What Works for whom in which Circumstances? An Integrated Realist Evaluation Model for Organisational Interventions

Abstract

Realist evaluation is a recommended approach to evaluate organisational interventions. It examines how specific intervention mechanisms work in a given context to produce certain outcomes through developing and testing Context-Mechanism-Outcome (CMO) configurations. Inspired by realist evaluation, the five-phase model was developed by Nielsen and Abildgaard (2013). However, this model (1) does not include some crucial intervention components that should be evaluated in each intervention phase, and (2) does not follow the full realist evaluation cycle. In this article, we address these limitations of the five-phase model. First, we integrate the contents of the RE-AIM framework into the five-phase model to include crucial intervention components. Then, we explain how to follow a realist evaluation cycle, provide guidance on when, why, and how to develop and test CMO configurations for intervention components, and develop examples of CMO configurations for intervention components. In doing so, we develop an Integrated Realist Evaluation Model for Organisational Interventions (IREMOI). As such, this article demonstrates how working with CMO configurations systematically in an intervention may improve the understanding of ‘what works for whom in which circumstances’ and thereby the likelihood of intervention success.