Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation

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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.European Journal of Clinical Nutrition (2009) 63, 1136-1142; doi:10.1038/ejcn.2009.38; published online 17 June 2009

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