Realist evaluation as a research method to explore integrated primary health care for people experiencing or at risk of homelessness
Susan (Suzi) Taylor1, Mark Petrich11Chief Allied Health Office, Clinical Excellence Division, WA Department of Health, Perth, WA, Australia
Abstract
Background: Complex interventions should be optimised as much as possible prior to a full trial. This requires information on underlying theory including the interaction between contexts, intervention mechanisms and outcomes. Realist evaluation is an often-overlooked research method that can support this aim.
Objectives: To describe the realist evaluation methods used to investigate a complex health care intervention including:
• realist literature review
• realist interviews
Method: Descriptive narrative on methods used to a) develop the core components of an integrated service model, and b) design a realist evaluation framework for trial of the service model.
Results: The literature review identified 109 contexts, 174 mechanisms, and 111 outcomes related to integrated primary health care for people experiencing homelessness. These were simplified into five statements and used as interview guides with N=27 participants across Australia (n=20 service providers; n=7 people with a lived experience of homelessness). The interviews refined the literature review data to 42 contexts, 74 mechanisms, and 37 outcomes which established twelve core components of an integrated health care model. These findings enabled design of a realist organisational case study method to evaluate a trial of the core components in practice.
Conclusion: Despite its complexity, realist evaluation can help understand the casual relationships between contexts and intervention mechanisms, and how they bring about client outcomes. This paper highlights an underrated research method that is useful when intervention components are undefined. Realist evaluation can inform robust evaluation and generate empirical data enabling health care providers to enhance service provision.
Biography
Susan (Suzi) Taylor is a registered occupational therapist with a PhD in health sciences through Curtin University. Over the last 10 years Suzi has worked in senior research positions embedded within hospitals and community organisations in Western Australia leading industry-based research projects. Suzi leads the Homeless Health portfolio in the WA Chief Allied Health Office and is focussed on integrated and equitable health care approaches for people experiencing homelessness.