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Allaire JF, Morin P, Doré C, Hyppolite SR, Suzanne Badji M, Zomahou HTV. Integrated Community Care Delivered by Public Health-Care and Social-Care Systems: Results from a Realist Synthesis. Int J Integr Care 2024; 24:11. [PMID: 38370568 PMCID: PMC10870956 DOI: 10.5334/ijic.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/09/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Integrated community care (ICC) is defined as an interweaving of health-care and social-care interventions deployed in spatial and relational proximity using an interdisciplinary and cross-sectoral approach. Consideration of territory scale and time scale are at the center of ICC practices. Its deployment in public health and social care networks (HSCN) can be complex due to their broad mandate, the complexity of their management, and accountability. Therefore, we aimed to describe ICC delivered by public HSCN to determine how, why, for whom, and in what circumstances ICC works and produces outcomes. Methods A realist synthesis was conducted consisting of five steps consistent with realist synthesis standards (RAMESES projects) to produce configurations of Context - Mechanism - Outcomes (CMOc) and development of a middle-range explanatory theory of why and how the identified outcomes may have occurred. Results In total, 26 studies were selected and used, as evidence, to support-either partially or fully-the production of CMOc based on the initial program theory. Nine unique CMO configurations were identified based on the data analyses and team discussion. ICC middle-range theory is informed by the CMO configurations identified. Discussion This realist synthesis allowed us to identify the central mechanisms of ICC delivered by public HSCN and to produce a middle range theory. ICC is based on a specific philosophy and deployed by a professional agency oriented toward a community agency within a local system of interdisciplinary and cross-sectoral action. Conclusion Our middle-range theory will provide a solid analytical framework as a foundation for ICC implementation and future research.
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Affiliation(s)
- Jean-François Allaire
- Institut universitaire de première ligne en santé et services sociaux (IUPLSSS) du Centre intégré universitaire de santé et de services sociaux de l’Estrie –Centre hospitalier universitaire de Sherbrooke (CIUSSSE-CHUS), Hopital et centre d’hébergement D’Youville, Sherbrooke, QC, Canada
| | - Paul Morin
- Institut universitaire de première ligne en santé et services sociaux (IUPLSSS) du Centre intégré universitaire de santé et de services sociaux de l’Estrie –Centre hospitalier universitaire de Sherbrooke (CIUSSSE-CHUS), Hopital et centre d’hébergement D’Youville, Sherbrooke, QC, Canada
- Université de Sherbrooke, Canada
| | - Chantal Doré
- Institut universitaire de première ligne en santé et services sociaux (IUPLSSS) du Centre intégré universitaire de santé et de services sociaux de l’Estrie –Centre hospitalier universitaire de Sherbrooke (CIUSSSE-CHUS), Hopital et centre d’hébergement D’Youville, Sherbrooke, QC, Canada
- School of Nursing and Researcher, Université de Sherbrooke, Canada
| | - Shelley-Rose Hyppolite
- Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Canada
- Faculté de médecine, Université Laval, Canada
| | - Marie Suzanne Badji
- Institut universitaire de première ligne en santé et services sociaux (IUPLSSS) du Centre intégré universitaire de santé et de services sociaux de l’Estrie –Centre hospitalier universitaire de Sherbrooke (CIUSSSE-CHUS), Hopital et centre d’hébergement D’Youville, Sherbrooke, QC, Canada
| | - Hervé Tchala Vignon Zomahou
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Institut national d’excellence en santé et services sociaux, Quebec, Québec, Canada
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de Jong MAJG, Wink G, Koelen MA, Wagemakers A. Unravelling mechanisms underlying the action principles of a community-based health promotion programme: a realist evaluation. Arch Public Health 2023; 81:9. [PMID: 36653819 PMCID: PMC9850519 DOI: 10.1186/s13690-023-01027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Since 1986, WHO has advised that applying action principles such as citizen participation and intersectoral collaboration leads to better health. However, less is known about the workability of these principles and how they trigger specific outcomes in interaction with the context. A critical realist perspective was applied to get a better understanding of what worked, and why it worked, in the context of a Dutch community-based health promotion programme (CBHPP). The aim of the study was to unravel the mechanisms underlying the action principles and find combinations of contextual factors and mechanisms that trigger outcomes in a CBHPP. METHODS In this single case study, a critical realist methodology was followed. Qualitative data used in this study originated from multiple sources and methods to ensure validity. They include evaluation sessions with coalition members (n = 6) and individual interviews (n = 6); group sessions with community workers (n = 1), a health broker (n = 1), and citizens (n = 12); and seven semi-annual progress reports and minutes of the coalition meetings. The collected data were then compared with the programme theory through a heuristic process of constructing, exploring, and refining context-mechanism-outcome configurations. RESULTS The programme initiated a variety of new activities that differed in content, intensity, duration, and number of participants, organised and implemented together with citizens. The most prominent mechanism underlying both action principles were programme-related, namely, patience, personal contact, contribution of budget, and the programme coordinator's leadership. Another important mechanism was creating visibility, which resulted in the involvement of the municipality and a budget to sustain the programme. CONCLUSION In this case study, personal contact, patience, perseverance, participatory action research activities, and visibility were found to be the most notable mechanisms underlying the citizen participation and intersectoral collaboration action principles. As the principle-based approach added value to the existing context and introduced most of the mechanisms that triggered the outcomes, it is recommended to include citizen participation and intersectoral collaboration not only as action principles but explicitly as targets in a CBHPP.
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Affiliation(s)
- Marja A. J. G. de Jong
- GGD IJsselland (Municipal Health Service), Zwolle, the Netherlands ,grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
| | - Gerda Wink
- grid.10417.330000 0004 0444 9382Department of Primary and Community Care, Radboud University Medical Centre, AMPHI Academic Collaborative Centre, Nijmegen, the Netherlands
| | - Maria A. Koelen
- grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
| | - Annemarie Wagemakers
- grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
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Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative. Int J Integr Care 2022; 22:12. [DOI: 10.5334/ijic.6421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
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Malengreaux S, Doumont D, Scheen B, Van Durme T, Aujoulat I. Realist evaluation of health promotion interventions: a scoping review. Health Promot Int 2022; 37:daac136. [PMID: 36166263 DOI: 10.1093/heapro/daac136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This scoping review aims to give a narrative account of existing realist evaluation practices in health promotion. Realist evaluations of health promotion interventions published between 2010 and 2021 were identified by searching five academic databases: Embase, Pubmed, PsycINFO, ScienceDirect and Scopus. A data-charting form was created based on the characteristics of realist evaluation and four core features of an approach appropriate for evaluating health promotion interventions. Seventeen articles met the inclusion criteria. These were classified into two types of studies: those aiming to build an initial program theory and those aiming to test an initial program theory. Our results revealed a great variety of realist evaluation practices and uncovered a growing interest in realist evaluation over the years. Our searches identified a lack of participative practice and capacity-building intention. Our examination of the data collection and analysis methods points to some common practices in using multi-methods. Perspectives on realist evaluation practices and on assessing the effectiveness of health promotion have been identified.
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Affiliation(s)
- Ségolène Malengreaux
- University Centre for Health Promotion RESO, Institute of Health and Society, Université catholique de Louvain, Clos chapelle-aux-champs 30, B1.30.14, 1200 Woluwé-St-Lambert, Brussels, Belgium
| | - Dominique Doumont
- University Centre for Health Promotion RESO, Institute of Health and Society, Université catholique de Louvain, Clos chapelle-aux-champs 30, B1.30.14, 1200 Woluwé-St-Lambert, Brussels, Belgium
| | - Bénédicte Scheen
- University Centre for Health Promotion RESO, Institute of Health and Society, Université catholique de Louvain, Clos chapelle-aux-champs 30, B1.30.14, 1200 Woluwé-St-Lambert, Brussels, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, Université catholique de Louvain, Clos chapelle-aux-champs 30, B1.30.13, 1200 Woluwé--St-Lambert, Brussels, Belgium
| | - Isabelle Aujoulat
- University Centre for Health Promotion RESO, Institute of Health and Society, Université catholique de Louvain, Clos chapelle-aux-champs 30, B1.30.14, 1200 Woluwé-St-Lambert, Brussels, Belgium
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Mukumbang FC, De Souza D, Liu H, Uribe G, Moore C, Fotheringham P, Eastwood JG. Unpacking the design, implementation and uptake of community-integrated health care services: a critical realist synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009129. [PMID: 35940630 PMCID: PMC9364400 DOI: 10.1136/bmjgh-2022-009129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Community-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not. Methods and analysis Critical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate. Results Three programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination. Conclusion We systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions. PROSPERO registration number CRD42020210442.
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Affiliation(s)
- Ferdinand C Mukumbang
- Department of Global Health, University of Washington, Seattle, Washington, USA .,Ingham Institute, Liverpool, New South Wales, Australia
| | - Denise De Souza
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Hueiming Liu
- Torrens University Australia, Adelaide, South Australia, Australia.,Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Gabriela Uribe
- Sydney Local Health District, Camperdown, New South Wales, Australia.,The University of Newcastle, Callaghan, New South Wales, Australia
| | - Corey Moore
- Ingham Institute, Liverpool, New South Wales, Australia
| | | | - John G Eastwood
- Ingham Institute, Liverpool, New South Wales, Australia.,Sydney Local Health District, Camperdown, New South Wales, Australia
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Developing New Methods for Person-Centred Approaches to Adjudicate Context-Mechanism-Outcome Configurations in Realist Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042370. [PMID: 35206560 PMCID: PMC8871803 DOI: 10.3390/ijerph19042370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, and there is a growing body of work using realist evaluation to analyse interventions in healthcare organizations, including those using Lean Six Sigma improvement methodologies. Whilst realist evaluation facilitates the analysis of interventions using both qualitative and quantitative research, there is little guidance given on methods of data collection and analysis. The purpose of this study is to address this lack of guidance through detailing the use of innovative person-centred methods of data collection and analysis in a realist evaluation that enabled us to understand the contribution of Lean Six Sigma to person-centred care and cultures. This use of person-centred principles in the adjudication of identified program theories has informed novel methods of collecting and analysing data in realist evaluation that facilitate a person-centred approach to working with research participants and a way of making the implicit explicit when adjudicating program theory.
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