Realist Synthesis Research Articles

Main Mechanisms of Remote Monitoring Programs for Cardiac Rehabilitation and Secondary Prevention: A SYSTEMATIC REVIEW.

The objective of this report was to identify the main mechanisms of home-based remote monitoring programs for cardiac rehabilitation (RM CR) and examine how these mechanisms vary by context. This was a systematic review using realist synthesis. To be included, articles had to be published in English between 2010 and November 2020 and contain specific data related to mechanisms of effect of programs. MEDLINE All (1946-) via Ovid, Embase (1974-) via Ovid, APA PsycINFO (1806-), CINAHL via EBSCO, Scopus databases, and gray literature were searched. From 13 747 citations, 91 focused on cardiac conditions, with 23 reports including patients in CR. Effective RM CR programs more successfully adapted to different patient home settings and broader lives, incorporated individualized patient health data, and had content designed specifically for patients in cardiac rehabilitation. Relatively minor but common technical issues could significantly reduce perceived benefits. Patients and families were highly receptive to the programs and viewed themselves as fortunate to receive such services. The RM CR programs could be improved via incorporating more connectivity to other patients. No clear negative effects on perceived utility or outcomes occurred by patient age, ethnicity, or sex. Overall, the programs were seen to best suit highly motivated patients and consolidated rather than harmed existing relationships with health care professionals and teams. Remote monitoring CR programs are perceived by patients to be beneficial and attractive. Future RM CR programs should consider adaptability to different home settings, incorporate individualized health data, and contain content specific to patient needs.

Lost in translation: how can education about dementia be effectively integrated into medical school contexts? A realist synthesis

ObjectivesThe prevalence of dementia in both community and hospital settings requires a clinical workforce that is skilled in diagnosis and management of the condition to competently care for patients. Though...

The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study - the MiMoS Study.

Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed. To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres. Staff and adult survivors in English sexual assault referral centres and partner agency staff. A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5). There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma. The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic. People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have 'complex' needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault. Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21. This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347.

Promoting men's health through sports clubs: a rapid realist review

Abstract Background Traditional health promotion interventions have failed to engage men. Sports clubs offer male-friendly health promotion settings for men, but little is known about implementable intervention strategies and subsequent effects. This rapid realist review (RRR) aims to identify context, mechanisms and effects of health promotion interventions targeting men by or in collaboration with sports clubs. Methods The RRR methodology was developed in collaboration with a panel of Danish practice and policy representatives and international academics. A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SportDiscus databases and through grey literature sources. Included studies: 1) targeted men aged 18+ years, 2) reported health promotion outcomes, and 3) were delivered primarily by or in collaboration with sports clubs. Results Fifty-two studies were included. Preliminary analyses indicate that interventions delivered through sports clubs show promise for engaging men with high cardiometabolic risk and producing favorable health outcomes. Preliminary findings from the realist synthesis show that if men felt a strong attachment to the sports club (context), it resonated with their feelings of social identity which outweighed a former reluctance to attend health programs (mechanism), and thus increased the men's likelihood for program engagement and health behavior change (outcome). Conclusions Our study indicates that men's health promotion through sports clubs is emergent. While great strides have been made to increase men's involvement in health promoting activities by delivering interventions through sports clubs, research has predominantly focused on select behaviours (e.g., physical activity), sub-groups (e.g., sports fans) and predominantly Caucasian, overweight, middle-aged men.

Exploring the impact of evaluation on learning and health innovation sustainability: protocol for a realist synthesis

BackgroundWithin the Learning Health System (LHS) model, learning routines, including evaluation, allow for continuous incremental change to take place. Within these learning routines, evaluation assists in problem identification, data collection, and data transformation into contextualized information, which is then re-applied to the LHS environment. Evaluation that catalyzes learning and improvement may also contribute to health innovation sustainability. However, there is little consensus as to why certain evaluations seem to support learning and sustainability, while others impede it. This realist synthesis seeks to understand the contextual factors and underlying mechanisms or drivers that best support health systems learning and sustainable innovation.MethodsThis synthesis will be guided by Pawson and colleagues’ 2005 and Emmel and colleagues’ 2018 guidelines for conducting realist syntheses. The review process will encompass five steps: (1) scoping the review, (2) building theories, (3) identifying the evidence, (4) evidence selection and appraisal, and (5) data extraction and synthesis. An Expert Committee comprised of leaders in evaluation, innovation, sustainability, and realist methodology will guide this synthesis. Review findings will be reported using the RAMESES guidelines.DiscussionThe use of a realist review will allow for exploration and theorizing about the contextual factors and underlying mechanisms that make evaluations ‘work’ (or ‘not work’) to support learning and sustainability. Depending on results, we will attempt to synthesize findings into a series of recommendations for evaluations with the intention to support health systems learning and sustainability. Finalized results will be presented at national and international conferences, as well as disseminated via a peer-reviewed publication.Systematic review registrationThis realist synthesis protocol has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero/ ID 382690).

An introduction to realist evaluation and synthesis for kidney research

Realist research describes a methodological approach that aims to explore how and why interventions work, for whom, and under what circumstances. Rather than quantifying how well an intervention works under specific conditions, realist theory explores the function of interventions in detail and specifically considers how the contexts in which interventional components are delivered influence the mechanisms that lead to outcomes. Realist methods can be applied to primary data (realist evaluation) or secondary data (realist synthesis). Although realist techniques are increasingly being used in the evaluation of complex interventions, there are relatively few published studies in the field of kidney care. In this review, we outline the theory and principles behind realist methods through discussion of a published realist synthesis describing complex interventions promoting delivery of optimal chronic kidney disease care. We discuss other kidney studies that have used realist methodology and situations where realist techniques could be applied to advance our understanding of how to best deliver care to patients with kidney disease.

Exploring targeted preventive health check interventions – a realist synthesis

BackgroundPreventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work.MethodsThe study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks.ResultsBased on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation;Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants’ everyday lives as well as meaningful to the professionals involved.The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation.ConclusionThe results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.

How, and under what contexts, do academic–practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol

IntroductionInternationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped...

Physical activity interventions for inpatients in secure mental health settings: what works, for whom, in what circumstances and why? A protocol for a realist synthesis

IntroductionThe physical health of individuals with severe mental illness (SMI) is a cause for concern. While the purpose of inpatient mental health settings is rehabilitation and treatment, the physical health...

From Two Dimensions to Multidimensions: A Mechanistic Model to Support Deliberate CPD Development, Coordination, and Evaluation.

The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes. Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management. Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent. Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.

What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis

BackgroundA third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people.MethodsA realist synthesis following the Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidelines was completed. A scoping literature review informed the generation of an initial programme theory. Systematic searches of different databases were conducted, and documents screened for eligibility, with data extracted based on a Context, Mechanisms, Outcome (CMO) configuration to develop further our programme theory. Documents were appraised based on assessments of relevance and rigour. A Stakeholder consultation with 26 primary care health care professionals (HCPs), 10 patients and three informal carers was conducted to test and refine the programme theory. Data synthesis was underpinned by Normalisation Process Theory to identify key mechanisms to enhance the implementation of MDT medication review and deprescribing in primary care.FindingsA total of 2821 abstracts and 175 full-text documents were assessed for eligibility, with 28 included. Analysis of documents alongside stakeholder consultation outlined 33 CMO configurations categorised under four themes: 1) HCPs roles, responsibilities and relationships; 2) HCPs training and education; 3) the format and process of the medication review 4) involvement and education of patients and informal carers. A number of key mechanisms were identified including clearly defined roles and good communication between MDT members, integration of pharmacists in the team, simulation-based training or team building training, targeting high-risk patients, using deprescribing tools and drawing on expertise of other HCPs (e.g., nurses and frailty practitioners), involving patents and carers in the process, starting with ‘quick wins’, offering deprescribing as ‘drug holidays’, and ensuring appropriate and tailored follow-up plans that allow continuity of care and management.ConclusionWe identified key mechanisms that could inform the design of future interventions and services that successfully embed deprescribing in primary care.

What is known about what works in community-involved decision-making relating to urban green and blue spaces? A realist review protocol

BackgroundThere is now a relatively well-established evidence base suggesting that greener living environments and time spent in urban green and blue spaces (UGBS) can be beneficial for human health and wellbeing. However, benefits are not universal and there remain widespread social inequalities in access to such resources and experiences, particularly along axes of class, race, ethnicity, age and disability, and in relation to efforts to increase the availability and accessibility of such spaces. These injustices often relate to distributive, procedural and recognition-based processes. There is growing interest in how to ensure that efforts to increase access to or use of UGBS (whether through infrastructural or social programmes) result in equitable outcomes whilst minimising potential for exacerbating existing inequalities and injustices. Community engagement is considered an important step towards more inclusive UGBS decision-making, from planning and design to management and maintenance processes. It is thought to contribute to better and more widely trusted decisions, enhanced democracy, community satisfaction, civic interest and feelings of green space ownership, and greater longevity of UGBS projects. However, uneven representation and barriers to participation can create imbalances and undermine these benefits.MethodsAn iterative, multi-stage realist-inspired review will be conducted to ask what works, in what context and in what ways relating to the meaningful involvement of communities in UGBS decision-making, focusing on the skills, capacities and capabilities of different stakeholders and the role of contexts and processes. ‘Effectiveness’ (or what works) will be understood as a multifaceted outcome, encompassing both the processes and results of community engagement efforts.Following a scoping stage to identify initial programme theory, inclusion/exclusion criteria and derive search terms, relevant databases and grey literature will be searched to identify interdisciplinary literature in two phases. The first phase will be used to further develop programme theories, which will be articulated as ‘if then’ statements. The second phase searches will be used to identify sources to further explore and evidence the programme and formal theory. We will assess all includable evidence for conceptual richness, prioritising more conceptually rich sources if needed.DiscussionThe realist synthesis will explore the key context, mechanism and outcome configurations that appear to explain if and how different approaches to community-involved UGBS decision-making are or are not effective. We will consider factors such as different conceptualisations of community, and if and how they have been involved in UGBS decision-making; the types of tools and approaches used; and the socio-cultural and political or governance structures within which decision-making takes place.

Conditional cash transfers in OECD countries: a realist synthesis.

Conditional Cash Transfers (CCTs) schemes have been adopted mostly in low-income countries as a tool to break the vicious cycle of poverty transmission. Although their use is controversial, behavioral conditionalities have also been widely used in welfare-to-work strategies, minimum income scheme, and labor market "activation" policies in OECD countries. The paper presents the results of a Realist Review to synthesize the evidence of CCTs related to work conditionality, delivered in OECD countries. The evaluation literature of 23 selected CCT programs was analyzed by reconstructing Context-Mechanism-Outcome configurations. The main findings show that CCTs can be an effective counterbalance to work disincentives introduced by welfare measures. The unintended negative impacts, the role of sanctioning, and the causal pathways that may affect the most disadvantaged people and their children are discussed.

84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.

O.4.4-8 Promoting men’s health through sports clubs: a rapid realist review

Abstract Purpose Traditional health promotion interventions have failed to engage men. Sports clubs offer male-friendly environments that have been identified as an attractive setting for men’s health promotion, but little is known about implementable intervention strategies and subsequent effects. This rapid realist review (RRR) aims to close this gap by assessing context, mechanisms and effects of health promotion interventions targeting men by or in collaboration with sports clubs. Methods The RRR methodology was developed in collaboration with a panel of Danish practice and policy representatives and international academics. A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SportDiscus databases. Included studies: 1) targeted men aged 18+ years, 2) reported health promotion outcomes, and 3) were delivered primarily by or in collaboration with sports clubs. A grey literature search of National Sports Associations and Federations and non-government men’s health organizations was also performed. Dalkin’s conceptualization of mechanisms in realist methodology was used to identify context- mechanism-outcome configurations (CMOc) and develop a program theory. The study follows Cochrane’s guidance for rapid reviews and is registered in Research Registry (ID: reviewregistry1556). Results We identified 2.720 studies after duplicates removal. Preliminary analyses indicate that interventions delivered through sports clubs show promise for engaging men and producing favorable health outcomes (e.g., weight loss, increased physical activity and improved social support). The realist synthesis suggests that health interventions delivered through sports clubs (resource mechanism) targeted at men who have high attachment to the sport or club (context), may align with their interests and identities (mechanism), to increase the potential for engagement and health behavior change (outcome). The analysis will be finalised by August. Conclusions Our study indicates that men’s health promotion through sports clubs is emergent. While great strides have been made to increase men’s involvement in health promoting activities by delivering interventions through sports clubs, research has predominantly focused on select behaviours (e.g., physical activity) and sub-groups (e.g., sports fans). Support/Funding Source This work was funded by the five Steno Diabetes Centers in Denmark, which are partly funded by the Novo Nordisk Foundation.

How does participatory research work: protocol for a realist synthesis

IntroductionParticipatory research science deals with partnerships underlying research, governance and ownership of research products. It is concerned with relationships behind research objectives and methods. Participatory research has gained significant traction...

The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis.

In health professions education (HPE) the effect of assessments on student motivation for learning and its consequences have been largely neglected. This is problematic because assessments can hamper motivation and psychological well-being. The research questions guiding this review were: How do assessments affect student motivation for learning in HPE? What outcomes does this lead to in which contexts? In October 2020, the authors searched PubMed, Embase, APA PsycInfo, ERIC, CINAHL, and Web of Science Core Collection for "assessments" AND "motivation" AND "health professions education/students." Empirical papers or literature reviews investigating the effect of assessments on student motivation for learning in HPE using quantitative, qualitative, or mixed methods from January 1, 2010-October 29, 2020, were included. The authors chose the realist synthesis method for data analysis to study the intended and unintended consequences of this complex topic. Assessments were identified as stimulating autonomous or controlled motivation using sensitizing concepts from self-determination theory and data on context-mechanism-outcome were extracted. Twenty-four of 15,291 articles were ultimately included. Assessments stimulating controlled motivation seemed to have negative outcomes. An example of an assessment that stimulates controlled motivation is one that focuses on factual knowledge (context), which encourages studying only for the assessment (mechanism) and results in surface learning (outcome). Assessments stimulating autonomous motivation seemed to have positive outcomes. An example of an assessment that stimulates autonomous motivation is one that is fun (context), which through active learning (mechanism) leads to higher effort and better connection with the material (outcome). These findings indicate that students strategically learned what was expected to appear in assessments at the expense of what was needed in practice. Therefore, health professions educators should rethink their assessment philosophy and practices and introduce assessments that are relevant to professional practice and stimulate genuine interest in the content.

Family engagement in paediatric acute care settings: A realist review.

To create a programme theory of family engagement in paediatric acute care to explicate the relationships between contexts and mechanisms of family engagement that align with family, direct care providers and healthcare organization outcomes. Realist review and synthesis. PubMed, CINAHL, PsycINFO and Web of Science searches for the 2.5-year period (July 2019-December 2021) following our 2021 scoping review. Following methods described by Pawson and Rycroft-Malone, we defined the scope of the review, searched for and appraised the evidence, extracted and synthesized study findings and developed a supporting narrative of our results. Of 316 initial citations, 101 were included in our synthesis of the final programme theory. Contexts included family and direct care provider individualism, and the organizational care philosophy and environment. Mechanisms were family presence, family enactment of a role in the child's care, direct care providers facilitating a family role in the child's care, unit/organizational promotion of a family role, relationship building and mutually beneficial partnerships. Outcomes were largely family-focussed, with a paucity of organizational outcomes studied. We identified four context-mechanism-outcome configurations. This realist review uncovered underlying contexts and mechanisms between patients, direct care providers and organizations in the family engagement process and key components of a mutually beneficial partnership. Given that successful family engagement requires direct care provider and organizational support, future research should expand beyond family outcomes to include direct care providers, particularly nurses and healthcare organization outcomes. The final programme theory of family engagement in paediatric acute care provides a roadmap for clinicians to develop complex interventions to engage families and evaluate their impact. The components of our final programme theory reflect family engagement concepts that have been evolving for decades. The team conducting this review included members from the practice setting (JT & KG). In the future, as we and others use this model in practice, we will seek input for refinement from clinicians, patients and caregivers.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol

Background: A robust Health Technology Assessment (HTA) mechanism is crucial to address the rising burden of healthcare costs and expenditures of patients. This research aims to describe the HTA methods and mechanisms for successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Methods: Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. Conclusions: To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

Developing a definition of body neutrality and strategies for an intervention

The aim of this study was to provide a definition for body neutrality and understand the key strategies recommended to improve body neutrality for testing in future interventions. There is minimal academic literature on body neutrality and thus this study focused on examining websites where the concept has been discussed for some time. This was achieved using a realist synthesis of websites and a common elements approach to extract the key definition elements of body neutrality, strategies to improve body neutrality, in addition to the common critiques of both the body positivity and body neutrality movements. The initial search found 175 websites, of which 107 were included in the final synthesis, and common elements analysis followed after removal of duplicates and ineligible websites. Three elements, with several sub-elements, best operationalised the definition of body neutrality. Six strategies were found for development of a body neutrality intervention. This innovative study paves the way for rigorous evaluation of body neutrality. Recommendations for future work are provided, including the use of current measures, creating a new measure, and evaluating prevention and intervention programs including Single Session Interventions (SSIs).