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ASTBURY, B. & LEEUW, F. (2010) Unpacking black boxes: mechanisms and theory building in evaluation. American Journal of Evaluation, 31, 363-381.

BARNES, M., MATKA, E. & SULLIVAN, H. (2003) Evidence, understanding and complexity. Evaluation in non-linear systems. Evaluation, 9, 265-284.

BEGUN, J. W., ZIMMERMAN, B. & DOOLEY, K. (2003) Health care organisations as complex adaptive systems. Advances in health care organization theory. First ed., Jossey-bass.

BENT, E. (1999) Complexity science: a worldview shift. Emergence, 7, 5-19.

BIRCKMAYER, J. D. & WEISS, C. H. (2000) Theory-based evaluation in practice. What do we learn? Eval Rev, 24, 407-31.

BLAISE, P. & KEGELS, G. (2004) A realistic approach to the evaluation of the quality management movement in health care systems: a comparison between European and African contexts based on Mintzberg's organizational models. Int J Health Plann Manage, 19, 337-64.

BLAISE, P., MARCHAL, B., LEFÈVRE, P. & KEGELS, G. (2010) Au-delà des méthodes expérimentales: l'approche réaliste en évaluation. In POTVIN, L., MOQUET, M.-J. & JONES, C. (Eds.) Réduire les inégalités sociales en santé. Paris, INPES.


BYNG, R., NORMAN, I. & REDFERN, S. (2005) Using realistic evaluation to evaluate a practice-level intervention to improve primary healthcare for patients with long-term mental illness. Evaluation, 11, 69-93.

BYNG, R., NORMAN, I., REDFERN, S. & JONES, R. (2008) Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. BMC Health Serv Res, 8, 274.

CALNAN, M. & FERLIE, E. (2003) Analysing process in healthcare: the methodological and theoretical challenges. Policy and Politics, 31, 185-93.

CHEN, H.-T. & ROSSI, P. (1987) The theory-driven approach to validity. Evaluation and Program Planning, 10, 95-103.

CILLIERS, P. (1998) Complexity and postmodernism. Understanding complex systems, London and New York, Routledge.

CONNELLY, J. B., DUASO, M. J. & BUTLER, G. (2007) A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public Health, 121, 510-7.

COSTNER, H. (1989) The validity of conclusions in evaluation research: a further development of Chen and Rossi's theory-driven approach. Evaluation and Program Planning, 12, 345-353.

DAVIES, R. (2004) Scale, complexity and the representation of theories of change. Evaluation, 10, 101-121.


DIELEMAN, M., GERRETSEN, B. & VAN DER WILT, G. J. (2009) Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review. Health Res Policy Syst, 7, 7.

DOUGLAS, F. C., GRAY, D. A. & VAN TEIJLINGEN, E. R. (2010) Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people. BMC Health Serv Res, 10, 49.

EVANS, D. & KILLORAN, A. (2000) Tackling health inequalities through partnership working: lessons from a realistic evaluation. Critical Public Health 10, 125-40.

FULOP, N., ALLEN, P., CLARKE, A. & BLACK, N. (2001) Issues in studying the organisation and delivery of health services. IN

FULOP, N., ALLEN, P., CLARKE, A. & BLACK, N. (Eds.) Studying the Organisation and Delivery of Health Services: Research Methods. London, Routledge.

GLOUBERMAN, S. & ZIMMERMAN, B. (2002) Complicated and complex systems: what would successful reform of Medicare look like? , Commission on the Future of Health Care in Canada.

GREENHALGH, T., HUMPHREY, C., HUGHES, J., MACFARLANE, F., BUTLER, C. & PAWSON, R. (2009) How do you modernize a health service? A realist evaluation of whole-scale transformation in London. Milbank Q, 87, 391-416.

GREENHALGH, T., KRISTJANSSON, E. & ROBINSON, V. (2007) Realist review to understand the efficacy of school feeding programmes. BMJ, 335, 858-61.

GROCOTT, P., COWLEY, S. & RICHARDSON, A. (2002) Solving methodological challenges using a theory-driven evaluation in the study of complex patient care. Evaluation, 8, 306-321.

GUICHARD, A. & RIDDE, V. (2009) Etude exploratoire des mécanismes de l'efficacité des interventions visant à réduire les inégalités sociales de santé. Etude pilote dans trois régions françaises., Institut National de Prévention et d'Education pour la Santé (INPES), France.

HILL, P. S. (2010) Understanding global health governance as a complex adaptive system. Glob Public Health, 1-13.

ILES, V. & SUTHERLAND, K. (2001) Organisational change. A review for health care managers, professionals and researchers. Managing change in the NHS. London, NHS Service Delivery and Organisation R&D Programme.

JUDGE, K. & BAULD, L. (2001) Strong theory, flexible methods: evaluating complex community-based initiatives. Critical Public Health, 11, 19-38.

KANE, S., GERRETSEN, B., SCHERPBIER, R., DAL POZ, M. & DIELEMAN, M. (2010) A realist synthesis of randomised control trials involving the use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Services Research, 10, 286.



KERNICK, D. (2006) Wanted--new methodologies for health service research. Is complexity theory the answer? Fam Pract, 23, 385-90.

LEONE, L. (2008) Realistic evaluation of an illicit drug deterrence programme. Evaluation, 14, 19-28.

MACKENZIE, M. & BLAMEY, A. (2005) The practice and theory. Lessons from the application of a Theories of Change approach. Evaluation, 11, 151-168.

MALUKA, S., KAMUZORA, P., SAN SEBASTIAN, M., BYSKOV, J., NDAWI, B., OLSEN, O. & HURTIG, A. K. (2011) Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation. Implementation Science, 6.

MANZANO-SANTAELLA, A. 2011. A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis. Evaluation, 17, 21-36.

MARCHAL, B., DEDZO, M. & KEGELS, G. (2010) Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana). BMC Public Health, 10, 787.

MARCHAL, B., DEDZO, M. & KEGELS, G. (2010) A realist evaluation of the management of a well-performing regional hospital in Ghana BMC Health Services Research, 10.

MASON, P. & BARNES, M. (2007) Constructing theories of change. Methods and sources. Evaluation, 13, 151-170.

MERCIER, C., PIAT, M., PELADEAU, N. & DAGENAIS, C. (2000) An application of theory-driven evaluation to a drop-in youth center. Evaluation Review, 1, 73-91.




MERTON, R. K. (1968) Social theory and social structure, New York, The Free Press.

MICHIELSEN, J., CRIEL, B., DEVADASAN, N., SOORS, W., WOUTERS, E. & MEULEMANS, H. 2010. Contextual factors for improving access to quality care in India: the issue of health insurance. International Journal for Quality in Health Care, 23, 471-48

OGRINC, G. & BATALDEN, P. (2009) Realist evaluation as a framework for the assessment of teaching about the improvement of care. J Nurs Educ, 48, 661-7.

PAWSON, R. (2001) Evidence based Policy: II. The promise of 'realist synthesis'. ESRC UK Centre for Evidence Based Policy and Practice, Queen Mary, University of London.

PAWSON, R. (2002) Evidence-based policy: the promise of 'realist synthesis'. Evaluation, 8, 340-358.

PAWSON, R., GREENHALGH, T., HARVEY, G. & WALSHE, K. (2005) Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy, 10 Suppl 1, 21-34.

PAWSON, R. & TILLEY, N. (1997) Realistic Evaluation, London, Sage.

PAWSON, R. & TILLEY, N. (2006) Realist Evaluation. DPRN Thematic Meeting 2006 Report on Evaluation. Development Policy Review Network.



POMMIER, J., GUÉVEL, M.-R. & JOURDAN, D. (2010) Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. BMC Public Health, 10.

RIDDE, V. & GUICHARD, A. 2011. Perception de quelques mécanismes favorables à la reduction des inégalités sociales de santé en France. Global Health Promotion, 18, 47-60.

ROBERT, E., RIDDE, V., FOURNIER, P. & BICABA, A. (2010) How to use the Realist approach to inform policy-making: the example of a research method on user fees abolition policies in Africa. 2010 symposium of Canadian Cochrane Centre.

ROSENHEAD, J. (1998) Complexity theory and management practice. Science as culture.

RYCROFT-MALONE, J., FONTENLA, M., BICK, D. & SEERS, K. (2010) A realistic evaluation: the case of protocol-based care. Implement Sci, 5, 38.

STACEY, R., GRIFFIN, D. & SHAW, P. (2000) Complexity and management. Fad or radical challenge to systems thinking?, London, Routledge.

STAME, N. (2004) Theory-based evaluation and types of complexity. Evaluation, 10, 58-76.


STURMBERG, J. & MARTIN, C. (2009) Complexity and health - yesterday's traditions, tomorrow's future. Journal of Evaluation in Clinical Practice, 15, 543-48.

SULLIVAN, H., BARNES, M. & MATKA, E. (2002) Building collaborative capacity through 'Theories of change'. Early lessons from the evaluation of Health Action Zones in England. Evaluation, 8, 205-226.

TASAKA, H. (1999) Twenty-first-century management and the complexity paradigm. Emergence, 7, 115-123.

VAN BELLE, S., MARCHAL, B., DUBOURG, D. & KEGELS, G. (2010) How to develop a theory-driven evaluation design - Lessons learned from an adolescent sexual and reproductive health programme in West-Africa. BMC Public Health, 10, 741.

WEISS, C. (1995) Nothing as practical as good theory: exploring theory-based evaluation for comprehensive community initiatives.

IN CONNELL, J., KUBISCH, A., SCHORR, L. & WEISS, C. (Eds.) New approaches to evaluating comprehensive community initiatives: concepts, methods and contexts. Washington, DC, The Aspen Institute.

WONG, G., GREENHALGH, T. & PAWSON, R. (2010) Internet-based medical education: a realist review of what works, for whom and in what circumstances. BMC Med Educ, 10, 12.


-People in a meeting, woman explaining theory using a blackboard
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    TDI workshop

    On 22 and 23 November 2010, the Unit of Health Care Management, Department of Public Health (ITM), organised an international expert meeting on theory-driven evaluation.

    About 15 researchers presented research and evaluations and discussed the methodological challenges of realist evaluation, theory-driven evaluation and realist synthesis in health systems research.

    In total 30 researchers, policymakers and programme managers attended the workshop.

    About this website

    This theory-driven inquiry website is developed by the Health Care Management Unit of the Department of Public Health, Institute of Tropical Medicine, Antwerp and the Development Policy & Practice Unit of the Royal Tropical Institute, Amsterdam. We collaborate on the development and implementation of theory-driven inquiry in health systems research, and aim at stimulating a better understanding of the advantages of this approach among both researchers and policymakers. To this end, we are engaged in a number of research and evaluation studies that use TD inquiry principles.

    Institute of Tropical Medicine

    Unit of Health Care Management

    TD inquiry project evaluations
    Défi Jeunes

    TD inquiry research projects
    PhD Bruno Marchal
    PhD Pierre Blaise

    The cluster Research methodology for complexity in healthcare


    Bruno Marchal - personal page
    Guy Kegels - personal page
    Tom Hoerée
    Josefien Van Olmen - personal page
    Sara Van Belle




    Royal Tropical Institute

    Department of Development, Policy and Practice

    TD inquiry project evaluations

    Realist evaluation of ASHA program in a district (India)

    TD inquiry research projects

    Realist inquiry in capacity building
    PhD Marjolein Dieleman

    Research and evaluation methodology

    Marjolein Dieleman
    Barend Gerretsen
    Sumit Kane
    Prisca Zwanikken