Improvement science and research methods seminar September 2020: Reflections upon incorporating a realist evaluation within a clinical trial by Dr Paul Leighton

The latest in the CaHRU seminar series was given on 30 September 2020 by Dr Paul Leighton, Associate Professor of Applied Health Services Research at the University of Nottingham and Senior Visiting Fellow at the University of Lincoln where he has been closely associated with CaHRU for several years. As a research methodologist Paul has worked across a number of clinical areas, including his work as a co-applicant on twelve successful NIHR awards. His expertise is in qualitative methods and process evaluation, and he has an interest in social (and sociological) aspects of healthcare. His work has included intervention development, feasibility studies as well as multi-centre trials; and studies have focused upon the experiences of both patients and healthcare professionals.

The seminar title was (to hear the talk click the link), ‘What worked for us in which circumstances, and what didn’t: reflections upon incorporating a realist process evaluation within a clinical trial.‘ Paul reflected on his experiences of leading a realist evaluation within the Falls in Care Homes (FinCH) trial, of a falls management tool, the Guide to Action in Care Homes (GtACH) for use in care homes. In his talk he described the complementary insight that a realist approach provided in interpreting the trial findings and in shaping future plans for wider implementation.

He considered the elements which typified a realist approach: adopting an emergent focus in different contexts, the use of theoretical sampling, and programme theory development in the form of context-mechanism-outcome configurations. He described how these key elements were practically incorporated into the trial. The approach helped the research team to understand why outcomes varied in different settings and how the intervention could be implemented to enhance its effects.

Finally he reflected upon the methodological challenges of integrating a realist evaluation within a large-scale complex intervention trial, including the ‘good’, the ‘bad’ and the ‘ugly’ of realist approaches. This was a well attended, informative and entertaining start to this autumn’s seminar series.

To see the seminar or slides click below. Please contact Sue Bowler ( if you would like to attend future seminars.

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