Implementing a transition pathway developed to improve services for young people with long-term conditions moving between children’s and adult health care services: A Realist Evaluation

Student thesis: Doctoral Thesis


Background and research aim
Delivering well-planned and co-ordinated transition processes for young people with long-term conditions has become a key priority for healthcare organisations. Within the existing literature transition programmes to improve this process have mostly been evaluated using outcome-based methods. This approach to evaluation fails to acknowledge the complex systems in which health transition programmes are implemented and, the agency of implementers. This study proposes an alternative approach to the evaluation of transition programmes, utilising realist evaluation to examine the processes that exist within a transition programme’s implementation and identifies the contexts which influence or hinder implementation processes and outcomes.

The study used a single qualitative embedded case study design informed by a realist evaluation approach. Data were collected through a review of programme
documentation and semi-structured interviews with programme designers and
implementers. Thematic analysis and context, mechanism, outcome (CMO) analysis were used to analyse the data.

The findings of this study suggest that the outcomes of programme implementation are influenced by the complex interaction of macro, meso and micro processes and contexts. Features of the context which facilitated the successful implementation of the transition programme included the active participation of implementers in the change process, having well-established inter-organisational social networks and fostering a collective commitment and coordinated behaviour change from professionals across children’s and adult services. However, findings further highlight contextual barriers that affect implementation.

Through its application of a realist evaluation framework this study identifies the role that context and human agency play in facilitating or hindering the successful implementation of transition programmes. It demonstrates how formal theories of implementation and organisational behaviour can be used to understand the processes and contexts that exist within the implementation of complex transition programmes.

Key words
Transition programme, healthcare organisations, implementation, realist evaluation.

Date of Award10 Feb 2022
Original languageEnglish
Awarding Institution
  • Edge Hill University
SupervisorAXEL KAEHNE (Director of Studies) & JOANN KIERNAN (Supervisor)


  • Transition programme
  • healthcare organisations
  • implementation
  • realist evaluation

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