Article type
Year
Abstract
Background: Realist synthesis is an explanatory analysis of how and why complex interventions have (limited) effect in particular contexts or settings. Several systematic reviews have applied this approach to synthesizing research evidence, but few offer an appraisal of its strengths and limitations.
Objectives: To present methodological reflections on our experiences with application of the realist synthesis approach in a systematic review on the effectiveness of interventions designed to prevent female genital cutting.
Methods: After completing a systematic review in accordance with the Cochrane handbook we applied the realist evaluation approach. The realist explanation involved identifying and examining the three components outcome patterns, generative mechanisms, and contextual conditions of interventions, and finally integrating all data to address the context-mechanisms-outcomes (CMO) configurations that underpinned interventions.
Results: We included 8 effectiveness studies and 27 context studies which delineated factors related to the target behavior in settings where the interventions occurred. Strengths of the realist approach included the systematic involvement of stakeholders which ensured that relevance was maintained, and the focus on explanation rather than judgment. Due to the centrality of mechanisms of change there was greater analytic power in identifying and explaining heterogeneity of trial results. We found the realist synthesis challenging regarding having program theory as the unit of analysis. Given the approach is iterative, ensuring standardization and reproducibility was difficult. Because of the studies’ limited descriptions of context and mechanisms, CMO configurations had to be reconstructed through argumentational analysis, which was complicated and time-consuming.
Conclusions: The application of a realist synthesis in our systematic review uncovered likely reasons for lack of intervention effectiveness and promising intervention content to test in the future. While the realist synthesis can yield valuable insights, conducting one is a complex and laborious undertaking, which requires a high level of experience in academia, program service, and systematic reviewing.
Objectives: To present methodological reflections on our experiences with application of the realist synthesis approach in a systematic review on the effectiveness of interventions designed to prevent female genital cutting.
Methods: After completing a systematic review in accordance with the Cochrane handbook we applied the realist evaluation approach. The realist explanation involved identifying and examining the three components outcome patterns, generative mechanisms, and contextual conditions of interventions, and finally integrating all data to address the context-mechanisms-outcomes (CMO) configurations that underpinned interventions.
Results: We included 8 effectiveness studies and 27 context studies which delineated factors related to the target behavior in settings where the interventions occurred. Strengths of the realist approach included the systematic involvement of stakeholders which ensured that relevance was maintained, and the focus on explanation rather than judgment. Due to the centrality of mechanisms of change there was greater analytic power in identifying and explaining heterogeneity of trial results. We found the realist synthesis challenging regarding having program theory as the unit of analysis. Given the approach is iterative, ensuring standardization and reproducibility was difficult. Because of the studies’ limited descriptions of context and mechanisms, CMO configurations had to be reconstructed through argumentational analysis, which was complicated and time-consuming.
Conclusions: The application of a realist synthesis in our systematic review uncovered likely reasons for lack of intervention effectiveness and promising intervention content to test in the future. While the realist synthesis can yield valuable insights, conducting one is a complex and laborious undertaking, which requires a high level of experience in academia, program service, and systematic reviewing.