ArticleBMC medical research methodology2018
Mechanisms, contexts and points of contention: operationalizing realist-informed research for complex health interventions.
Article in BMC medical research methodology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review.Implementation science : IS · 2020Pooled it
- A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT.Health technology assessment (Winchester, England) · 2020Trial
- A realist inspired barriers and facilitators evaluation of the co-creation process in the Youth-centred Participatory Action Project.Health promotion international · 2026Article
- Applying the Behavioural Science Approach to Realist Reviews and Evaluations (BARR/E): A Protocol for a Review of Antidepressant Deprescribing Interventions in Primary Care.Behavioral sciences (Basel, Switzerland) · 2026Article
- How Is Equity-Based Co-Creation Enacted in Health and Social Services? An Evaluation of Four Case Studies.Health expectations : an international journal of public participation in health care and health policy · 2026Article
- Development of a nurse-led clinical pathway to prevent delirium in older adults in general hospital wards: a realist review protocol.BMJ open · 2025Article
- How can policies impact the relational process of deprescription? A realist review protocol with an initial theory.Frontiers in public health · 2025Article
- Relationships between arts participation, social cohesion, and well-being: an integrative review of evidence.Frontiers in public health · 2025Review
- Optimising digital clinical consultations in maternity care: a realist review and implementation principles.BMJ open · 2024Review
- How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia.International journal of behavioral medicine · 2024Article
- Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions.BMJ open · 2024Review
- Working mechanisms of the use and acceptability of ecological momentary interventions: a realist evaluation of a guided self-help ecological momentary intervention targeting self-esteem.BMC public health · 2024Article
- Key elements and contextual factors that influence successful implementation of large-system transformation initiatives in the New Zealand health system: a realist evaluation.BMC health services research · 2024Article
- Discussing methodological gaps in psychosocial intervention research for dementia: an opinion article from the INTERDEM Methodology Taskforce guided by the MRC framework.Frontiers in dementia · 2024Article
- Article
- How to successfully implement population health management: a scoping review.BMC health services research · 2023Article
- Article
- Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke.Journal of rehabilitation medicine · 2023Article
- Unravelling mechanisms underlying the action principles of a community-based health promotion programme: a realist evaluation.Archives of public health = Archives belges de sante publique · 2023Article
- Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis.Health policy and planning · 2023Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe concept of "mechanism" is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. Our large, interdisciplinary research team has also experienced challenges in making the concept useful in our study of the implementation of models of integrated community-based primary health care (ICBPHC) in three international jurisdictions (Ontario and Quebec in Canada, and in New Zealand).
methodsIn this paper we summarize definitions of mechanism found in realist methodological literature, and report an empirical example of a realist analysis of the implementation ICBPHC.
resultsWe use our empirical example to illustrate two points. First, the distinction between contexts and mechanisms might ultimately be arbitrary, with more distally located mechanisms becoming contexts as research teams focus their analytic attention more proximally to the outcome of interest. Second, the relationships between mechanisms, human reasoning, and human agency need to be considered in greater detail to inform realist-informed analysis; understanding these relationships is fundamental to understanding the ways in which mechanisms operate through individuals and groups to effect the outcomes of complex health interventions.
conclusionsWe conclude our paper with reflections on human agency and outline the implications of our analysis for realist research and realist evaluation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.