This thesis makes two significant contributions to the advancement of knowledge within crime prevention. The first of these is to evaluate the success of repeat victimisation prevention interventions. Interventions across four crime types are assessed herein, and the context-mechanisms-outcome configurations examined. The second contribution of this thesis is to assess two techniques of meta-evaluation: systematic reviews and realist syntheses. Each of these techniques is used in turn to assess the repeat victimisation prevention interventions. The contribution of each technique to the knowledge pool is then discussed, and the question of whether they are complementary or contradictory approaches answered. The thesis is framed in the context of evolutionary epistemology, which is the philosophy underpinning both approaches to meta-evaluation addressed herein. The thesis starts, with an examination of: firstly, how the evaluation methods in question have evolved, and the background to their scientific worth; and secondly, how situational crime prevention measures have evolved over time. The thesis then examines the two competing approaches for their contribution to the evaluation ecosystem by using both to assess repeat victimisation prevention interventions. Finally, the last section poses the question of whether it is survival of the fittest, or whether co-existence or adaptation could be the key to survival for these two meta-evaluative methodologies. Repeat victimisation prevention is revealed as an effective way of reducing crime, with a need for further research to apply the principle across further crime types. A requirement is identified for a greater breadth and depth of information to be included in future crime prevention evaluations. The systematic review is shown to be a useful way of assessing the overall effectiveness of the interventions, whilst the realist synthesis fills in the detail of why some interventions work and others fail. It is concluded that both approaches to meta-evaluation have useful contributions to make, and that a third way incorporating the best elements from each method should be developed.

Safeguarding adults is a priority in adult social care, and training is one of the main ways in which policy and guidance around it is implemented. Training transfer refers to the use of new learning on the job, and while the transfer literature is well developed, it does not extend to safeguarding adults training. This research aimed to identify, develop and refine a programme theory of safeguarding adults training transfer by identifying factors that facilitate or inhibit the use of safeguarding adults training in practice, and the impact that the training has. A cross sectional mixed methods realist synthesis approach was used to evaluate two safeguarding adults training programmes provided in Cornwall, UK between 2009 and 2011. Realist synthesis aims to uncover what works, for whom, in which circumstances and how, and develops policy makers’ programme theories of interventions using evidence. A systematic review of training transfer generally, and then of health and social care transfer specifically led to a revision of the policy makers’ programme theory of training. Empirical research in the form of a factorial survey and narrative analysis of qualitative interviews was then undertaken, to further revise the programme theory to be specific to safeguarding adults training. Findings emphasise the importance of considering the effect of the training culture and transfer climate on safeguarding adults training effectiveness. Factors such as opportunity to use learning and supervisor support are important to transfer and the conflict between adult learning principles and mandatory training was explored. Safeguarding adults-specific supports were also highlighted, emphasising the importance of supporting practice using mechanisms other than training. Recommendations are provided regarding how the safeguarding related transfer climate can be improved. Limitations of the study include a high likelihood of sampling bias. The limitations of individual methods and problem of generalising findings obtained from a case study of Cornwall were reduced using the realist synthesis approach.

The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

Health promotion interventions are a key public health strategy aimed at improving population health and reducing health inequities. It is paramount that societies be able to assess whether investments in health promotion strategies are effective. However, the traditional or orthodox, evidence-based medicine approach to assessing the effectiveness of medical interventions has not proved to be appropriate for assessing health promotion interventions. Thus, there is a desperate need for workable, alternative approaches to assessing health promotion effectiveness. This study reviews current work in the field aimed at developing such alternatives and provides a critical analysis of some of the deep methodological challenges that confront this work. Through the use of a specific case study of a project aimed at implementing one of these alternative approaches ('realist synthesis'), this dissertation offers an original, empirically based analysis of the types of emerging issues that one particular attempt at developing an alternative approach must deal with. This study offers an ethnomethodological analysis of video-recorded 'work sessions', where the research team is working through specific aspects of the 'realist synthesis' project; particularly the conceptualization and categorization of 'contextual factors', and the identification and specification of `outcomes'. Through this analysis, it is demonstrated that alternative approaches to synthesizing evidence for health promotion interventions must rely upon the mundane, practical, everyday competencies of 'abstraction' and 'objectification' as they are carried out, for all practical purposes, by a research team, as it goes about solving problems and completing normal research tasks. The study concludes that much more attention needs to be paid to developing skills, representational tools and training research assistants, if alternative approaches are to be successful in completing reviews and sustaining credibility for end-users.

Yes / Health services in many countries are investing in inter-organisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why, and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semi-structured interviews. Eligibility criteria The co-ordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library and Applied Social Sciences Index and s (ASSIA). Outcomes Changes in patients’ clinical risks. Results We did not find any detailed accounts of the sequences of events that policy makers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the co-ordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the socio-technical nature of co-ordination problems. Review registration: PROSPERO CRD42017073004 / NIHR Grant 16/53/03

L’implication des volontaires de santé communautaire, tels que les volontaires de la Fédération Internationale des Sociétés de la Croix-Rouge et du Croissant-Rouge, peut constituer un moyen approprié de s’attaquer au problème d’inégalités sociales et de santé. Pourtant, les connaissances manquent sur ce qui marche pour améliorer la performance des volontaires. Objectifs Comprendre comment, pourquoi, pour quels volontaires et dans quelles circonstances les stratégies organisationnelles mises en œuvre pour améliorer la performance des volontaires de santé communautaire marchent. Méthodes En raison de la complexité des programmes impliquant des volontaires de santé communautaire, nous avons adopté l’évaluation réaliste comme approche méthodologique et l’étude de cas comparative comme modèle d’étude. Dans un premier temps, des entretiens, une synthèse réaliste de la littérature ainsi qu’une revue des théories d’action qui sous-tendent ces programmes ont été réalisés pour développer le cadre théorique de l’évaluation. Ensuite, deux cas ont été sélectionnés sur Kampala, la capitale de l’Ouganda, ou la Société Nationale de la Croix-Rouge et du Croissant-Rouge Ougandaise développe des stratégies pour améliorer la performance des volontaires. Chaque cas correspond à une unité organisationnelle de la Société Nationale Ougandaise, responsable de la mise en place des programmes de santé au niveau d’un district du pays. Les méthodes de collecte de données ont inclus des entretiens individuels, des groupes de discussion, des observations, ainsi qu’une revue de documents. Un processus méthodologique de comparaison constante a été utilisé pour l’analyse des données. Résultats Les stratégies d’intervention, dont les pratiques managériales peuvent influencer positivement la performance lorsqu’elles favorisent la satisfaction des besoins psychologiques des volontaires (l’autonomie, la responsabilisation, la compétence et le lien social). Pour ce faire, les stratégies et leur mise en œuvre doivent s’adapter aux différentes formes de motivation des volontaires et à l’évolution de celles-ci pendant le volontariat. S’agissant du contexte, la reconnaissance communautaire et la reconnaissance organisationnelle sont deux facteurs clés qui interviennent dans la satisfaction des besoins psychologiques des volontaires. Discussion Cette recherche doctorale a des implications pour la Fédération Internationale des Sociétés de la Croix Rouge et du Croissant Rouge. Les résultats fournissent des informations utiles à l’action relative à la mise en place de programmes de volontaires de santé communautaire et l’approche évaluative a des implications générales en ce qui concerne la dynamique d’apprentissage organisationnel. Par ailleurs l’approche de l’évaluation réaliste a également contribué, à sa mesure, au développement du champ de l’évaluation de programme en santé. L’opérationnalisation des concepts de l’approche réaliste a été discutée et approfondie afin de contribuer au développement de cette approche. / Context The recruitment of community health volunteers, such as the volunteers of the International Federation of Red Cross and Red Crescent Society, is an established approach to improve the health of underserved communities. However, there is a dearth of evidence about what works to improve volunteers’ performance. Objectives To understand why, how, for which volunteers and under which circumstances intervention approaches to improve volunteers’ performance is more likely to be successful. Methods Given the complexity of the intervention under study, a realist evaluation as methodological approach and a case study as study design was adopted. Firstly, a realist review together with interviews with the main stakeholders and a review of the theories underlying community health volunteers programme have been conducted to develop the theoretical basis for the evaluation. Secondly for the case study, two contrasted cases have been then selected at district level in the capital of Uganda, where the Red Cross Society is implementing a community-based programme. A case is as a Red Cross unit run by a programme manager that operate around one governmental district structures. Data collection included document review, participant observation and interviews. The constant comparative method was used for the analysis. Results Intervention approaches that include supervision supportive of autonomy, skills and knowledge enhancement and that is adapted to the different sub-groups of volunteers, leads to satisfaction of the three key drivers of volunteer motivation: feelings of autonomy, of competence and of connectedness. This contributes to volunteers’ better performance. Enabling contextual conditions include the responsiveness of the organisation to community needs and recognition from the organisation and the community of the work of the volunteers. Discussion The findings will inform the management of community health volunteers and have implication for the International Federation of Red Cross and Red Crescent Societies regrading organisational learning. It also contributed to building the field of programme evaluation in Health and led to methodological developments for doing realist evaluation.