Realist review--a new method of systematic review designed for complex policy interventions.
Realist review--a new method of systematic review designed for complex policy interventions.
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DOI：
10.1258/1355819054308530
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发表时间：
2005-07-01
影响因子：
2.4
通讯作者：
Walshe, Kieran
中科院分区：
文献类型：
--
作者：
Pawson, Ray;Greenhalgh, Trisha;Walshe, Kieran
以证据为基础的政策是当代公共服务的一个主要主题，但在决策中使用证据所涉及的实际现实和挑战是巨大的。问题的部分原因在于复杂性。在卫生服务和其他公共服务方面，我们正在处理复杂的社会干预措施，这些干预措施作用于复杂的社会系统--如排行榜、绩效衡量、监管和检查，或资金改革。这些不是总能命中目标的“灵丹妙药”，而是其效果关键取决于背景和执行情况的方案。传统的审查方法侧重于衡量和报告方案的有效性，往往发现证据参差不齐或相互矛盾，很少或根本没有提供任何线索，说明在不同的背景或情况下、由不同的利益攸关方部署或用于不同的目的时，干预措施为什么奏效或不奏效。本文提供了一个研究综合模型，该模型旨在与复杂的社会干预或方案一起工作，并基于新兴的“现实主义”评估方法。它提供了一种解释性分析，旨在辨别什么对谁起作用、在什么情况下、在什么方面以及如何起作用。第一步是明确方案理论--关于干预措施如何发挥作用以及预期会产生什么影响的基本假设。然后，我们寻找经验证据来充实这一理论框架，在此过程中支持、矛盾或修改方案理论。审查的结果结合了理论理解和经验证据，重点解释了干预的实施背景、运作机制和产生的结果之间的关系。其目的是使决策者能够更深入地了解干预措施以及如何使其最有效地发挥作用。现实主义的回顾不会为复杂的问题提供简单的答案。它不会告诉政策制定者或管理人员某事是否奏效，但将为政策和实践界提供对复杂的社会干预措施的丰富、详细和高度实际的了解，这可能对他们在国家、区域或地方一级规划和执行方案时更有用。
Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems--things like league tables, performance measures, regulation and inspection, or funding reforms. These are not 'magic bullets' which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging 'realist' approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories)--the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level.