TABLE 21Programme theory conception and planning stage: CMO configurations

Adaptation (mechanism)Context + outcome (systematic review)Context + outcome (qualitative interviews)
2. Exploratory phase with target population (different group from intervention group)Discussions with community for a community-based group healthy eating intervention for African American population revealed that there were many competing community-based research activities, which may limit interest in the present intervention315,316‘So all that’s to say that and, and you know the kind of research that’s valued in the academy tends to be you know working with secondary data sets you know behind your desk or you know doing the more rigorous kinds of studies that you can do in a university context, so, so the type of research that engages these populations is not highly valued, because you have to develop these relationships, many of which have been, have been broken by years of em exploitation or if not active exploitation at least em kind of neglect’ (P13, physical activity, USA)
3. Exploratory phase with community leadersCommunity-based outreach intervention for smoking cessation and physical activity for an African American population noted the importance of speaking to community members about participation, and not just limiting discussion to community advisory groups, as low participation in the health activities was observed398
20. Material developed specifically for target population (by project investigators, expert opinion, tools)Targeted material for smoking cessation intervention which was pilot tested with African Americans in New York may not be equally salient to an African American population in Georgia as intervention participants were observed to be more responsive to surface-level targeting (e.g. materials) and less so to deep-structure targeting341
Utilising specified models of behaviour change in the development of the intervention was found in some cases to improve effectiveness;293,324,335 however, some behavioural theories were suggested to be more appropriate than others, e.g. social cognitive theory was salient for the personal life experiences of African American women in terms of prevailing against formidable obstacles399
31. Address concerns with medical programmes, procedures and medicationExploratory phase indicated that randomisation to a no-treatment control for a physical activity and healthy eating intervention for an African American population was not acceptable to participants and was therefore not utilised in study design290,291,395,396
Other studies also have reiterated that randomisation was inappropriate in church settings,308,397 particularly when interest was low315,316
The background tailoring of control groups may remove the effect of the intervention in terms of assessing the effectiveness of adaptation; however, not tailoring for the control group was often unacceptable to the participants296
P: ‘Randomisation is, is a hard thing with community groups in general, they don’t understand randomisation. I mean one thing we found in our project that was that, this design where you don’t have a real control group but you give the comparison churches a different intervention that they’re equally happy with [right] actually worked really well, they were very, the community was much happier with that than, you are the control group and you are the intervention group. And em and yet some of the funders don’t like that cause they think there’s gonna be some you know contamination doing anything with the comparison churches so we have to do some education around that [laughter] I think’
I: ‘For the funders or for the community?’
P: ‘Yeah for the people that review the grants, I mean this whole idea that you can maintain a sort of peer control groups doesn’t go over very well, when you get out to the community nobody wants to be in the no intervention control group [mm mhm]. Em so those are some of the big challenges’ (P22, healthy eating, USA)

From: 8, Realist synthesis: prioritisation for implementation and future research

Cover of Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis
Adapting Health Promotion Interventions to Meet the Needs of Ethnic Minority Groups: Mixed-Methods Evidence Synthesis.
Health Technology Assessment, No. 16.44.
Liu JJ, Davidson E, Bhopal RS, et al.
Southampton (UK): NIHR Journals Library; 2012 Nov.
© 2012, Crown Copyright.

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