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Table 2 TAPUPAS Quality standards framework

From: A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare

TAPUPAS

Quality standards description

Link to phase 3 of research

Transparency

“The process of knowledge generation should be open to outside scrutiny. For knowledge to meet this standard, it should make plain how it was generated, clarifying aims, objectives and all the steps of the subsequent argument, so giving readers access to a common understanding of the underlying reasoning” ([44], p., 38).

We have discussed our aims, theoretical guidance, setting, methods and process of data analysis.

Accuracy

“All knowledge claims should be supported by and faithful to the events, experiences, informants and sources used in their production. For knowledge to meet this standard, it should demonstrate that all assertions, conclusions and recommendations are based upon relevant and appropriate information” ([44], p., 38).

We used participant’s quotations to accurately report the perspectives gathered and show how these perspectives informed the CMOcs identified during analysis.

Purposivity

“The approaches and methods used to gain knowledge should be appropriate to the task in hand, or ‘fit for purpose’. For knowledge to meet this standard, it should demonstrate that the inquiry has followed the opposite approach to meet the stated objectives of the exercise” ([44], p., 38).

We identified that a realist evaluation of multiple stakeholders across multiple cases experiencing the program in question would enable us to explore the CMOcs identified during the realist review. We conducted triangulation using date from a realist review and evaluation to address our research question. We also used middle-range theory during each of those research phases.

Utility

“Knowledge should be appropriate to the decision setting in which it is intended to be used, and to the information need expressed by the seeker after knowledge. For knowledge to meet this standard, it should be ‘fit for use’, providing answers that are as closely matched as possible to the question” ([44], p., 39).

We gathered multiple perspectives of multiple stakeholder professions across multiple cases in the decision setting studied. We also demonstrate limitations to data collection and other sources of knowledge that would have added to utility.

Propriety

“Knowledge should be created and managed legally, ethically and with due care to all relevant stakeholders. For knowledge to meet this standard, it should present adequate evidence, appropriate to each point of contact, of the informed consent of relevant stakeholders. The release (or withholding) of information should also be subject to agreement” ([44], p., 39).

We followed ethical procedures of informed consent for all participants and the ethical guidelines of the research boards that granted ethical approval. Each participant read and signed informed consent before each interview. Data was audio recorded, transcribed and anonymized.

Accessibility

“Knowledge should be presented in a way that meets the needs of the knowledge seeker. To meet this standard, no potential user should be excluded because of the presentational style employed” ([44], p., 40).

This reporting uses academic language for journal publication standards. This research will also be fed back to the organization in the form of an evidence brief form and lay language summary presentation.

Specificity

“The knowledge must pass muster within its own source domain, as perceived by its participants and proponents” ([44], p., 40).

We followed RAMSES II reporting standards for realist evaluations [45].