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"r%.Hl<1Z( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` |p0&  $ !"#$%&'(-.123456?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *&(h___PPT2001D<4XDe___PPT10E .$ hss401.6? %0PjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  6'/Searching, Relevance Testing, & Data Extraction00$Zsearch strategy relevance, 2 stream approach data extraction, final relevant papers Z[7(Search Strategiesbroad, not discipline-specific, corresponding to healthcare in general approx 39 lines of search text used with Boolean operators 8)Search Results6 online databases (1997-2007): (Medline, CINAHL, Embase, PsycInfo, Sociological Abstracts, Web of Science) Health Sciences Librarians (Dalhousie University, McMaster University) consulted on search strategies run March 5, 2007 in OVIDF"N"Ne,59*Search Results24,021 electronic references Medline 4,530 Embase 8,482 CINAHL 5,683 PsycInfo 4,993 Sociological Abstracts 248 Web of Science 130 196 potentially-relevant papers based on title and abstract (return rate of 0.8%)PPfP<PPfS,+:+Inclusion Criteria $Urelate to purpose statement: What are the interventions and strategies that are effective in enabling evidence-informed health care? published in the last 10 years english-language healthcare related all disciplines not limited by research focus or design (e.g. papers addressing intervention application in addition to effectiveness)lPlP~POPi~O;,Data Extraction papers divided among 5 work groups further papers eliminated based on full versions data extraction of each paper by 2 reviewers final data extraction resulted in a number of papers being omitted 4&.Overall Process: What challenges were overcome// Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  23%!Overall Process: What worked well"" Communication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:!Refine data extraction templates N  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"! 0 80P\(  \ \  0l5.A S" @0   . r \ S 6. p  . d \ 07.   Alison Hutchinson, Australia/Canada Alyce Schultz, USA Brendan McCormack, UK Bridie Kent, New Zealand Cheryl Stetler, USA Erna Snelgrove-Clarke, Canada Jo Rycroft-Malone, UK Kara DeCorby, Canada Lars Wallin, Sweden Marita Titler, USA Tracey Bucknall, Australia Val Wilson, Australia 2m      +         " H \ 0޽h ? 3f33f___PPT10i..+D='  = @B +  0 ` <(   ~   s *2   ~   s *D`  H   0޽h ? v`___PPT10i.D+D='  = @B +r|l";K+Xl<1[( / 00DArialW1)0TTD*ܖx: 0ܖ"DArial Black0TTD*ܖx: 0ܖ" DArial (W1)0TTD*ܖx: 0ܖ0DSymbolW1)0TTD*ܖx: 0ܖ B .  @n?" dd@  @@`` x4'  $ !"#$%&'(-.123456;?b$A3M}L9y4$b$uԍ?ݯl'\n 0AA >3gQ@8mJ ʚ;[j8ʚ; g4BdBdx: 0ppp@ <4dddd  0T *<4dddd  0T *&(h___PPT2001D<4XDe___PPT10E .$ hss401.6? %oQjReS-IS Realist Synthesis  Implementation Strategies (66.6" 2 $The story so far& .$ Outline P Background & methodology Searching & retrieval Process issues Emerging findings$QO(P  Background  KU colloquia Frustration Existing evidence base for  effective interventions (OO,O The state of the evidence base Systematic review evidence* Some indications: Facilitative approaches, feedback, education& . Some limitationsD./.$/ $m  Limitations  zEquivocal findings Don t necessarily relate to the professional practice of all practitioners Use of behaviour change as outcome measure Lack of acknowledgement about complexity and context JA different approach  different lens&&$% 8Want to know about what is working, what isn t working: Different contexts (& levels) Different stakeholders Address meaningful questions Theoretical driven<8508$5 0$   Methodology  , Realist synthesis (Pawson et al, 2004) A method for studying complex interventions using diverse bodies of data Clear objectives and inclusion criteria Benefits Flexible but rigorous Capacity for providing detailed and practical recommendations t'ZqZ ZUZZq U ,  The Realist Alternative  Review method based on principles of realistic evaluation Focus is on reviewing complex social interventions e.g. policy, management, service delivery Review takes place at the level of theories that underpin complex interventions Explanatory focus; seeking answers to the question  What works, for whom, in what circumstances, in what respects and why? 2cH c  /Characteristics of Complex Social Interventions00  0  Consist of theories Involve actions of people Consist of a chain of steps or processes that interact Constituent steps and processes are rarely linear Embedded in social systems Prone to modification Open systems that change through learning (Pawson et al, 2004)0ZZ   2Rethinking the Standard Systematic Review Template 32$ 3 Clarifying the scope of the review Searching for evidence Appraisal of primary studies Data extraction Data synthesis Interpretation of findings/ presentation of results and recommendations WxgZ   "Clarifying the Scope of the Review#"  # MIdentify the review question Nature and content of the intervention Circumstances or context for its use Policy intentions or objectives Refine the purpose of the review Theory integrity, adjudication, comparison Articulate key theories to be explored Draw up long list Group, categorise or synthesise Design the evaluative frameworkZlZ!Z+Z'ZRZl!+'R   N +Purpose of the Reviewi What are the interventions and strategies that are effective in enabling evidence informed healthcare?jj    &'%Four Theories and 13 Theoretical Foci&&  & nTheory area 1 - Properties of change agency in KU What impact do the characteristics of the change agent have on KU What is the overall impact of the change agent intervention on KU? What impact does the interaction between the change agent and the setting have on KU? Theory area 2  system change in KU What impact do characteristics of the systems change intervention(s) have on KU? What is the overall impact of the system change intervention(s) used? What impact does the interaction between the system change and the setting have on KU? What impact do senior leadership roles have in creating practice environments that integrate daily use of evidence at the point of care delivery? v3ZZ#Z$Z3#  (Theory area 3  properties of technologies (paper & electronic) used in KU What impact do the characteristics of the technological intervention(s) have on KU? What is the overall impact of the technological intervention(s) used? What impact does the interaction between the technological intervention and the setting have on KU? Theory area 4  education interventions in KU What impact do the characteristics of the education intervention(s) have in enabling KU? What is the overall impact of the education intervention(s) used? What impact does the interaction between the education intervention and the setting have on KU? ^L.L. y )Core and Quality Analysis  sCore Areas Analysis Is there evidence of particular theoretical perspective(s) impacting on the effectiveness of the intervention? Is there evidence of contextual factors impacting on the effectiveness of the intervention? Is there evidence of the level of the intervention impacting on the effectiveness of the intervention? Is there evidence of the intervention dose impacting on the effectiveness of the intervention? Quality Analysis Is the evidence provided in this theory area good and relevant enough to be included in the synthesis (consider issues of sample size, data collection, data analysis and claims made) ZZZZ KOP6-s t Search for Evidence  4Searching by stages to: Get a  feel for the literature Identify key programme theories (and refine inclusion criteria) Test and refine programme theories Purposive and snowball sampling Look across policy domains Final search for additional studies when review nearing completion <ZZZ  Data Extraction  JDevelop  bespoke set of data extraction forms and notation devices Extract different data from different studies to populate evaluative framework with evidence Interest is in the  chains of inference in the original study:  this body of evidence allows me to draw the following conclusions &n& & Data Synthesis  Basic task is to refine the programme theory i.e. determine what works, for whom, in what circumstances, in what respects and why Use contradictory evidence to generate insights about the influence of context  6'/Searching, Relevance Testing, & Data Extraction00$Zsearch strategy relevance, 2 stream approach data extraction, final relevant papers Z[7(Search Strategiesbroad, not discipline-specific, corresponding to healthcare in general approx 39 lines of search text used with Boolean operators 8)Search Results6 online databases (1997-2007): (Medline, CINAHL, Embase, PsycInfo, Sociological Abstracts, Web of Science) Health Sciences Librarians (Dalhousie University, McMaster University) consulted on search strategies run March 5, 2007 in OVIDF"N"Ne,59*Search Results24,021 electronic references Medline 4,530 Embase 8,482 CINAHL 5,683 PsycInfo 4,993 Sociological Abstracts 248 Web of Science 130 196 potentially-relevant papers based on title and abstract (return rate of 0.8%)PPfP<PPfS,+:+Inclusion Criteria $Urelate to purpose statement: What are the interventions and strategies that are effective in enabling evidence-informed health care? published in the last 10 years english-language healthcare related all disciplines not limited by research focus or design (e.g. papers addressing intervention application in addition to effectiveness)lPlP~POPi~O;,Data Extraction papers divided among 5 work groups further papers eliminated based on full versions data extraction of each paper by 2 reviewers final data extraction resulted in a number of papers being omitted 4&.Overall Process: What challenges were overcome// Methodology Questions asking the right question to get the literature Search terms Volume Choice of one area first to refine process Inclusion or exclusion criteria Health & non-health papers Empirical & non empirical papers Theory papers Interventional papers Process of analysis, 2 independent reviews double checking all papers Clarity, confidence in process Assumptions on data extraction P P0P P2P P`PP2PPP  0 2  `  23%!Overall Process: What worked well"" Communication- face to face and phone email Yahoo discussion group Variable perspectives International group Research methods used Range of specialties Variable work processes Established process Agree rules of engagement, responsibilities and outputs Small and large group Product Development Established database Completed preliminary review Refined processes Learning Access and exposure to new literature Realist synthesis method and philosophy P6PP?PPcPPDP POPP6?c  D   O=- Preliminary Findings0,+Theory Area1: Impact of Change Agents on KU,,$4Character of the literature Crosses a number of theory areas Poor linkages between processes, context and outcomes Methodological problems and study design challenges(l    -Impact of the Characteristics of the Change Agent? Role characteristics Knowledge characteristics Overall impact of change agent interventions? Potential to change practice context Increasing knowledge of others Providing feedback Awareness raising Some practice change How?^3Z/Z.ZZ3 /. "  #     . Impact of Education (overlap with theory area 4) Change agent and education interventions Education that includes content and process Barriers and how to overcome these Specific projects and professional/personal growth(11      /Impact of the interaction between change agent and setting? Relationship between character of context and impact of change agent Illogical inferences!,<Z[Z<[8     2  Next Steps:Refine data extraction templates Complete synthesis for theory area 1 Write up process, challenges, findings Begin review process for other theory areas Need funding!!!!!! b  *!Strengths of the Realist Approach""$ " IFirm roots in philosophy and the social sciences Not a method or formula, but a logic of enquiry Pluralist and flexible Explanatory, as opposed to judgemental Learns from, rather than attempting to control, real world phenomena Engages stakeholders in a systematic way Has the potential to maximise learning across policy domainsBaZZZa J  Some Limitations  kStage of development of the realist approach; small number of completed reviews Cannot be used as a protocol driven approach Handling potentially large volume of evidence Developing/documenting reproducible methods Demonstrating and maintaining objectivity Requires a high level of experience on the part of the reviewer Leads at best to tentative recommendations*lZ  X l /"$  0 4$(  4r 4 S    3  r 4 S # ` 3  H 4 0޽h ? 3f33f80___PPT10.*23$  0 $(  r  S _   r  S 0`  H  0޽h ? 3f33f80___PPT10.$8Ór,2E-=+q/=1Root EntrydO)@9+PicturesvCurrent User/SummaryInformation(?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxy{|}~