Potential Applications of Realist Methodologies to Implementation Science Research

There is a growing demand for more focus on developing and testing theories in implementation science (IS). This involves creating and testing theories about the different dynamics contributing to implementation strategies’ success or failure in different settings. While the application of realist methodologies is gaining traction in IS, their contributions to the field have not been explicitly articulated. To this end, we highlight six potential contributions of realist methodologies to IS: (1) leading with ontology, (2) formulating “program theories” of implementation strategies, (3) opening up the “black box” of implementation strategies, (4) moving from “context as nuanced” to “context as causal”, (5) mixed-methods integration for causality-based theorizing and (6) embracing the complex and adaptive nature of health systems. Through these six potential contributions, realist methodologies can greatly contribute to understanding the role of implementation strategies in improving the uptake of evidence-based interventions. This combination calls for IS and realist methodologies to join forces when appropriate, adding an additional dimension to both IS and realist work. Such integration can enhance the transferability and contextualization of evidence-based practice by more fully accounting for the complex interplay between implementation components, contextual conditions, actors, causal mechanisms, and expected outcomes.