Pulling apart the Population health intervention black box: The concept of 'mechanism' from a realist evaluation perspective

Nov 12, 20121 like514 views

To quote: Lacouture A., Breton E., Ridde V., Guichard A. Pulling apart the population health intervention black box: the concept of 'mechanism' from a realist evaluation perspective. 5th Annual European Public Health Conference. All Inclusive Public Health. Portomaso, St Julian's, Malta. 7-10 November 2012.

Pulling apart the
Population health intervention black box:
The concept of ‘mechanism’
from a realist evaluation perspective.
Anthony Lacouture 1, Eric Breton 1, Valéry Ridde 2, Anne Guichard 3
1. EHESP School of Public Health, Rennes, France
2. Montreal University Hospital Research Centre CRCHUM, Montreal, Canada
3. National Institute for Prevention and Health Education INPES, Saint Denis, France

To open the intervention
black box, 3 reading keys M
Agency Structure
per ‘mechanism’ (M): O
Intervention black box
FORCE / POWER C DYNAMIC PROCESS
Generative causation RELATION / Implementation
• M hidden, but real INTERACTION • Anteriority/History
• M produces outcomes (O) • Temporality
Interrelationships Agency/Structure
• M depends on context (C)
• M: Reasoning/Resources
 Existence of families of
• M: Reactions
‘mechanisms’  Logic of intervention

For Whom ? What ?
Actors in Population health (PH) intervention Challenges of complex intervention
(Stakeholders, researchers, practitioners…) evaluation
• Complex nature of context-dependant
Acting at different levels of intervention
intervention
(Practice, programme, policy…) • Shortfalls of (quasi) experimental
Involved in different issues evaluation design
• Realist approach: a theory-based
(Health system management, Health
evaluation (Pawson & Tilley, 1997)
promotion, Healthcare access…)
“Context-Mechanism-Outcomes” configuration

Scoping study Defining the concept of ‘mechanism’
• Exploratory study of the grey and scientific • No consensus about the definition
literature • Clarification is required for a more
• Conceptual analysis: term, sense, referent coherent use (Marchal et al, 2012)
(Gerring, 1999; Sartori, 2009; Daigneault & Jacob, 2012) • Very recent debate in PH evaluation
• 57 documents included (out of 1442 • The proponents of the realist approach
references) featuring an implicit or explicit have suggested a general methodological
definition of ‘mechanism’ framework rather than a strict one

How ? Why ?
5th Annual European Public Health Conference
7-12 November 2012, Malta
This study is a component of the ‘AAPRISS’ programme carried out by: This study was funded by the French National Research Agency (ANR)
Eric Breton, PhD: Eric.Breton@ehesp.fr
Valéry Ridde, PhD: Valery.Ridde@umontreal.ca
Anne Guichard, PhD: Anne.Guichard@inpes.sante.fr
Anthony Lacouture, MSc: Anthony.Lacouture@ehesp.fr

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Pulling apart the Population health intervention black box: The concept of 'mechanism' from a realist evaluation perspective

1. Pulling apart the Population health intervention black box: The concept of ‘mechanism’ from a realist evaluation perspective. Anthony Lacouture 1, Eric Breton 1, Valéry Ridde 2, Anne Guichard 3 1. EHESP School of Public Health, Rennes, France 2. Montreal University Hospital Research Centre CRCHUM, Montreal, Canada 3. National Institute for Prevention and Health Education INPES, Saint Denis, France To open the intervention black box, 3 reading keys M Agency Structure per ‘mechanism’ (M): O Intervention black box FORCE / POWER C DYNAMIC PROCESS Generative causation RELATION / Implementation • M hidden, but real INTERACTION • Anteriority/History • M produces outcomes (O) • Temporality Interrelationships Agency/Structure • M depends on context (C) • M: Reasoning/Resources  Existence of families of • M: Reactions ‘mechanisms’  Logic of intervention For Whom ? What ? Actors in Population health (PH) intervention Challenges of complex intervention (Stakeholders, researchers, practitioners…) evaluation • Complex nature of context-dependant Acting at different levels of intervention intervention (Practice, programme, policy…) • Shortfalls of (quasi) experimental Involved in different issues evaluation design • Realist approach: a theory-based (Health system management, Health evaluation (Pawson & Tilley, 1997) promotion, Healthcare access…) “Context-Mechanism-Outcomes” configuration Scoping study Defining the concept of ‘mechanism’ • Exploratory study of the grey and scientific • No consensus about the definition literature • Clarification is required for a more • Conceptual analysis: term, sense, referent coherent use (Marchal et al, 2012) (Gerring, 1999; Sartori, 2009; Daigneault & Jacob, 2012) • Very recent debate in PH evaluation • 57 documents included (out of 1442 • The proponents of the realist approach references) featuring an implicit or explicit have suggested a general methodological definition of ‘mechanism’ framework rather than a strict one How ? Why ? 5th Annual European Public Health Conference 7-12 November 2012, Malta This study is a component of the ‘AAPRISS’ programme carried out by: This study was funded by the French National Research Agency (ANR) Eric Breton, PhD: Eric.Breton@ehesp.fr Valéry Ridde, PhD: Valery.Ridde@umontreal.ca Anne Guichard, PhD: Anne.Guichard@inpes.sante.fr Anthony Lacouture, MSc: Anthony.Lacouture@ehesp.fr

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