Navigate the links below to jump to a specific section of the page:

• Definition
• When is a Realist Review methodology appropriate?
• Methods and Guidance
• Examples of Realist Reviews
• Supplementary Resources

Realist reviews are specifically designed for evaluating complex social interventions for implementing programs and policy.

According to Pawson et al. (2005), a realist review, or a realist synthesis, is a method for studying complex interventions in response to the perceived limitations of conventional systematic review methodology. It involves identification of Contexts, Mechanisms, and Outcomes for individual programs to explain differences, intended or unintended, between them. Pawson et al. (2005) add that "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" (p.21).

Characteristics

Rycroft-Malone et al. (2012) describe that "a realist synthesis follows similar stages to a traditional systematic review, but with some notable differences" which include:

• The focus of the synthesis is derived from a negotiation between stakeholders and reviewers and therefore the extent of stakeholder involvement throughout the process is high.
• The search and appraisal of evidence is purposive and theoretically driven with the aim of refining theory.
• Embraces multiple methods (both qualitative and quantitative) and multiple types of information and evidence can be included.
• The process is iterative.
• The findings from the synthesis focus on explaining to the reader why (or why not) the intervention works and in what ways, to enable informed choices about further use and/or research.

When to Use It: As stated by Wong (2019), realist reviews are used when needing to answer the question "what works, for whom, under what circumstances?" Rycroft-Malone et al. (2012) state that realist reviews are "particularly appropriate for unpacking the impact of complex interventions because it works on the premise that one needs to understand how interventions work in different contexts, and why" (p.9). Wong (2019) confirms that realist reviews are steadily on the rise.

The following resource provides further support on conducting a realist review.

Methods & Conduct

• Booth, A., Briscoe, S., & Wright, J. M. (2020). The "realist search": A systematic scoping review of current practice and reporting. Research synthesis methods, 11(1), 14–35. doi: 10.1002/jrsm.1386
• Marchal, B., Belle, S. V., & Westhorp, G. (2018, April 18). Realist Evaluation. BetterEvaluation. https://www.betterevaluation.org/en/approach/realist_evaluation
• Westhorp, G. (2014). Realist Impact Evaluation: An Introduction. Methods Lab. https://www.betterevaluation.org/resources/realist-impact-evaluation-introduction
• Wong, G. (2018). Realist reviews in health policy and systems research. In Langlois, É. V., Daniels, K, & Akl, E. A. (Eds.), Evidence Synthesis for health policy and systems: A methods guide. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK569585/

• Wong, G., MacPhee, M., Merrett, K., Miller, K., Taylor, S., & Pawliuk, C. (2020, March 10). The Realist Review Process Workshop [Presentation]. doi: 10.14288/1.0390457

Reporting Standards

• Wong, G., Westhorp, G., Manzano, A., Greenhalgh, J., Jagosh, J., & Greenhalgh, T. (2016). RAMESES II reporting standards for realist evaluations. BMC medicine, 14(1), 96. doi: 10.1186/s12916-016-0643-1

• Berg, R. C., & Nanavati, J. (2016). Realist review: current practice and future prospects. Journal of research practice, 12(1), Article R1. http://jrp.icaap.org/index.php/jrp/article/view/538/449 

• Byng, R., Norman, I., Redfern, S., & Jones, R. (2008). Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. BMC health services research, 8, 274. doi: 10.1186/1472-6963-8-274

• Evans, D., & Killoran, A. (2000). Tackling health inequalities through partnership working: learning from a realistic evaluation. Critical Public Health, 10(2), 125–140. doi: 10.1080/09581590050075899

• Flynn, R., Rotter, T., Hartfield, D., Newton, A. S., & Scott, S. D. (2019). A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare. BMC health services research, 19(1), 912. doi: 10.1186/s12913-019-4744-3

• Kantilal, K., Hardeman, W., Whiteside, H., Karapanagiotou, E., Small, M., & Bhattacharya, D. (2020). Realist review protocol for understanding the real-world barriers and enablers to practitioners implementing self-management support to people living with and beyond cancer. BMJ open, 10(9), e037636. doi: 10.1136/bmjopen-2020-037636

• Manzano-Santaella, A. (2011). A realistic evaluation of fines for hospital discharges: incorporating the history of programme evaluations in the analysis. Evaluation, 17(1), 21–36. doi: 10.1177/1356389010389913

• Marchal, B., Dedzo, M., & Kegels, G. (2010). A realist evaluation of the management of a well-performing regional hospital in Ghana. BMC health services research, 10, 24. doi: 10.1186/1472-6963-10-24

• Marchal, B., Dedzo, M., & Kegels, G. (2010). Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana). BMC public health, 10, 787. doi: 10.1186/1471-2458-10-787

• Booth, A., Briscoe, S., & Wright, J. M. (2020). The "realist search": A systematic scoping review of current practice and reporting. Research synthesis methods, 11(1), 14–35. doi: 10.1002/jrsm.1386

• Marchal, B., Belle, S. V., & Westhorp, G. (2018, April 18). Realist Evaluation. BetterEvaluation. https://www.betterevaluation.org/en/approach/realist_evaluation
• Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005). Realist review--a new method of systematic review designed for complex policy interventions. Journal of health services research & policy, 10(Suppl 1), 21–34. doi:10.1258/1355819054308530

• Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., DeCorby, K., Bucknall, T. K., Kent, B., Schultz, A., Snelgrove-Clarke, E., Stetler, C. B., Titler, M., Wallin, L., & Wilson, V. (2012). Realist synthesis: illustrating the method for implementation research. Implementation science:IS, 7, 33. doi: 10.1186/1748-5908-7-33

• Sridharan, S. (n.d.). A brief introduction to Realist Synthesis. University of Toronto - Health Policy, Evaluation and Management. https://www.ncchpp.ca/docs/Sridharan_JASP_realistAN_nov08.pdf
• Westhorp, G. (2014). Realist Impact Evaluation: An Introduction. Methods Lab. https://www.betterevaluation.org/resources/realist-impact-evaluation-introduction
• Wong, G. (2019, October 28). The rise and rise of realist reviews? Centre for Evidence-Based Medicine. https://www.cebm.ox.ac.uk/news/views/the-rise-and-rise-of-realist-reviews
• Wong, G. (2018). Realist reviews in health policy and systems research. In Langlois, É. V., Daniels, K, & Akl, E. A. (Eds.), Evidence Synthesis for health policy and systems: A methods guide. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK569585/

• Wong, G., MacPhee, M., Merrett, K., Miller, K., Taylor, S., & Pawliuk, C. (2020, March 10). The Realist Review Process Workshop [Presentation]. doi: 10.14288/1.0390457

• Wong, G., Westhorp, G., Manzano, A., Greenhalgh, J., Jagosh, J., & Greenhalgh, T. (2016). RAMESES II reporting standards for realist evaluations. BMC medicine, 14(1), 96. doi: 10.1186/s12916-016-0643-1