Dear RAMESES group, 

I'm a PhD student  investigating how to maximise the effectiveness of safeguarding adults training. I am attempting (perhaps foolishly) to carry out a realist synthesis to help answer this question.

I've already carried out an integrative review of the training transfer literature, which supports the notion that 3 main factors- individual characteristics, training design and delivery, and workplace factors, affect training transfer (how much learning is applied on the job) generally. I want to specify the review to health and social care training (I can only find 1 paper evaluating safeguarding adults training, so can’t go that specific) using realist synthesis.

My question is: where does the individual fit in the context- mechanism- outcome model? The transfer literature states that individual characteristics (things like motivation, self efficacy, locus of control, personality, cognitive ability) are an important factor to transfer, and presumably this means characteristics of the individual must be accounted for in programme theories (or does it?). Additionally McCrae and Banerjee, on evaluating mental health interventions, state “Programmes do not ‘work’; people make them work” and I think this rightly applies to training; as the saying goes you can lead a horse to water but you can’t make it learn and subsequently apply its learning to practice.  

Policy, on the other hand, makes no mention of individual characteristics other than, to paraphrase, “staff must be trained”.

The other argument, articulated by Mark Pearson recently on this thread states that the mechanism is not the reaction to the intervention but the intervention itself*; this implies (if I've understood it correctly) that individual characteristics, which influence reactions to interventions, can’t be part of programme theories. So something like “motivation” cannot be a mechanism, as it could be interpreted as an individual characteristic and a reaction to training. 
This brings me to another issue, which is that factors such as motivation, which are hailed as important in the training transfer literature, could be seen as context, mechanisms, or outcomes; e.g. 

Context: whether delegates are motivated to learn, attend training, and transfer training or not- affected by workplace systems, how training is framed etc
(accordingly maybe the workplace systems that affect motivation are the context, rather than motivation itself?)
Mechanism: training results in better services by increasing staff motivation to perform, which leads to improved (e.g.) prevention and detection of abuse 
Outcome: One purpose of training may be to increase motivation, through raising awareness of safeguarding related issues/ valuing staff by providing them with continuing professional development opportunities

What I'm trying to ask is,
- is possible/ sensible to account for individual characteristics in programme theories?
- do you have any thoughts about whether they could or should be entered as context, mechanism or outcomes?
Or would it be better to focus on the training design and delivery, and workplace factors?

Thanks very much in advance for your thoughts.

*In context- Mark said in reference to the Access to health workers in rural and remote areas review, “Conceptualisation of mechanisms- people's reactions to programmes are conceptualised as 'mechanisms' throughout the review (x leads to y in context z) rather than mechanisms being something internal to people that is caused to 'fire' (in certain contexts..) by the programme. So, in my understanding, just as a bullet fired from a gun is not a mechanism, neither are people's reactions to a programme.”

Best wishes, 
Lindsey

Lindsey Pike
PhD student
School of Social Science and Social Work, University of Plymouth
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07814 843903
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