An introduction to realist evaluation and synthesis for kidney research

Realist research describes a methodological approach which aims to explore how and why interventions work, for who, and under which circumstances. Rather than quantifying how well an intervention works under specific conditions, realist theory explores the function of interventions in detail, and specifically considers how the contexts in which interventional components are delivered influence the mechanisms that lead to outcomes. Realist methods can be applied to primary data (realist evaluation) or secondary data (realist synthesis). Although realist techniques are increasing being used in the evaluation of complex interventions, there are relatively few published studies in the field of kidney care. In this review, we outline the theory and principles behind realist methods through discussion of a published realist synthesis describing complex interventions promoting delivery of optimal chronic kidney disease care. We discuss other kidney studies that have used realist methodology, and situations where realist techniques could be applied to advance our understanding of how to best deliver care to patients with kidney disease.