Original Article
European Journal of Clinical Nutrition (2009) 63, 1136–1142; doi:10.1038/ejcn.2009.38; published online 17 June 2009
Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation
Contributors: CH, WL, MM and PK designed the study, PK carried out the fieldwork and analysis of the primary data, MM and PK wrote the preliminary version of this manuscript and all authors contributed to the final version.
M Mackenzie1, P Koshy2, W Leslie2, M Lean2 and C Hankey2
- 1Department of Urban Studies, University of Glasgow, Glasgow, UK
- 2Department of Human Nutrition, University of Glasgow, Glasgow, UK
Correspondence: Dr P Koshy, Department of Human Nutrition, Division of Developmental Medicine, Glasgow Royal Infirmary, Glasgow G31 2ER, UK. E-mail: p.koshy@clinmed.gla.ac.uk
Received 5 October 2008; Revised 7 April 2009; Accepted 16 May 2009; Published online 17 June 2009.
Abstract
Objectives:
This paper discusses the benefits that a 'realist' approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.
Subjects and setting:
Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.
Results:
A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context–mechanism–outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.
Conclusion:
Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches.
Keywords:
realistic evaluation, smoking cessation, weight management
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