Developing effective health behaviour change interventions: a novel ‘Realist’ methodology for formative process evaluation

Abstract

Background: Developing a novel methodology for formative process evaluation of behaviour change interventions following MRC guidelines for process evaluation of complex interventions (2014) using a Realist Evaluation approach. Methods: A logic model (developed from Realist Review, case studies, focus groups) outlined context-mechanism-outcome chains (CMOs) of interest in bringing about intended behaviour change. Nine practitioners delivering the intervention, and 30 men in intervention participated. Session recordings were rated according to presence/absence of intended behaviour/s. ‘Realist interviews’ explored CMOs of interest for intended behaviour change. Framework Analysis (FA) was used; the framework built from CMOs. Findings: This novel methodology provided rich detailed data regarding contexts, mechanisms, and outcomes of interest and their impact on intended behaviour changes. Iterative intervention development was informed by identifying behaviours happening/not-happening, and linking these with theory and data about CMOs important in that behaviour change. Discussion: This novel method for understanding how and in what context/s mechanisms for change act to bring about behaviour change in an intervention supports development of interventions more likely to affect intended health behaviour change.