Using Realist Evaluation to Understand Process Outcomes in a COVID-19-Impacted Yoga Intervention Trial: A Worked Example.

Abby Haynes,Heidi Gilchrist,Anne Tiedemann,Juliana S Oliveira

doi:10.3390/ijerph18179065

Abstract

Realist evaluation offers a valuable way to understand how interventions function and thus how they can be improved and locally adapted. Consequently, realist evaluation is increasingly conducted in parallel with intervention trials. It comprises a clear philosophical foundation and view of causality, pragmatic mixed data collection methods, and a theory-driven approach in which hypothesised program theories are tested and refined. However, detailed methods for data analysis are seldom well-described in realist studies and no clear method for analysing and presenting realist evaluation data has yet emerged. In this methodological paper we use the worked example of our realist process evaluation of the SAGE yoga trial to illustrate an applied process of data analysis and presentation of findings. We show how we drew on other realist studies for ideas, provide examples of six key tasks involved in conducting a realist process evaluation (including coding data and structuring results) and describe strategies that did not work and our rationale for rejecting them. This detailed account of the decisions and methods that worked for us is intended to provide a practical and informed point of departure for researchers conducting a realist evaluation.

Highlights

Realist evaluation is a theory-driven approach to evaluation that aims to explain why policies and programs work, for whom, and under which circumstances [1,2]
We provide a stepwise overview of a realist process evaluation for researchers who may have limited experience of qualitative methods and who are interested in realist evaluation but have yet to use it as a method
A realist process evaluation was conducted in parallel with the trial (Trial registration: ACTRN12619001183178), focusing on the Successful AGEing (SAGE) yoga exercise program

Summary

Introduction

Realist evaluation is a theory-driven approach to evaluation that aims to explain why policies and programs work (or not), for whom, and under which circumstances [1,2]. Realist evaluation can add value by improving the clarity, depth, and transferability of findings; provide evaluators with pragmatic techniques for dealing with context and complexity; and give implementers helpful tools and lenses for critically appraising programs and generating knowledge, including for scale-up, translation and longer-term sustainability [1,4]. This methodological paper adds to the literature on analysis in realist evaluation by providing a worked example of a realist process evaluation conducted in parallel with a randomised controlled trial of yoga classes for older adults aimed at preventing falls.

Methods

Results

Discussion

Conclusion