Developing Initial Programme Theories for a Realist Evaluation of an Intervention to Support Adults in Adapting to Life With Type 1 Diabetes: Methodological Insights and Implications for Practice

A key component of realist evaluation is the development of initial programme theories. However, methods for developing initial programme theories are often underreported and there is limited guidance on how to construct initial programme theories based on exploratory qualitative data. In this article, we attend to these gaps by describing the development of initial programme theories for a realist evaluation of an intervention to support adults in adapting to life with type 1 diabetes. Our development of initial programme theories was based on literature related to the intervention, creative writing sessions, qualitative data from a feasibility study of the intervention, and input from stakeholders. The stakeholders included healthcare professionals delivering the intervention, an advisory group of the realist evaluation study involving people with diabetes and healthcare professionals, and a realist research peer support group. We applied a retroductive analysis approach to identify causal insights related to the intervention and develop initial programme theories. The initial programme theories were shared with the stakeholders which led to further refinement of the theories. We grouped the final initial programme theories into ten categories which illustrate the connections between contexts, mechanisms, and outcomes of the intervention. Based on our process of developing initial programme theories, we suggest using qualitative data to construct and refine programme theories although the data may not have been collected with a realist evaluation perspective. Furthermore, we encourage using visual aids to engage stakeholders in programme theory building and suggest that researchers adapt their approach to engage stakeholders according to the different stakeholder groups involved.