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The concept of mechanism from a realist approach: a scoping review to facilitate its operationalization in public health program evaluation

Overview of attention for article published in Implementation Science, October 2015
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (92nd percentile)
  • Good Attention Score compared to outputs of the same age and source (77th percentile)

Mentioned by

1 policy source
36 X users


185 Dimensions

Readers on

550 Mendeley
1 CiteULike
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The concept of mechanism from a realist approach: a scoping review to facilitate its operationalization in public health program evaluation
Published in
Implementation Science, October 2015
DOI 10.1186/s13012-015-0345-7
Pubmed ID

Anthony Lacouture, Eric Breton, Anne Guichard, Valéry Ridde


Public health interventions are complex by nature, and their evaluation requires unpacking their intervention logic and their interactions with open social systems. By focusing on the interrelationships between context, mechanism, and outcome, Pawson and Tilley's realist approach appears a promising innovation for public health-related evaluation works. However, and as expected of any methodological innovation, this approach is being constructed gradually by answering the multiple challenges to its operationalization that fall in its path. One of these challenges, users of this approach agree on, is the necessity of clarifying its key concept of mechanism. We first collected the definitions of mechanism from published works of Pawson and colleagues. Secondly, a scoping review was conducted to identify the ones quoted by users of the realist approach for evaluating public health interventions (1997-2012). We then appraised the clarity and precision of this concept against the three dimensions defined by Daigneault and Jacobs "term, sense and referent." Of the 2344 documents identified in the scoping review, 49 documents were included. Term: Users of the realist approach use adjectives qualifying the term mechanism that were not specifically endorsed by Pawson and colleagues. Sense: None of the attributes stated by Pawson and colleagues has been listed in all of the documents analyzed, and some contributions clarified its attributes. Referent: The concept of mechanism within a realist approach can be ascribed to theory-based evaluation, complex social interventions, and critical realism. This review led us to reconsider the concept of mechanism within the realist approach by confronting the theoretical stance of its proponents to the practical one of its users. This resulted in a clearer, more precise definition of the concept of mechanism which may in turn trigger further improvements in the way the realist approach is applied in evaluative practice in public health and potentially beyond. A mechanism is hidden but real, is an element of reasoning and reactions of agents in regard to the resources available in a given context to bring about changes through the implementation of an intervention, and evolves within an open space-time and social system of relationships.

X Demographics

X Demographics

The data shown below were collected from the profiles of 36 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 550 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 6 1%
Chile 1 <1%
Indonesia 1 <1%
France 1 <1%
Canada 1 <1%
Unknown 540 98%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 87 16%
Researcher 85 15%
Student > Master 80 15%
Other 48 9%
Student > Doctoral Student 35 6%
Other 88 16%
Unknown 127 23%
Readers by discipline Count As %
Social Sciences 131 24%
Medicine and Dentistry 81 15%
Nursing and Health Professions 46 8%
Psychology 28 5%
Business, Management and Accounting 23 4%
Other 79 14%
Unknown 162 29%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 24. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 November 2021.
All research outputs
of 23,752,589 outputs
Outputs from Implementation Science
of 1,736 outputs
Outputs of similar age
of 286,208 outputs
Outputs of similar age from Implementation Science
of 35 outputs
Altmetric has tracked 23,752,589 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 93rd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,736 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.7. This one has done well, scoring higher than 83% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 286,208 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 92% of its contemporaries.
We're also able to compare this research output to 35 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 77% of its contemporaries.