Publisher: Wiley Blackwell Country of Publication: England NLM ID: 101543738 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1759-2887 (Electronic) Linking ISSN: 17592879 NLM ISO Abbreviation: Res Synth Methods Subsets: MEDLINE

Publication: : Chichester : Wiley Blackwell
Original Publication: Malden, MA : John Wiley & Sons, 2010-

Adolescent Behavior* ; Research Design* ; Review Literature as Topic*; Adolescent ; Humans ; Program Evaluation ; Publications ; Risk-Taking ; Treatment Outcome

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Here we discuss the benefits of this adapted methodology alongside an overview of the research through which the methodology was developed. A key finding from this research was that combining the complexity checklist with primary data from stakeholder engagement enabled us to systematically interrogate the data across data sources, uncovering and evidencing mechanisms which may otherwise have remained hidden, giving greater ontological depth to our research findings. This paper builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research. HIGHLIGHTS: Published reporting standards for realist review provide a set of guiding principles for conducting realist research. However, these are not recommended to be used in a prescriptive sense, and customization of the methodology to account for potential idiosyncrasies within a specific evidence base is accepted. A small number of papers within the existing literature have used each of the two key adaptions discussed within this study, though reasons for doing so have not been considered in any great depth. Furthermore, combining both of these adaptions to take an evaluative approach to realist synthesis is novel to this work and lends greater ontological depth to the research findings than may otherwise have been achieved. This study builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research.
(© 2020 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd.)

Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist Synthesis: An Introduction. Manchester: ESRC Research Methods Programme, University of Manchester; 2004.
Moore GF, Evans RE, Hawkins J, et al. From complex social interventions to interventions in complex social systems: future directions and unresolved questions for intervention development and evaluation. Evaluation. 2019;25(1):23-45.
Westhorp G. Using complexity-consistent theory for evaluating complex systems. Evaluation. 2012;18:405-420.
Jagosh J. Realist synthesis for public health: building an ontologically deep understanding of how programs work, for whom, and in which contexts. Annu Rev Public Health. 2019;40:361-372.
Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. BMC Med. 2013;11(1):21.
Pawson R, Tilley N. An introduction to scientific realist evaluation. Evaluation for the 21st Century: A Handbook; 1997: London: Sage.
Jagosh J, Pluye P, Wong G, et al. Critical reflections on realist review: insights from customizing the methodology to the needs of participatory research assessment. Res Syn Meth. 2014;5(2):131-141.
Carr T, Quinlan E, Robertson S, Gerrard A. Adapting realist synthesis methodology: the case of workplace harassment interventions. Res Syn Meth. 2017;8(4):496-505.
Cooper C. Complex Interventions to Prevent Adolescents from Engaging in Multiple Risk Behaviours: A Realist Enquiry [PhD thesis], 2018. Newcastle upon Tyne: Northumbria University.
Sawyer SM, Afifi RA, Bearinger LH, et al. Adolescence: a foundation for future health. The Lancet. 2012;379(9826):1630-1640.
Patton R, Deluca P, Kaner E, Newbury-Birch D, Phillips T, Drummond C. Alcohol screening and brief intervention for adolescents: the how, what and where of reducing alcohol consumption and related harm among young people. Alcohol Alcohol. 2013;49(2):207-212.
Laski L. Realising the health and wellbeing of adolescents. BMJ. 2015;351:h4119.
Jessor R. Risk behavior in adolescence: a psychosocial framework for understanding and action. J Adolesc Health. 1991;12:597-605.
Jessor R, Donovan JE, Costa FM. Beyond Adolescence: Problem Behaviour and Young Adult Development. Cambridge: Cambridge University Press; 1994.
DuRant RH, Smith JA, Kreiter SR, Krowchuk DP. The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents. Arch Pediatr Adolesc Med. 1999;153(3):286-291.
Coleman J, Hagell A. Young people, health and youth policy. Youth Policy. 2015;114(5):17-30.
de Looze M, Ter Bogt TF, Raaijmakers QA, Pickett W, Kuntsche E, Vollebergh WA. Cross-national evidence for the clustering and psychosocial correlates of adolescent risk behaviours in 27 countries. Eur J Public Health. 2014;25(1):50-56.
Laxer RE, Brownson RC, Dubin JA, Cooke M, Chaurasia A, Leatherdale ST. Clustering of risk-related modifiable behaviours and their association with overweight and obesity among a large sample of youth in the COMPASS study. BMC Public Health. 2017;17(1):102.
National Institute for Health and Care Excellence. Harmful sexual behaviour among children and young people, 2017. https://www.nice.org.uk/guidance/ng55. Accessed December 16, 2019.
National Institute for Health and Care Excellence. Sexually transmitted infections and under-18 conceptions: prevention, 2007. https://www.nice.org.uk/guidance/ph3. Accessed December 16, 2019.
National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people, 2008. https://www.nice.org.uk/guidance/ph23. Accessed December 16, 2019.
National Institute for Health and Care Excellence. Drug misuse prevention: targeted interventions, 2017. https://www.nice.org.uk/guidance/ng64. Accessed December 16, 2019.
Hale DR, Viner RM. Policy responses to multiple risk behaviours in adolescents. J Public Health (Oxf). 2012;34(suppl 1):i11-i19.
Botvin GJ, Eng A, Williams CL. Preventing the onset of cigarette smoking through life skills training. Prev Med. 1980;9(1):135-143.
Botvin GJ, Baker E, Dusenbury L, Tortu S, Botvin EM. Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study. J Consult Clin Psychol. 1990;58(4):437.
Botvin GJ. Preventing adolescent drug abuse through life skills training: theory, evidence of effectiveness, and implementation issues. In: Hansen WB, Giles SM, Fearnow-Kenney MD, eds. Improving Prevention Effectiveness. Greensboro, NC: Tanglewood Research; 2000:141-153.
Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Philosophy Rhetoric. 1977;10(2):130-132.
Fishbein M, Ajzen I. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.
McNeal RB Jr, Hansen WB, Harrington NG, Giles SM. How all stars works: an examination of program effects on mediating variables. Health Educ Behav. 2004;31(2):165-178.
Marlatt GA. Harm reduction: come as you are. Addict Behav. 1996;21(6):779-788.
Newton NC, Andrews G, Teesson M, Vogl LE. Delivering prevention for alcohol and cannabis using the internet: a cluster randomised controlled trial. Prev Med. 2009;48(6):579-584.
Newton NC, Andrews G, Champion KE, Teesson M. Universal internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: a cluster randomised controlled trial. Prev Med. 2014;65:109-115.
Rutter M. Resilience: some conceptual considerations. J Adolesc Health. 1993;14(8):626-631, 690-6.
Bernat DH, Resnick MD. Healthy youth development: science and strategies. J Public Health Manag Pract. 2006;12:S10-S16.
Brooks FM, Magnusson J, Spencer N, Morgan A. Adolescent multiple risk behaviour: an asset approach to the role of family, school and community. J Public Health (Oxf). 2012;34(suppl 1):i48-i56.
Patterson GR, Reid JB, Dishion TJ. Antisocial Boys. Vol 4. Oregon: Castalia Publishing Company; 1992.
Deković M. Risk and protective factors in the development of problem behavior during adolescence. J Youth Adolesc. 1999;28(6):667-685.
Sigfúsdóttir ID, Thorlindsson T, Kristjánsson ÁL, Roe KM, Allegrante JP. Substance use prevention for adolescents: the Icelandic model. Health Promot Int. 2008;24(1):16-25.
Patton GC, Glover S, Bond L, et al. The Gatehouse Project: a systematic approach to mental health promotion in secondary schools. Aust N Z J Psychiatry. 2000;34(4):586-593.
Pearson M, Chilton R, Wyatt K, et al. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implementation Sci. 2015;10(1):149.
Wong G, Westhorp G, Greenhalgh J, Manzano A, Jagosh J, Greenhalgh T. Quality and reporting standards, resources, training materials and information for realist evaluation: the RAMESES II project. Health Services Delivery Res. 2017;5(28):1-108.
Rycroft-Malone J, McCormack B, Hutchinson AM, et al. Realist synthesis: illustrating the method for implementation research. Implementation Sci. 2012;7(1):33.
Pawson R. The Science of Evaluation: A Realist Manifesto. London: Sage; 2013.
Pawson R. A complexity checklist. The Science of Evaluation: A Realist Manifesto. London: Sage; 2013.
Morrow V. Ethical dilemmas in research with children and young people about their social environments. Child Geogr. 2008;6(1):49-61.
Morrow V. Using qualitative methods to elicit young people's perspectives on their environments: some ideas for community health initiatives. Health Educ Res. 2001;16(3):255-268.
Emmel N. I'm not dancing-I'm zigzagging. Wordpress, 2015. https://realistmethods.files.wordpress.com/2015/03/im-not-dancing-im-zigzagging.pdf. Accessed December 16, 2019.
Bhaskar R. On the possibility of social scientific knowledge and the limits of naturalism. J Theory Soc Behav. 1978;8:1-28.
Harré R. Social Being: A Theory for Social Psychology. New York: Rowman and Littlefield; 1980.
Bandura A. Social-learning theory of identificatory processes. In: Goslin D, ed. Handbook of Socialization Theory and Research; New York: Guilford press. 1969:213-262.
Catalano RF, Hawkins JD. The social development model: a theory of antisocial behavior. In: Hawkins JD, ed. Delinquency and Crime: Current Theories. Cambridge Criminology Series. Cambridge: Cambridge University Press; 1996:149-197.
Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychol Rev. 2015;9(3):323-344.
Hale DR, Fitzgerald-Yau N, Viner RM. A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence. Am J Public Health. 2014;104(5):e19-e41.
Sloboda Z, Stephens P, Pyakuryal A, et al. Implementation fidelity: the experience of the adolescent substance abuse prevention study. Health Educ Res. 2008;24(3):394-406.
Ennett ST, Haws S, Ringwalt CL, et al. Evidence-based practice in school substance use prevention: fidelity of implementation under real-world conditions. Health Educ Res. 2011;26(2):361-371.
Dooris M. Healthy settings: challenges to generating evidence of effectiveness. Health Promot Int. 2006;21(1):55-65.
Chapman RL, Buckley L, Sheehan M, Shochet I. School-based programs for increasing connectedness and reducing risk behavior: a systematic review. Educ Psychol Rev. 2013;25(1):95-114.
King MRN, Rothberg SJ, Dawson RJ, Batmaz F. Bridging the Edtech evidence gap: a realist evaluation framework refined for complex technology initiatives. J Syst Inf Technol. 2016;18(1):18-40.
Goodman MS, Sanders Thompson VL. The science of stakeholder engagement in research: classification, implementation, and evaluation. Transl Behav Med. 2017;7(3):486-491.
Lhussier M, Eaton S, Forster N, Thomas M, Roberts S, Carr SM. Care planning for long-term conditions-a concept mapping. Health Expect. 2015;18(5):605-624.
Manzano A. The craft of interviewing in realist evaluation. Evaluation. 2016;22(3):342-360.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
Westhorp G. Understanding mechanisms in realist evaluation and research In Emmel N, Greenhalgh J, Manzano A, Monaghan M, and Dalkin S, eds. Doing Realist Research. London: Sage; 2018.
Maidment I, Booth A, Mullan J, McKeown J, Bailey S, Wong G. Developing a framework for a novel multi-disciplinary, multi-agency intervention (s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)--a realist synthesis. Syst Rev. 2017;6(1):125.
Lhussier M, Forster N, Carr SM. Realist Synthesis: Learning from a Complex Intervention Targeted at a Complex Group and Reported Through a Heterogeneous Literature Base. London: Sage; 2017.
Rogers P, Westhorp G, Walker B. Dealing with complexity in a realist synthesis: community accountability and empowerment initiatives. In: Bamberger M, Vaessen J, Raimondo E, eds. Dealing with Complexity in Development Evaluation: A Practical Approach. London: Sage; 2015:385-404.

MR/K02325X/1 United Kingdom MRC_ Medical Research Council

Keywords: adolescent risk behavior; customization; evaluative synthesis; methodology; realist research; synthesis

Date Created: 20200410 Date Completed: 20210615 Latest Revision: 20210615

20221216

10.1002/jrsm.1407

32271990