Realist evaluation
Research Methods
Definition. Realist evaluation is a theory-driven approach to evaluating programmes that asks what works, for whom, in what circumstances and why, by identifying how contexts trigger mechanisms that generate outcomes.
Explanation
Pawson and Tilley (1997) argued that programmes do not work in themselves; they offer resources and opportunities that people respond to differently depending on context. The evaluator therefore starts from an initial programme theory, expresses it as context-mechanism-outcome (CMO) configurations, tests these configurations against qualitative and quantitative data, and refines the theory. The aim is a transferable, middle-range explanation rather than a single average effect.
The approach is now widely used in health services research, and the RAMESES II project produced consensus reporting standards for realist evaluations through a Delphi panel (Wong et al., 2016). It suits complex organisational interventions such as multidisciplinary tumour boards, telehealth and quality improvement programmes, where effects vary by setting (Realist Evaluation and QCA of Complex Interventions in Oncology Management). A frequent weakness is labelling any qualitative study as realist without specifying and testing mechanisms.
Related concepts
Implementation science Middle-range theory Fuzzy-set qualitative comparative analysis (fsQCA) Mixed methods research
Read on The Health Topics
- Realist Evaluation and QCA of Complex Interventions in Oncology Management: MDT, Telehealth/ePRO and QA/QI
- Realist Reviews: Purpose, Practice, and Pitfalls in Quality and Safety
- Realist Case Studies for Health in All Policies Implementation
References
Pawson, R., & Tilley, N. (1997). Realistic evaluation. Sage.
Wong, G., Westhorp, G., Manzano, A., Greenhalgh, J., Jagosh, J., & Greenhalgh, T. (2016). RAMESES II reporting standards for realist evaluations. BMC Medicine, 14, Article 96. https://doi.org/10.1186/s12916-016-0643-1
Cite this entry: Kurutkan, M. N. (2026). Realist evaluation. In The Health Topics glossary. https://healthtopic.org/glossary/realist-evaluation/