Programming Theory Research Articles

Mindfulness-based interventions to support wellbeing of adults in low socio-economic settings: a realist review

BackgroundMindfulness as a modality involves training the innate human capacity for present-moment awareness with a view to cultivating a more harmonious and integrated life experience, especially in the face of hardship. Over the past four decades, the field of mindfulness has grown rapidly. Despite a substantial body of literature outlining the many benefits of mindfulness practice within a range of contexts and populations, the authors noticed that studies addressing the adaptation, application and value of mindfulness-based interventions (MBIs) for adults within socio-economically challenged setting were scant. To address this gap, we conducted a realist review of studies pertaining to MBIs within low socio-economic settings, to determine the extend and nature of research in this sector and culminating in a program theory which may be useful for the design of interventions going forward.MethodsWe selected realist review as the methodology as it is well suited to investigating the complex nature of social interventions. The value of realist review is that the exploration of the causal relationships between the mechanisms (M) within a specific context (C) towards particular outcomes (O) offers a deeper understanding of the intervention which may assist in more effective delivery going forward. The review follows the guidelines presented by the Realist and Meta-narrative Evidence Synthesis – Evolving Standards project.ResultsOf the 112 documents identified, 12 articles met the inclusion criteria. Of these 12 studies, 10 were conducted in the United States, with little representation across the rest of the globe. The interventions described in these articles were varied. We identified mechanisms that offered beneficial outcomes for participants across a range of contexts, with indications of how interventions might be adapted towards greater accessibility, acceptability, and feasibility within communities.ConclusionBy reviewing the various programs in their respective contexts, we developed a program theory for implementing socio-culturally adapted MBIs in low socio-economic settings. In the future, this program theory could be tested as a means to create a sense of wellbeing for people living in low socio-economic settings.

Understanding paramedic work in general practice in the UK: a rapid realist synthesis

BackgroundGeneral practice in the UK is under substantial pressure and practices are increasingly including paramedics as part of their workforce. Little is known about how different models of paramedic working may affect successful implementation of the role, as viewed from patient, clinician and system perspectives. This realist synthesis developed theories about ‘models of paramedic working in general practice’ in different UK contexts to understand their impact.MethodsThe rapid realist synthesis comprised data from: (1) empirical and grey literature searches; (2) semi-structured realist interviews with system leaders involved with the implementation of the role; and (3) a stakeholder event with healthcare professionals and the public, to develop initial programme theories that can be tested in future work. Sources were analysed using a realist approach that explored the data for novel or causal insights to generate initial programme theories.ResultsEmpirical sources (n = 32), grey sources (n = 95), transcripts from system leader interviews (n = 7) and audio summaries from the stakeholder event (n = 22 participants) were synthesised into a single narrative document. The findings confirmed the presence of a wide variety of models of paramedic working in UK general practice. The perceived success of models was influenced by the extent to which the paramedic service was mature and embedded in practice, and according to four theory areas: (1) Primary care staff understanding and acceptance of the paramedic role; (2) Paramedic induction process, including access to training, supervision and development opportunities; (3) Patient understanding and acceptance of the role; (4) Variations in paramedic employment models.ConclusionsVariability in how the paramedic role is operating and embedding into general practice across the UK affects the success of the role. These findings provide a theoretical foundation for future research to investigate various ‘models of paramedic working’ in different contexts.

A stochastic two-stage microgrid formation strategy for enhancing distribution network resilience against earthquake event incorporating distributed energy resources, parking lots and responsive loads

The sustainability of energy systems has been severely affected in recent years by the quantity and intensity of high-impact, low-probability events. As a result, the resilience concept has been introduced to analyze the operation of networks against such events. This paper proposes a stochastic two-stage microgrid formation formulation to maximize the restored loads and enhance the resilience index of electrical distribution systems in the face of earthquake events. In this regard, an earthquake incident is modeled in the first step utilizing geographical data, peak ground acceleration and fragility curves. Then, a two-stage linear programming and graph theory is applied to form microgrids in response to the mentioned disturbances, where the variables in the planning and operating states are optimized in the first and second stages, respectively. The influence of different components including diesel generators, renewable energies, storage units and electric vehicles is investigated. In addition, the role of responsive loads and uncertainties related to line failure, load variation, renewable resources availability and electric vehicles are considered during the analysis. The results for various scenarios validate that the presented approach increases load supply capability and resiliency index by 38.7% and 38.8%, respectively.

Communities of practice to facilitate change in health professions education: A realist synthesis

BackgroundCommunities of practice could contribute to transformations in health professions education to meet complex and emerging challenges. However, little is known about the underlying mechanisms of communities of practice in this setting, and how context influences outcomes. ObjectiveTo understand when, why and how communities of practice with health professions education faculty work to facilitate higher education change. DesignA realist synthesis according to the RAMESES standards and steps described by Pawson and colleagues. Review methodsEarly scoping of the literature informed the development of an initial program theory to describe underlying assumptions about how communities of practice in higher education, implemented with health professions education faculty, were likely to work. The theory was tested and further refined through a realist synthesis. A systematic search for evidence using search terms ‘faculty’, ‘communities of practice’ and ‘higher education’ and related terms was supplemented with citation tracking and hand searching of significant authors and journals. Following study appraisal, data were extracted and synthesised from 21 manuscripts describing 16 communities of practice. The realist synthesis focused on identifying patterns in context-mechanism-outcome interactions, and the alignment with substantive theory. ResultsFrom the included manuscripts, ten context-mechanism-outcome configurations were identified that describe a range of individual, interpersonal and institutional outcomes of communities of practice with health professions education faculty and context-mechanism interactions that contribute to achieving these outcomes. ConclusionsThis study expands theoretical understandings of how and why communities of practice work. There is value in communities of practice in the higher education sector, primarily in the field of health professions education. Communities of practice implemented in the context of complex change with participants who have a desire to participate can facilitate change in health professions education, including institutional level changes, through reflection, experiential learning and creating a shared agenda for change. Findings from this study can be used by policy and decision-makers within health education to best apply communities of practice to achieve meaningful outcomes.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

BackgroundChronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory.MethodsRealist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory.ResultsFour contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client’s home, skilled occupational therapists, and clients feeling ready for making changes.ConclusionsThe ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings.Trial registrationThe trial was prospectively registered on www.ClinicalTrials.gov (registration date: 05/03/2020; identifier: NCT04295837) prior to data collection that occurred between August 2020 and October 2021.

Understanding for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works: a realist review.

To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation (AF) service delivery works (or does not work). A realist review of integrated approaches to AF service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesized data using realist techniques to create context-mechanism-outcome configurations for integrated approaches to AF service, and developed an integrated approach refined programme theory. A total of 5433 documents were screened and 39 included. The refined programme theory included five context-mechanism-outcome configurations for how clinical and system-wide outcomes are affected by the way integrated approaches to AF service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organization to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar, lifestyle and risk factor reduction, should be recognized within an AF care pathway. It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an aging population and increased prevalence of AF.

What works, how and in which contexts when supporting parents to implement intensive speech and language therapy at home for children with speech sound disorder? A protocol for a realist review

IntroductionSpeech and language therapists (SLTs) worldwide report challenges with providing recommended, evidence-based intervention intensity for children with speech sound disorder (SSD). Challenges such as service constraints and/or family contexts impact...

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis.

Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. This study is registered as PROSPERO CRD42021276671. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

The fascinating theory of fetal programming of adult diseases: A review of the fundamentals of the Barker hypothesis.

The theory of fetal programming of adult diseases was first proposed by David J.P. Barker in the eighties of the previous century, to explain the higher susceptibility of some people toward the development of ischemic heart disease. According to his hypothesis, poor maternal living conditions during gestation represent an important risk factor for the onset of atherosclerotic heart disease later in life. The analysis of the early phases of fetal development is a fundamental tool for the risk stratification of children and adults, allowing the identification of susceptible or resistant subjects to multiple diseases later in life. Here, we provide a narrative summary of the most relevant evidence supporting the Barker hypothesis in multiple fields of medicine, including neuropsychiatric disorders, such as Parkinson disease and Alzheimer disease, kidney failure, atherosclerosis, coronary heart disease, stroke, diabetes, cancer onset and progression, metabolic syndrome, and infectious diseases including COVID-19. Given the consensus on the role of body weight at birth as a practical indicator of the fetal nutritional status during gestation, every subject with a low birth weight should be considered an "at risk" subject for the development of multiple diseases later in life. The hypothesis of the "physiological regenerative medicine," able to improve fetal organs' development in the perinatal period is discussed, in the light of recent experimental data indicating Thymosin Beta-4 as a powerful growth promoter when administered to pregnant mothers before birth.

Supporting Sensemaking by Introducing a Connecting Thread Throughout

Introductory courses typically provide an overview of the study program's relevant topics, concepts, theories, and terminology. They could also help socialize students into their roles as students of and future experts in the field of study. Both of these goals require a course design that supports learning of various, often fragmented, topics by connecting them meaningfully.

Developing the Initial Programme Theories on Health Research Capacity Strengthening of African Universities: A Realist Synthesis Protocol

Background: Health research capacity strengthening (HRCS) has been deemed as a complex, multifaceted, and dynamic activity. Despite this, most studies that assess the effectiveness of health research capacity strengthening programmes have not employed complexity-aware approaches and therefore, evidence on how and why such programmes work across different contexts is underdeveloped. This realist study seeks to elicit the initial programme theories (IPTs) that describe how and why the ‘Developing Excellence in Leadership, Training and Science Africa’ (DELTAS Africa) programme – one of the flagship research capacity strengthening programmes in Africa – works to generate research capacity outcomes specifically in the participating African universities. Methods and Analysis: A realist review of the DELTAS Africa programme documents, and relevant published papers that report on similar research capacity interventions will be carried out. This will help to both identify the outcome pathways and underlying assumptions of the DELTAS Africa programme, as well as tacit theories as postulated by other researchers. The review evidence will inform the drafting of the initial programme theories (IPTs). Interviews with the DELTAS Africa programme designing team will be conducted using a realist interviewing technique to unearth ontologically deeper insights on context, mechanism, and outcomes. Using the realist context-mechanism-outcome configurational maps, we will identify how contexts (i.e., within the African universities) shape mechanisms (the processes, reasoning, or behaviours triggered by the HRCS activities) through which the programme brings about an outcome at institutional level. Conclusion: The initial programme theories will describe how and why health research capacity strengthening works, for whom and under what circumstances across the participating African universities. The programme theories will provide policy-relevant insights on the generative causal mechanisms of HRCS; evidence that is critically needed to inform the design, implementation, and evaluation of HRCS initiatives.

Workforce development in community pharmacies in England: Opportunities and tensions for a private sector provider of NHS services.

The intention to more effectively mobilise and integrate the capabilities of the community pharmacy workforce within primary care is clearly stated within National Health Service (NHS) England policy. The Pharmacy Integration Fund (PhIF) was established in 2016 to support the development of clinical pharmacy practice in a range of primary care settings, including community pharmacy. This study sought to determine how PhIF funded learning pathways for post-registration pharmacists and accuracy checking pharmacy technicians enabled community pharmacy workforce transformation, in what circumstances, and why. Realist evaluation. We identified two main programme theories underpinning the PhIF programme and tested these theories against data collected through 41 semi-structured qualitative interviews with community pharmacist and pharmacy technician learners, educational supervisors, and community pharmacy employers. The data supported the initial programme theories and indicated that the learning pathway for post-registration pharmacists had also provided opportunity for pharmacists to develop and consolidate their clinical skills before pursuing an independent prescribing qualification. Employer support was a key factor influencing learner participation, whilst employer engagement was mediated by perceptions of value expectancy and clarity of purpose. The study also highlights the influence of contextual factors within the community pharmacy setting on opportunities for the application of learning in practice. When designing and implementing workforce transformation plans and funded service opportunities that require the engagement of a diverse range of private, for-profit businesses within a mixed economy setting, policymakers should consider the contextual factors and mechanisms influencing participation of all stakeholder groups.

Supporting People With Musculoskeletal Conditions From Underserved Communities in the United Kingdom to Engage With Physical Activity: A Realist Synthesis and Q-Methodology Study.

In the United Kingdom, 20 million individuals suffer from a musculoskeletal condition, for which physical activity (PA) is a core treatment. Minority ethnic communities experience a disproportionate impact, experiencing higher levels of pain and engaging in less PA. Research has identified various factors that affect their participation in PA, including lack of access to support, limited knowledge of resources, language barriers, fear of racial harassment while exercising, and insufficient communication/information from healthcare professionals. This project adopted a realist perspective, aiming to understand "what works, in which circumstances, and for whom?" The project had 4 steps: (1) defining review scope with stakeholders; (2) searching and extracting literature, creation of initial program theories; (3) refining/validating initial program theories with stakeholders; and (4) adopting Q-methodology to highlight priority areas. 17 papers were included. Three program theories were identified: (1) Lack of initial access to health service support; (2) Nature of musculoskeletal self-management support-the importance of the therapeutic relationship and value of shared conversations; and (3) Accessible long-term support for PA engagement. The Q-sort exercise highlighted priority areas: (1) complex booking procedures and inadequate translation services, (2) time constraints impact effective patient-centered care, (3) dismissive attitudes/mismatched expectations impact shared decision making, (4) rebuilding trust to strengthen therapeutic relationships, (5) cultural relevance in developing therapeutic relationships, and (6) clinician recommended PA opportunities increase knowledge of PA. Our findings shed light on inequities across the UK's musculoskeletal pathways, specifically in relation to PA engagement. This points toward priority areas for future research and interventions.

NPCs in video games: a reflective resource for sports coaches and participant engagement.

This perspective article explores the potential of non-player characters (NPCs) in video games as a reflective tool for coaches to enhance participant engagement in sports. While coaches traditionally focus on movement skill instruction, their role extends to fostering young people's immersion in sports contexts and potentially contribute to the possibility of lifelong participation. However, challenges persist in translating coaching theory in coach education programs into practice, including the awareness of roles and how to make young people immersion in sports. Integrating elements from video games, where NPCs play pivotal roles in shaping player experiences, presents a possible avenue for re-thinking the role of coach, especially in participation. By drawing parallels between NPCs and coaches, this article advocates for a new reflection tool for coaching roles. Future research should investigate the effectiveness of leveraging NPCs to enhance athlete engagement and motivation, ultimately creating dynamic and inclusive coaching environments that cater to the evolving needs of participants.

A Fully Distributed ADP Algorithm for Real-Time Economic Dispatch of Microgrid

This paper proposes a fully distributed approximate dynamic programming (FD-ADP) algorithm framework for real-time economic dispatch of a microgrid (MG). Firstly, a modified distributed consensus-based algorithm (DCBA) framework with power restriction factors is proposed to distributedly obtain the real-time ED decision of MG containing distributed energy resources with linear cost functions, which improves the convergence stability compared with the traditional DCBA framework. Then, combined with the approximate dynamic programming (ADP) theory, a FD-ADP algorithm is proposed to deal with data uncertainties. To this end, the piece-wise linear (PWL) function is applied to approximate the value function, and a distributed slope update approach is proposed to embed empirical knowledge into the value function while ensuring the distributed property in off-line training. With the well-trained PWL function assisting in decision, the distributed real-time ED strategy of MG with approximate global optimality is obtained by the proposed FD-ADP algorithm during the entire schedule horizon (e.g., 24 hours). Finally, case studies on the modified IEEE 6-bus MG system and IEEE 123-bus MG system demonstrate the superiority of solution convergence, validity of distributed training, and optimality of distributed schedule of the proposed FD-ADP algorithm.

Realist synthesis protocol on the effectiveness of a rapid response system in managing mental state deterioration in acute hospital settings

IntroductionPatient mental state deterioration impacts patient outcomes, staff and increases costs for healthcare organisations. Mental state is broadly defined to include not only mental health but a broad range of...

Making it transparent: A worked example of articulating programme theory for a digital health application using Intervention Mapping.

Digital health interventions for behaviour change are usually complex interventions, and intervention developers should 'articulate programme theory', that is, they should offer detailed descriptions of individual intervention components and their proposed mechanisms of action. However, such detailed descriptions often remain lacking. The objective of this work was to provide a conceptual case study with an applied example of 'articulating programme theory' for a newly developed digital health intervention. Intervention Mapping methodology was applied to arrive at a detailed description of programme theory for a newly developed digital health intervention that aims to support cardiac rehabilitation patients in establishing heart-healthy physical activity habits. Based on a Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) logic model of the problem, a logic model of change was developed. The proposed mechanisms of action were visualised in an acyclic behaviour change diagram. Programme theory for this digital health intervention includes 4 sub-behaviours of the main target behaviour (i.e. habitual heart-healthy physical activity), 8 personal determinants and 12 change objectives (i.e. changes needed at the determinant level to achieve the sub-behaviours). These are linked to 12 distinct features of the digital health intervention and 12 underlying behaviour change methods. This case study offers a worked example of articulating programme theory for a digital health intervention using Intervention Mapping. Intervention developers and researchers may draw on this example to replicate the method, or to reflect on most suitable approaches for their own behaviour change interventions.

DETERMINATION OF THE UPPER LIMIT OF THE LOAD-LOADING CAPACITY OF BENDING REINFORCED METAL-COMPOSITE RING PLATES IN CONTACT WITH A LIQUID INCOMPRESSIBLE MEDIUM 1. PROBLEM FORMULATION AND CALCULATION METHOD

The problem of determining the load-bearing capacity of a bendable reinforced annular plate resting on an incompressible liquid base is considered. The internal opening of the structure is closed with a continuous, absolutely rigid insert. The connection between the insert and the plate can be rigid or hinged. The structure is supported on the outer edge, and it is possible to move the support in the vertical direction, for example in the case of a movable jamming. In the limiting state, liquid flow from one front surface of the plate to another surface is not allowed. The materials of the components of the composition are isotropic and rigid-plastic, having the same yield limits in tension and compression. Plastic flow in the phases of the composition is associated with piecewise linear yield criteria (such as the Tresk's or Ishlinsky - Ivlev's yield conditions). The limit state of such a composite plate is described within the framework of the classical theory of transverse bending. Reinforcement structures have axial and radial symmetry. Two reinforcement options are considered: laying two families of fibers along radially symmetrical spiral trajectories and reinforcement in the radial and circumferential directions. The rein-forcing fibers are assumed to be continuous and have constant cross sections along their length, which gives rise to significant heterogeneity of the structures under consideration in the radial direction. The plastic flow of a metal-composition is calculated using a structural model that takes into account the presence of a plane stress state in all substructural elements. Structural formulas have been written that make it possible to determine the coordinates of corner points on piecewise linear yield curves of the compositions under consideration, taking into account their dependence on non-uniform reinforcement parameters: angles and densities. An extremal principle has been formulated that makes it possible to obtain an upper (kinematic) estimate of the maximum load for this type of structure. The formulated problem is discretized along the polar radius. Nodal values of the sagging speed and mechanical energy dissipation were used as unknown grid functions. A numerical algorithm for solving the formulated discretized problem has been developed, based on the application of the simplex method of linear programming theory.

One the development of a professional mandate by social workers in medical rehabilitation- key results from the SWIMMER Project.

Social work in the German rehabilitation sector is practiced with great variation and its interventions lack research evidence. The SWIMMER project aims to develop a program theory of social work in rehabilitation to explain this variation and to discuss possible conditions. The dealing with ethical dilemmas by social workers is one possible influence and the focus of this paper. The social workers' practice was analyzed using the triple mandate, a German-Swiss concept that describes three possible, sometimes simultaneous directives without a concrete call to action from society, the client or the profession. This qualitative, case-comparative research project collected data from interviews with social workers and managers, participant observation and counseling sessions in ten German rehabilitation facilities. Social workers were confronted with all three mandates. They prioritized either the societal mandate or the client mandate. A consequence for social work practice was the limitation of options under social law (mandate by society). Social workers relied on their professional experience to reflect on the mandates. They used a variety of strategies when faced with conflicting mandates. The research project has succeeded in systematizing the orientations of social workers in goal conflicts. Further investigation on this topic on a broader basis would be beneficial.

How can a Realist Evaluation Adhere to the Indigenous Research Principles? An Evaluation Protocol of a Health Research Capacity Strengthening Programme

Background: There is increasing demand for culturally responsive and contextually appropriate evaluation tools that can promote transformative change in the African development space. One way to address this demand is by adapting the existing Western-based evaluation theories to ensure that they are sensitive to the African settings. This protocol describes how the realist evaluation, which is a Western-based approach, would be implemented in a manner that respects the indigenous research principles. The study would be positioned within the African Research Initiative for Scientific Excellence (ARISE) programme – a research capacity strengthening initiative. Methods and Analysis: A multiple case study design will be used, specifically targeting three purposively selected research projects. Initial programme theories (IPTs) will be elicited through review of the ARISE programme documents, focus group discussions with project level stakeholders and beneficiaries and review of published literature. Qualitative methods will then be applied to test the IPTs. Interviews with the Principal Investigators (PIs), research collaborators, PIs’ mentors, finance and grants management (research support) staff and partners; (b) participant observation with the PIs and (c) storytelling sessions with the masters/PhD trainees. Retroductive theorising will be applied in data analysis. Deductive reasoning will seek to identify Contexts, Mechanism and Outcomes (CMOs) that are aligned with the IPTs. New CMOs will be inductively identified. The indigenous principles will be infused in different stages of the evaluation. Conclusion: This study will be the first of its kind to explore how the realist evaluation approach can be indigenised in an African setting. Tensions and incompatibilities between the realist evaluation approach and the indigenous research principles will be reported as part of the study results. An ‘indigenous-inspired realist evaluation’ framework will be suggested based on the reflections on the evaluation methods and processes which could be tested and refined by researchers in Africa.