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Realist synthesis : illustrating the method for implementation research

Rycroft-Malone, Jo, McCormack, Brendan, Hutchinson, Alison M., DeCorby, Kara, Bucknall, Tracey K., Kent, Bridie, Schultz, Alyce, Snelgrove-Clarke, Erna, Stetler, Cheryl B., Titler, Marita, Wallin, Lars and Wilson, Valerie 2012, Realist synthesis : illustrating the method for implementation research, Implementation science, vol. 7, no. 33, pp. 1-22, doi: 10.1186/1748-5908-7-33.

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Title Realist synthesis : illustrating the method for implementation research
Author(s) Rycroft-Malone, Jo
McCormack, Brendan
Hutchinson, Alison M.ORCID iD for Hutchinson, Alison M.
DeCorby, Kara
Bucknall, Tracey K.ORCID iD for Bucknall, Tracey K.
Kent, Bridie
Schultz, Alyce
Snelgrove-Clarke, Erna
Stetler, Cheryl B.
Titler, Marita
Wallin, Lars
Wilson, Valerie
Journal name Implementation science
Volume number 7
Issue number 33
Start page 1
End page 22
Total pages 22
Publisher BioMed Central
Place of publication London, England
Publication date 2012-04-19
ISSN 1748-5908
Keyword(s) method
implementation research
Summary Background
Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question 'what interventions and strategies are effective in enabling evidence-informed healthcare?' The strengths and challenges of conducting realist review are also considered.
The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses.
Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area.
Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.
Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Language eng
DOI 10.1186/1748-5908-7-33
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Biomed Central
Free to Read? Yes
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact