Realist Evaluation: Unraveling the mechanism of complex interventions

In today’s world, understanding why things work or don’t work can be a real challenge, especially in health interventions where numerous factors can influence the success or failure of a program. Realist evaluation is a research method that helps us unravel this complexity and gain a deeper understanding of how and why interventions work (or don’t work) in different contexts.

Realist evaluation is a type of qualitative research that seeks to explain the underlying mechanisms that produce outcomes. The central idea behind realist evaluation is the C-M-O configuration, which stands for Context-Mechanism-Outcome. This framework suggests that interventions work (or don’t work) because of the interplay between the context in which they are implemented, the mechanisms they trigger, and the outcomes they produce.

One of the challenges of realist evaluation is that it allows for multiple ways of conducting the method. This can make it difficult to know where to start and how to proceed. To address this, I’ve developed a slide that outlines one approach to realist evaluation. I use this slide to onboard colleagues and ensure that we’re on the same page in our evaluation projects. Be aware that this slide was developed a long time ago, with the purpose to check my own understanding of this powerful method. It may not be relevant to latest advancements.

I’ve found this method to be a powerful tool for uncovering the ‘realities’ of how programs work in the real world, but the process is also demanding. It involves a continuous cycle of data collection, analysis, and interpretation, pushing me to continuously refine my understanding. Finding the ‘mechanisms’ is half of the battle; the other half is understanding how the context allows the ‘firing’ of the mechanism.

To do this, the researcher isn’t simply collecting data, but working with informants to develop more nuanced explanations of how and why interventions work. This collaborative process can be challenging, but it’s essential for ensuring that the evaluation can capture the realities of the program.