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Table 1 Approach to realist review (adapted from Pawson[9])

From: Realist synthesis: illustrating the method for implementation research




Define the scope of the review

Identify the question

What is the nature and content of the intervention?

What are the circumstances or context of its use?

What are the policy intentions or objectives?

What are the nature and form of its outcomes or impacts?

Undertake exploratory searches to inform discussion with review stakeholders.

Clarify the purpose(s) of the review

Theory integrity – does the intervention work as predicted?

Theory adjudication – which theories around the intervention seem to fit best?

Comparison – how does the intervention work in different settings, for different groups?

Reality testing – how does the policy intent of the intervention translate into practice?

Find and articulate the programme theories

Search for relevant ‘theories’ in the literature.

Draw up list of programme theories.

Group, categorise or synthesise theories.

Design a theoretically based evaluative framework to be ‘populated’ with evidence.

Develop bespoke data extraction forms.

Search for and appraise the evidence

Search for the evidence

Decide and define purposive sampling strategy.

Define search sources, terms and methods to be used (including cited reference searching).

Set the thresholds for stopping searching at saturation.

Test of relevance

Test relevance – does the research address the theory under test?

Test rigour – does the research support the conclusions drawn from it by the researchers or the reviewers?

Extract and synthesise findings

Extract the results

Extract data to populate the evaluative framework with evidence.

Synthesise findings

Compare and contrast findings from different studies.

Use findings from studies to address purposes(s) of review.

Seek both confirmatory and contradictory findings.

Refine programme theories in the light of evidence including findings from analysis of study data.

Develop narrative


Involve commissioners/decision makers in review of findings.

Disseminate review with findings, conclusions and recommendations.