Abstract
Objective:to identify and analyze the concepts of the realist evaluation and the methodologies recommended for its development in the health area.Method:an integrative review, which included theoretical and methodological studies published in the following databases: COCHRANE Library, EVIPNet, Health Systems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for Change, and SciELO, in addition to Teses-CAPES and Google Scholar, for the gray literature. The mediation category underlay the analysis.Results:19 references were included, published between 1997 and 2018. It is an innovative proposal to direct the process of evaluating health programs, interventions, and/or policies, with the democratic participation of the parties involved, such as users, workers, managers and researchers; it proposes to elaborate theories about what works, for whom, in what context, and how. The mediation category indicated the need for these theories not to be restricted to the micro-context, but to incorporate the elements of the social macro-structure to which they are connected.Conclusion:It is indicated that the realist evaluation is to be conducted in 21 stages. It takes into account qualitative and procedural methods, which makes it powerful for understanding human and social relationships in the context analyzed. Theories that come from evaluating the functioning of the programs analyzed have greater explanatory chances if they are built by reference to the social totality.
Highlights
The evaluation of complex health interventions, as is the case with the public health policies and programs, is considered a challenge, especially given the assumption that it must organically monitor the creation and implementation of these interventions(1).The World Health Organization stresses the importance of evaluations based on the human rights principles and advocates the involvement of the socalled stakeholders, including beneficiaries, as they can contribute to a better understanding of the processes that bring about changes in a given reality(2).Complex interventions are often informed by elements of experience and are dependent on the resources of those who make health decisions
It is known that assumptions about the success of this type of intervention must be better understood through evaluation processes, since they occur concretely within the scope of social relationships, allowing to ascertain the plausibility of the intervention and assist the evaluators in deciding what should be prioritized(3)
It is verified that the dialectic reshapes the debates about the relationship between the parts and the whole. This integrative review (IR) made it possible to map the scientific production of the health area on the concepts, purposes, and stages of the realist evaluation
Summary
The evaluation of complex health interventions, as is the case with the public health policies and programs, is considered a challenge, especially given the assumption that it must organically monitor the creation and implementation of these interventions(1).The World Health Organization stresses the importance of evaluations based on the human rights principles and advocates the involvement of the socalled stakeholders (parties who are interested in the changes promoted by the programs and policies), including beneficiaries, as they can contribute to a better understanding of the processes that bring about changes in a given reality(2).Complex interventions are often informed by elements of experience and are dependent on the resources of those who make health decisions. The evaluation of complex health interventions, as is the case with the public health policies and programs, is considered a challenge, especially given the assumption that it must organically monitor the creation and implementation of these interventions(1). The World Health Organization stresses the importance of evaluations based on the human rights principles and advocates the involvement of the socalled stakeholders (parties who are interested in the changes promoted by the programs and policies), including beneficiaries, as they can contribute to a better understanding of the processes that bring about changes in a given reality(2). Procedural monitoring, with access by the team of evaluators to intermediate outcomes, is considered essential in the evaluation of complex health programs(4). The evaluations indicated for complex interventions involve stages that range from the identification of health needs to the design and implementation of the programs and policies. It is necessary that the evaluation process takes into account the discussion of the political priorities and considers collecting data at diverse moments, to capture changes over time(3)
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