How are realist reviews different from other reviews?

A realist review or realist synthesis, differs notably from conventional review methodologies, such as those used in systematic reviews and meta-analyses. A systematic review designed to assess the effectiveness of interventions primarily uses quantitative methods to aggregate findings across studies. This approach focuses on producing a summary of evidence to determine if an intervention works. In contrast, realist syntheses aim to uncover the underlying mechanisms and contextual factors influencing outcomes. Unlike systematic reviews, which often provide little or no clue about how or why an intervention works, realist reviews explore these dynamics in-depth, offering a richer understanding of the intervention’s impact within specific settings.

In the health sciences, where the complexity of interventions is often high, realist syntheses offer a unique advantage. While systematic reviews provide valuable insights into the overall effectiveness of interventions, they do not delve into the intricacies of programme theory. Realist reviews, guided by realist program theory, examine the interactions between context, mechanism, and outcome, offering a comprehensive view of how interventions work. This approach contrasts with the conventional review methodology, which may overlook these critical factors. By focusing on the realist program theory, realist syntheses provide practical insights that can inform the design and implementation of interventions, particularly in complex fields like health sciences.

How to conduct a realist review?

Conducting a realist review involves several key steps to ensure a thorough and systematic approach to understanding complex interventions. Here are the main steps:

Formulate the review question: Define the review question, objectives, and scope. This question should incorporate elements of context, mechanism, and outcome (CMO)(Pawson and Tilley 1997). The review focus should be on theory development and refining theory through empirical evidence and qualitative data.
Search for evidence: Conduct an iterative and flexible search process to gather a wide range of evidence. This includes primary studies and meta-narrative evidence syntheses that can provide insights into how the intervention works in different settings.
Appraise and extract data: Evaluate the relevance and rigour of the research evidence. Focus on extracting data that illuminate the mechanisms, contexts, and outcomes related to the intervention. Use inclusion and exclusion criteria to ensure the evidence is relevant to the review scope.
Synthesize evidence: Develop and refine theories about how the intervention works by identifying patterns across the studies. This involves constructing CMO configurations (Pawson and Tilley 1997) that explain the observed outcomes. Data synthesis is a crucial part of this process.
Interpreting and reporting: Interpret the findings to provide actionable insights. The final report should include recommendations on how the intervention can be adapted or improved based on the understanding of its mechanisms and contexts. Stakeholder involvement in this phase can enhance the practical relevance of the findings.

Conclusion

Conducting realist reviews offers a powerful approach to understanding the complexities of interventions in real-world settings. A realist review provides valuable insights that go beyond simple effectiveness, focusing on the interplay between context, mechanism, and outcome. This method is particularly beneficial in healthcare, education, social policy, and environmental initiatives, where understanding the contexts, mechanisms, and outcomes is crucial.

Realist reviews help design and implement interventions that are both effective and context-sensitive. They delve into the why and how behind outcomes, making them essential for developing evidence-based policy grounded in a deep understanding of real-world complexities.

Realist reviews use diverse evidence and explain variability in outcomes, enhancing our understanding of interventions and improving their practical application in real-world settings. As a result, they serve as an indispensable method for designing and implementing effective, context-sensitive interventions. Employing realist reviews in your research can lead to more impactful and sustainable solutions across various fields.