Uncovering the black box: the potential of stakeholder engagement in Realist Evaluation

Background and aim: Complex programs, with multiple components and stakeholders involved, are the norm rather than the exception in integrated care. With a focus on ‘what works, for whom, why, and under what circumstances’, Realist Evaluation (RE) offers a promising research paradigm to evaluate such programs in a transferable way. Furthermore, RE is highly participative: active involvement of program stakeholders is key to unearthing their perceptions about program functioning. The use of RE is growing steadily in social sciences. However, active stakeholder involvement and co-creation in RE may be challenging, amongst others, as experimental research paradigms are still quite dominant. Therefore, we have designed a workshop called ‘Uncovering the black box: the potential of stakeholder engagement in Realist Evaluation’. In this workshop, we have two aims: (1) to provide awareness and knowledge about RE, its potential and application to integrated care; (2) to give inspiration and practical tools for conducting RE in co-creation with different stakeholders. With the use of a co-creation tool called ‘the hats of Bono’ we want to provide participants with more hands-on practice in realist thinking and give them ideas on how to co-create with their future stakeholders. The workshop will use four hats to elicit feelings, ideas, benefits, and critiques focused on realist statements from a real-life case in integrated care. More specifically, we will present statements presenting the assumed functioning of shared-decision making support in general practice, particularly aimed at patients with low health literacy. Who is it for? Our workshop is for everyone interested in thinking beyond the traditional golden standard of randomised controlled trials and broadening their knowledge of research designs. For both researchers developing and implementing complex programs and people participating in studies (i.e. from professionals to citizens) this workshop may be valuable. Workshop program: We will start with a short general introduction about RE and an online question (using Wooclap) to the audience to gather their first impressions of RE (15 minutes). Then, we will provide an example project with realist statements (15 minutes). Next, the hats of Bono will be presented and explained; we will show only four out of the six hats. We then divide the groups into four subgroups, each representing one of the coloured hats of Bono and, thus, a different point of view on the statements. Within the subgroups half of the participants will take the perspectives of the patient and the other half of the healthcare provider, both often involved in RE of integrated care. Each group has 15 minutes to discuss their thoughts on the statements. Discussions are stimulated by the workshop organisers, who function as moderators. When time is up, all groups join the plenary presentation again, where each group can present their overall findings for each coloured hat, and findings will be discussed (30 min). We will end with a 5-minute closing and an online reflection (using Wooclap), asking the audience about whether they will use RE and what they learned about co-creation in RE.