Abstract
BackgroundA realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in specific kinds of situations. Yet realist reviews can require considerable and sustained investment over time, which does not always suit the time-sensitive demands of many policy decisions. ‘Rapid Realist Review’ methodology (RRR) has been developed as a tool for applying a realist approach to a knowledge synthesis process in order to produce a product that is useful to policy makers in responding to time-sensitive and/or emerging issues, while preserving the core elements of realist methodology.MethodsUsing examples from completed RRRs, we describe key features of the RRR methodology, the resources required, and the strengths and limitations of the process. All aspects of an RRR are guided by both a local reference group, and a group of content experts. Involvement of knowledge users and external experts ensures both the usability of the review products, as well as their links to current practice.ResultsRRRs have proven useful in providing evidence for and making explicit what is known on a given topic, as well as articulating where knowledge gaps may exist. From the RRRs completed to date, findings broadly adhere to four (often overlapping) classifications: guiding rules for policy-making; knowledge quantification (i.e., the amount of literature available that identifies context, mechanisms, and outcomes for a given topic); understanding tensions/paradoxes in the evidence base; and, reinforcing or refuting beliefs and decisions taken.Conclusions‘Traditional’ realist reviews and RRRs have some key differences, which allow policy makers to apply each type of methodology strategically to maximize its utility within a particular local constellation of history, goals, resources, politics and environment. In particular, the RRR methodology is explicitly designed to engage knowledge users and review stakeholders to define the research questions, and to streamline the review process. In addition, results are presented with a focus on context-specific explanations for what works within a particular set of parameters rather than producing explanations that are potentially transferrable across contexts and populations. For policy makers faced with making difficult decisions in short time frames for which there is sufficient (if limited) published/research and practice-based evidence available, RRR provides a practical, outcomes-focused knowledge synthesis method.
Highlights
A realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in specific kinds of situations
A number of reviews have focused on specific clinical specialties, domains or services, such as tele-health interventions, emergency department discharge practices, and optimal care models for chronic disease management programs
Rapid Realist Review’ methodology (RRR) have proven useful in providing evidence for and making explicit what is known on a given topic, as well as articulating where knowledge gaps may exist
Summary
A realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in specific kinds of situations. Pawson has broadly classified evidence synthesis approaches as being metaanalytical (re-analysing data from numerous studies to arrive at broadly generalizable findings) or narrative (using text-based data extractions to compare study findings as a way for understanding why programs or interventions have certain effects), both of which are commonly employed for informing policy decisions [2]. Traditional realist syntheses use these C-M combinations to generate transferable ‘program theories’ that suggest that certain interventions are more or less likely to work in certain ways, for certain people, in certain situations [3,4]. How does a change in context generate a particular mechanism that in turn produces specific outcomes?
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