Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol

Social care; Adult social worker; Adult social care system; social care service users; social worker-service user relationship; contact; model of practice; realist review. ALL Metrics - Views Downloads How to cite this article Todowede O, Parr J, Damery S et al. Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.14104.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Study Protocol [version 1; peer review: 2 approved with reservations] Olamide Todowede https://orcid.org/0000-0002-5785-1426 1, Janette Parr https://orcid.org/0000-0002-0629-1596 1, Sarah Damery2, [...] Naila Dracup1, Rachel Court1, Jon Glasby1, Amy Grove1Olamide Todowede https://orcid.org/0000-0002-5785-1426 1, Janette Parr https://orcid.org/0000-0002-0629-1596 1, [...] Sarah Damery2, Naila Dracup1, Rachel Court1, Jon Glasby1, Amy Grove1 PUBLISHED 17 Oct 2025 Author details Author details 1 University of Birmingham School of Social Policy, Birmingham, England, UK 2 Applied Health Sciences, University of Birmingham, Birmingham, UK 2 Applied Health Sciences, University of Birmingham, Birmingham, UK Olamide Todowede Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Janette Parr Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Sarah Damery Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Review & Editing Naila Dracup Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Rachel Court Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Jon Glasby Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Review & Editing Amy Grove Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Adults facing complex health and social care challenges require intervention through the adult social care system. Adult social workers play a vital role in facilitating these interventions to support care delivery and improve outcomes for social care service users. The interactions between adult social workers and service users are central to the provision of social care; however, the impact of these interactions on outcomes remains inadequately understood. This realist review aims to investigate how, why, for whom, and under what circumstances interactions with an adult social worker influence service users' well-being, quality of life, and other essential outcomes in the United Kingdom. We will search databases for relevant peer-reviewed articles that explore the perspectives of adult social care users in the United Kingdom. Grey literature will be identified through organisational websites, Overton, Dimensions, and advanced Google searching. Included studies will be assessed for relevance, richness and rigour. Diverse stakeholders, including adult service users, will be consulted to strengthen the depth of understanding and applicability. An interpretative, cross-case comparative approach will guide synthesis, identifying recurring patterns and developing context, mechanism, and outcome configurations. We will follow five iterative steps of conducting a realist review and the Realist and Meta-narrative Evidence Syntheses: Evolving Standards. We will identify CMOCs that describe the impact of social workers' contact with adult social care services on service users. Through evidence synthesis and engagement with stakeholders, we will identify CMOCs that describe the impact of social workers' contact with adult social care services on service users and present a programme theory that explains its influence on health and well-being outcomes. This review aims to inform evidence-based practice, offering practical and in-depth insights for policymakers, social workers, and the social care system to improve service delivery and outcomes for service users. PROSPERO - CRD420256520 Sometimes adults have complex health and social care needs and require extra support. Social care services can provide this support. Social care services help people to maintain independence and well-being. Adult Social Workers are among the key people who provide social care services to adults. They can support people by helping to understand their needs and planning their care, and this is known as “Contact”. This contact could be a visit or a telephone call between a social worker and social care service users. However, we do not know how much and the features of the contact with adult social workers are needed to help improve health and social care needs for people. To find out, we will conduct an 'evidence synthesis', which is a research method which brings together existing research studies to answer a research question. In this study, we aim to answer the following question: What are the effects of contact with adult social workers on the quality of life, well-being, and other key outcomes of adults using social care services? We will speak to people with lived experience of social care and social work to help to understand the research studies. Our results will use evidence from the synthesis and from people with lived experience. We will share our results and develop practical recommendations for adult social services. Social care; Adult social worker; Adult social care system; social care service users; social worker-service user relationship; contact; model of practice; realist review. Corresponding Author(s) Olamide Todowede ([email protected]) Grant information: This review is being funded by the NIHR Evidence Synthesis Programme (Award ID - NIHR153453). AG and SD are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands (Award ID - NIHR200165). JG is supported by the National Institute for Health and Care Research (NIHR) School for Social Care Research and by the ESRC/Health Foundation for IMPACT (ES/V001035/1P). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © Crown copyright, 2025 Todowede O et al.. This open access work is licensed under the Open Government Licence v3.0 How to cite: Todowede O, Parr J, Damery S et al. Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.14104.1) First published: 17 Oct 2025, 5:103 (https://doi.org/10.3310/nihropenres.14104.1) Latest published: 17 Oct 2025, 5:103 (https://doi.org/10.3310/nihropenres.14104.1) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Social care provides essential practical and emotional support, enabling individuals to live as independently as possible and achieve their potential. In the United Kingdom (UK), demand for social care services has increased, particularly among older people, disabled individuals, those with learning disabilities, people experiencing mental health challenges, and their carers. The increased need for both short and long-term social care among the UK population is driven by interconnected factors, including an ageing population, a growing prevalence of disability among working-age adults, increased mental illness, economic pressures, and environmental challenges such as poor housing and climate change1–3. Social work is a practice-based profession that provides and organises specialist intervention for people who draw on social care and support4. Social workers support people with diverse needs and who require tailored interventions, through the incorporation of multidisciplinary approaches and cross-sector partnerships, and the implementation of policies and practices5–7. Social workers operate in a range of settings (long or short-term basis), providing direct care or coordinating support from wider social care services. They either engage and interact with service users directly (directly (e.g. face-to-face visits) or perform administrative tasks (in office settings) to improve service users' range of outcomes8,9. Their responsibilities and involvement with individuals requesting and/or using services typically follow a pathway that includes referrals, conducting needs assessments, interventions, evaluations and monitoring, and crisis support9,10. Social workers rely on key elements throughout these pathways: establishing contact with individuals requesting or using the service, collaboratively developing a care plan with other social care professionals, implementing actions, regular care progress review, and concluding the process once the desired outcomes are achieved11. The delivery of social work occurs in phases as social workers interact with multiple professions and various health and social care systems8. Social workers bring a unique mix of skills, expertise and practices to social care, particularly the complexity of supporting older adults aged 65 and over12. Social workers play a vital role in social care services by facilitating services, building care delivery relationships and maintaining supportive relationships with individuals using or requesting social care services towards achieving the desired outcomes13,14. Social work is undertaken in a range of formations and contexts, guided by various theories that help social workers understand and address the complexity of human situations and societal issues15–17. These theories are embedded within models of practice and offer a structured understanding of how social workers can bring about positive change for individuals using care services18. Solution-focused, relationship-based, and strengths-based approaches are models of practice that emphasise the relationship between social workers and service users as a key driver for change in the outcome of care. These practices recognise the influence of wider social, organisational, and contextual factors on individuals seeking or using services18. Solution-focused practice is a future-oriented approach that supports individuals in identifying and building on their existing strengths to achieve the outcomes they value. It emphasises present-focused change and actively seeks solutions rather than dwelling on the root causes of problems. However, this approach can be challenging to integrate within certain core functions of contemporary social work, such as assessment, risk management, and care planning, where systemic analysis and accountability are often required19,20. In the UK, relationship-based and strength-based practices are often central to delivering social care, fostering collaboration and person-centred support by social workers to service users16,21. While relationship-based practice examines the interactions between social workers and service users, there remains limited evidence on the nature and impact of these relationships22. Conversely, strength-based practice promotes independence, resilience, and self-determination by drawing on individuals' strengths and assets to improve well-being23. Though establishing a successful strength-based approach relies on fostering a relationship-based practice, such as building a cooperative and trusting relationship between social workers and people using or requiring services21. Together, these approaches create an environment where service users' strengths are recognised and leveraged to achieve meaningful outcomes. Both approaches prioritise the quality of the relationship between providers and recipients, alongside the unique contributions of the individuals seeking support in delivering social work24. There is evidence indicating the importance of building rapport and establishing meaningful and effective relationships in social work practice, which is central to improving and delivering successful outcomes for service users14,23,25. However, there is limited information on how social work is organised and delivered within social care, with significant challenges arising from high workloads, the need for a strengths-based approach, and issues related to the retention and recruitment of social workers23,26. This relationship, established through contact between social workers and service users, facilitates the decision making processes that support service users' care and support needs and plays a crucial role in enabling change, alleviating distress, and achieving desired health and social care outcomes11,13,14,27,28. This is essential for supporting service users in building connections and fostering collaboration among social workers, care providers, service users, and their families, ultimately enhancing population well-being29–31. Yet, what constitutes effective contact that fosters these relationships and the factors that support positive interactions between providers and users remain unclear14. Furthermore, the impact of contact on well-being, quality of life, and other outcomes for service users remains under-explored. A research priority-setting review for adult social care and social work (2018 – 2019) stated that we have limited knowledge to understand how social work influences adult social care users' well-being32,33. A recent review (2024) of the response to the changes since the published priority setting reports recognised that subsequent research has only partially addressed the elements of the research questions stated in the reports32–34. This gap highlights the need for an investigation into how social work contacts influence service user outcomes, particularly within the complex landscape of social work and social care, where practice models and theory-informed approaches play a critical role. Our study will employ a realist review approach to investigate the impact of contact with social workers on the quality of life (QoL) and well-being outcomes of adult social care service users, both negative and positive effects. We aim to understand how contact with social workers is defined, whether social worker-service users’ interaction is useful (or not) from the perspective of service users and the differences in people and circumstances. To conduct a realist review on the effects of contact with an adult social worker on well-being, quality of life, and other key outcomes for adults (18+) using services in the United Kingdom. The research objectives are: 1. To understand the effect of contact with an adult social worker on the well-being of adult service users. 2. To understand the effect of contact with an adult social worker on quality-of-life outcomes for adult service users. 3. To identify and explain the causal processes that link interactions between adult social workers and service users to outcomes through the development of Context-Mechanism-Outcome configurations (CMOCs). 4. To develop programme theory that explains the influence of contact with an adult social worker on the well-being and quality of life of adult service users. 5. To develop recommendations and disseminate the findings to policymakers, researchers, the social care system and practitioners. The involvement of stakeholders throughout the review process ensures the inclusion of different perspectives and the incorporation of lived experiences38. Therefore, for this review, we established a patient and public involvement and engagement group that serves as the advisory group for the review. This group's members included individuals with lived experience of using or caring for someone using social care services and/or have experience interacting with social workers, registered adult social workers, and academic experts specialising in social care and social work. They will be involved in refining and shaping the research question and objectives, methods, analysis and dissemination of the study results by meeting virtually at each stage throughout the project timeline and, if necessary, additional expert advice via email. In the initial phase, PPI members convened for a one-hour discussion meeting, facilitated by a researcher(OT). During this meeting, they collaboratively refined the research question and objectives, and contributed to the development of the initial programme theory and protocol, drawing on their lived experiences and expertise. Their insights were invaluable in shaping a meaningful context for the study. Their input challenged our initial assumption of regular contact between social workers and service users, highlighting that frequency varies based on the complexity of need and that consistent interaction is not typical in real-world practice. This led us to revise the scope of the review from “regular contact” to “any form of contact,” making the research more aligned with real-world conditions. Additionally, they emphasised the need to examine both positive and negative impacts of contact with social workers on wellbeing, prompting a more balanced and comprehensive approach to the review. To complete this review, the PPI group will be involved in the development of the CMOC, recommendations and dissemination plan. A realist synthesis is a systematic, theory-driven interpretative approach, which is developed to make sense of different evidence about complex interventions applied in diverse contexts in a way that provides an opportunity to generate insights that are relevant to real-world contexts and inform policy and practice35–37. This is used to build, test and refine programme theories and focuses on understanding the underlying mechanisms and contextual factors that influence how an intervention works (or not), i.e. for whom it works, in what circumstances, and why38,39. A realist review begins with the development of an initial programme theory (IPT) describing the theoretical relationship between context, mechanisms, and outcomes, which is then iteratively refined throughout the review process (Figure 2). The IPT is then tested against empirical evidence to answer the question ‘How does it work?’, ‘Why does it work?’, ‘For whom does it work?’ and ‘In what circumstances does it work?’40. Realist approaches seek to understand the causal mechanisms of an intervention and how they interact with contextual factors to produce outcomes, represented through context-mechanism-outcome configurations (CMOC). The context (C) influences the underlying mechanisms (M) that determine specific outcomes (O); the outcomes describe the action or change expected in those contexts when a mechanism is triggered41,42. In this realist review synthesis, we aim to develop a middle-range theory that explains the context (C) in which adult social workers and service users interact, referred to as contact in this review. Middle-range theories bridge the gap between grand theories and empirical research by offering conceptually clear, context-specific explanations of phenomena. They are grounded in observed patterns and practical realities, using a limited set of concepts to support empirical testing. Their strength lies in their applicability to real-world practice, as they generate evidence-based insights that are both theoretically informed and operationally relevant43,44. We aim to understand the underlying causal processes and pathways (M) that explain the nature and stages of contact between social workers and adults using social care services, and how these mechanisms operate across different contextual conditions and produce outcomes (O) such as quality of life, wellbeing, and other meaningful outcomes for service users. Table 1 defines key terminologies used in the review. The middle-range theories generated from the review will explain how social workers function both as an intervention and as a mechanism for delivering interventions that influence quality of life, well-being, and other reported outcomes among adults who use social care services. Our review aligns with the realist approach, recognising that interventions that occur at different stages of contact (pathway) between social workers and adult service users may or may not work effectively in some contexts (referring to the circumstances influencing whether adult service users’ lives improve or not)37. | Term | Definition | |---|---| | Contact | In the context of adult social work, contact typically means maintaining ongoing communication and interaction with a service user. This can include, but is not limited to, phone calls, home visits, crisis response, or other methods. The frequency of contact depends on the individual’s needs and required care plan, to ensure support and monitoring of their well-being45. The documentation of contact between social workers and service users could include the frequency, purpose(s), method of contact and review and assessment of the service user's care plan and progression46. Therefore, we define contact in this review as: any meaningful, planned interaction between a social worker and any adult requiring and or using social care services, that aims to assess service users’ needs and provide support, to ensure autonomy and improved wellbeing. This contact includes episodic and crisis-focused interactions between social workers and service users and other mediating social care workers. The frequency of contact can take place one-off or over any length of time. | | Adult social worker | Adult social workers are the registered professionals who collaborate with adult social care service users within the framework of current legislation and procedures to assess and evaluate their needs, explore available options including counselling and therapy, provide support, and advocate for appropriate and coordinated care to enhance their wellbeing10. Adult social workers work closely with service users, their carers, various service providers and other social care professionals to facilitate comprehensive and responsive care solutions. There are different kinds of social workers, some are specialised, some less so, with different roles and operating in different settings in which they are more likely to work. Their role includes facilitating and promoting autonomy for vulnerable adults with complex social care needs due to disability, exclusion, or diminished capacity. In this review, we will include all types of registered adult social workers and exclude every other social care professional, such as nurses, occupational therapists, and care workers. | | Adult social care | Adult social care covers a wide range of activities that help people who are older or living with a disability or physical or mental illness to live independently and stay well and safe47. | | Other social care professionals | These are other social care professionals who provide direct care or medical care for individuals using social care services. This includes, but is not limited to, care workers, senior care workers, nurses, and occupational therapists. | | Context | This is the key concept in developing realist causal explanation, which is often defined as observable features (space, place, people, things) that trigger the mechanism through which an intervention works48. The observable feature in this review is adult social workers who trigger interventions for people who use social care services. | | Mechanism | These are underlying causal processes and pathways that explain how contact and the stages of contact between social workers and adult social care users interact to produce outcomes for service users, and how these processes and pathways interact in different contexts. This was determined through literature scoping and stakeholder engagement that the key mechanisms may include social workers' practice model, influence of other social care workers, complexities of service users' needs and social workers, stages of interactions (contacts) between social workers and service users. | | Outcomes | These are any significant and measurable outcomes reported in the included articles that result from contact between adult social workers and individuals using adult social care services. This review’s primary outcomes include well-being and/or quality of life outcome measures. The secondary outcomes, if reported, are distal organisation outcomes of interest (service costs) and any additional outcomes for service users in the included evidence, such as improved physical and mental health outcomes. | We will adapt the five iterative steps proposed by Pawson and colleagues for conducting a realist review: (1) define and refine the review scope, (2) develop an initial programme theory, (3) search for evidence, (4) select and appraise evidence, and (5) extract and synthesise data49,50. The process for this review is outlined in Figure 1, and each step is described below. Moreover, the realist review process is iterative, and the steps could overlap or proceed in parallel as the review progresses. We will report the review following the RAMESES I publication standard42. We will present Preferred Reporting Items for Systematic Reviews and a Meta-analysis (PRISMA) diagram of the included and excluded articles selection process for the review. Our realist protocol has been written by the research project team and prospectively registered with PROSPERO (CRD42025652026). The review is planned for approximately 12 months, from February 2025 to January 2026. This protocol was developed and reported following the PRISMA-Protocol checklist (Additional File 2). This review is conducted by the West Midlands Evidence Synthesis Group, a centre of excellence that produces evidence syntheses to inform and support evidence-based planning and delivery of health and social care services. The topic was identified as a national priority to inform adult social care services and commissioned through the National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme. The core review team developed the review protocol, which includes research methodologists (OT, AG, JP), social care experts (SD, JG) and information specialists (ND, RC). The advisory group members helped clarify the review’s scope and terminology and contributed to developing the initial programme theory (Figure 2), drawing on their real-world experiences and expertise. The consultation process included checks and clarifications on the framing of the research aims, questions and objectives. Consultations were conducted virtually according to the preference of the advisory group members. We believe that meeting with each group separately provides an advantage of capturing in-depth accounts of their perspectives and views, which is crucial for developing the initial programme theories. For example, service users were able to talk freely when service providers were not present. Programme theories are a fundamental element of realist research, including synthesis. They articulate specific propositions regarding the mechanisms through which a programme or intervention generates its intended or observed outcomes51. Realist programme theories illustrate the relationship between contexts, mechanisms and outcomes, which are presented as context–mechanism–outcome configurations (CMOCs). Figure 2 shows our hypothesised initial programme theory, articulating the underlying mechanism that explains how, why, for whom, and under what circumstances contact with social workers influences the well-being and quality of life outcomes for service users. We employed the following processes in the articulation and development of the initial programme theory. In this instance, we conducted a literature scoping to identify existing theories and frameworks that support well-being and quality of life outcomes within the context of social care. Additionally, consultations were held with advisory groups to gather real-world perspectives, thereby enriching the theoretical foundation with practical insights. Through literature scoping, we understood that the model of practice, sometimes known as the social work theory, is integral to the professional base of social work, guiding, informing and explaining diverse domains of social work practices18. The advisory group (social workers and social care experts) stated that the strength-based and relationship-based models of practice are the common models of practice in the United Kingdom. These practices are recognised to shape the delivery of social work and influence the wider social, organisational, and contextual factors that foster collaboration with other social care professionals and support person-centred service to achieve expected outcomes16,18,21. In our consultations with the advisory members (social care service users), we learned that while some interactions with social workers are guided by the social work model of practice, in many cases, these interactions are inconsistent or do not happen at all. The model of practice posits that social work is shaped by the interplay between social environment, practice contexts (including organisational context and complexities), service user and community expectations (expected outcomes), professional practice, purpose and framework18. The initial programme theory (Figure 2) reflects our preliminary understanding of how contact between social workers and service users may influence outcomes, developed through the advisory group inputs and literature scoping and will guide the development of the CMOCs without imposing rigid assumptions. In refining the IPT and development of the middle-range theory, we will draw on the early CMOC (Figure 2), which suggested that relational, strengths-based, and solutions-focused practices are central mechanisms through which contact may support or hinder service user outcomes. These early insights will assist in understanding the practicality of the theory in the real world and inform our focus on identifying the specific context under which diverse mechanisms are activated. This knowledge informs the framing of our IPT by illustrating how social workers facilitate and coordinate support and services across various stages of contact in practice, while collaborating with service users and other social care professionals to achieve expected outcomes (Figure 2). We envisaged the complexity of the social care workforce, the complexity of care needs required by service users and other challenges experienced by social workers, such as high caseloads and limited resources; therefore, with the input of the advisory group, the study team will continually review, prioritise and refine the IPT to develop the CMOCs. To develop explanatory depth and breadth of evidence from a realist review, realist reviewers are encouraged to use data from a wide range of sources, including academic and non-academic sources52. Searching will be carried out in stages. The first stage will be broad searches to capture existing theories underpinning UK adult social work practice. This stage will identify information to inform the initial programme theory. These will be carried out via search engines, organisational websites and our expert advisory group. The second phase of searches will be to identify empirical evidence to develop and refine the initial programme theory developed from phase 1. Our information specialist team (RC, ND) will develop the literature search strategies, in consultation with the review team (OT, SD, JP) (Sample -Additional File 1), to identify suitable papers to test and refine the initial programme theories40 selected in Step 2. In June 1990, the introduction of the NHS and Community Care Act 1990 marked a significant shift in health and social care in the United Kingdom. This Act transferred responsibility for community care to local authorities and placed a greater emphasis on person-centred care. Furthermore, it established a clear distinction between the provision and commissioning of healthcare, marking the start of an internal market within the NHS53. This milestone justifies our decision to carry out systematic literature searches of the following electronic databases from June 1990 to March 2025: Medline, Social Policy and Practice, CINAHL, PsycINFO, Sociological Abstracts, Social Science Citation Index, Applied Social Sciences Index and Abstracts (ASSIA), Social Work Abstracts and the International Bibliography of the Social Sciences (IBSS). We are focusing the review from a UK perspective, therefore, UK search filters will be applied where necessary54. In addition, we will search for grey literature from organisation websites, Overton, Dimensions, and advanced Google searching for reports, guidelines, policy documents and other contextual and/or conceptual information. Due to the rich and multifaceted nature of social care and social work, we will also employ the Citations, Lead authors, Unpublished materials, Scholar searches, Theories, Early examples, and Related projects (CLUSTER) searching approach - a systematic method for identifying complex intervention research55,56. This will ensure a transparent and comprehensive search strategy and facilitate the identification of “study clusters”, referring to a group of related papers (‘seed papers’) that explore and explain various features of a single research project and explore and provide necessary information about their context and theoretical foundations. We anticipate that the searches will be iterative, flexible and responsive to the theory-driven approach. The searches will be refocused and refined as necessary, as new concepts or mechanisms emerge from the data. We also aim to carry out targeted searches for specific mechanisms, contexts or outcomes of interest as the review progresses. Supplementary searching will be carried out by contacting social care experts and networks, forward and backwards citation searching and snowball techniques to identify additional studies. We will conduct an advisory member meeting with experts in adult social care and adults who have contact with social workers to help build the search terms based on their lived experiences and expertise. We will use bibliographic mining and consultation with experts to extend and strengthen the search. A reference list of eligible studies and review articles, conference proceedings, contact with study investigators, and unpublished studies will be compiled. Table 2 reports the inclusion and exclusion criteria we have developed to focus the review, but these will likely be refined as the review progresses. | Inclusion Criteria: We will include the following | | |---|---| | P – Population | Social care service users: Adult population aged 18 years and above, using or requesting adult social care services, for example, adults with disabilities, physical health issues and/or mental health challenges and their carers. | | I - Intervention | Registered adult social workers as an intervention in facilitating and supporting service users. This intervention is the contact and interactions at different stages of the care pathway between registered adult social workers and service users. | | C-Context | We will include reports from the perspective of adults using or requesting social care services and having/had contact with adult social workers. | | O – Outcomes | Well-being and/or quality of life outcome measures, distal organisation outcome of interest (service costs) and any additional outcomes for service users in the included evidence. | | S - Study design | There will be no restriction on study design, as a realist review includes a breadth of literature with diverse methodologies and approaches40. A range of methods including experiential, observational and intervention studies drawing on mixed, qualitative and quantitative methods, including non-empirical sources, e.g. opinion papers, guidelines, and editorials. Studies reporting actual or perceived effects of contact with social workers on social care users' wellbeing, quality of life and any other outcomes in the UK are eligible for inclusion. All sources that provide rich descriptions of the effect of contact with social workers on adults using the social care system or that report on ways this contact achieves or could achieve the outcome of improved quality of life, well-being or any other key outcomes. | | Exclusion criteria | | We will exclude social care support focused solely on services for children (under 18 years old), as the care pathway for children and young people differs from that of adult social care. We will exclude studies focusing on the effect of contact with other social care workers (defined in Table 1) We will exclude documents that lack a description of the effect of contact with social workers on adults using the social care system or do not report any findings. We will exclude reports from registered social workers' perspectives. | i. Article selection All search, screening and selection processes will be recorded and reported as part of the final report using a PRISMA flow chart, to ensure transparency of the selection process57. EndNote will be used to collate and manage duplicate references, while Covidence, a systematic review management tool, will be used for screening the literature. Screening of titles and abstracts will be undertaken by two independent reviewers, followed by full-text review. Selection and agreement of included documents will be through discussion at the research team meetings to allow for concept understanding to be jointly developed. As the review progresses, further refinement of the review scope may be discussed and decided on by the review team, depending on whether the studies selected can contribute to the refinement of the initial programme theory. If this occurs, the review team will decide on the new or revised selection criteria. ii. Quality appraisal A realist review focuses on developing explanatory theory, depending on the breadth of literature with diverse methodologies and approaches to establish evidence40. Therefore, quality assessment is applied differently to systematic review approaches, where many use assessment to determine inclusion. However, the inclusion of studies in a realist review is based on the data’s ability to contribute to theory building, testing and refinement, irrespective of the study’s quality58. Consequently, we will employ the criteria for evaluating evidence in realist reviews, namely, relevance, rigour, and richness42,56, and rate them as high, medium, or low based on the specified considerations in Table 356,58. All included evidence will be assessed for rigour and relevance to contributing to the refining and development of CMOCs. All documents will be included in the review regardless of their appraisal, as those with lower evidence strength may still provide valuable information that is relevant to the programme theory. | Appraisal criteria definition | Relevance36 defined as whether the data to be included can contribute to theory building and/or testing (this may change as the theory evolves). | Richness56 Defined as the degree of theoretical and conceptual development that explains how an intervention is expected to work. This will be used along with relevance criteria. | Rigour36 Defined as whether the method used to generate that particular data or information is credible and trustworthy. | | Things to consider | Does the document contain data relevant to the topic area and/or provide evidence relevant to theory development, refinement or testing? | Can the document meaningfully contribute to the theory development and/or testing? | Does the research support the conclusions drawn from it by the researchers or the reviewers? For trustworthiness of sources (topic area* assessment) - Is the source credible? Are the methods used appropriate and trustworthy? For coherence of theory** (theory assessment) - Is the theory consilient, simple, analogous to substantive theory? | | Criteria definition | Papers that have relevance, their framing of research and research questions are highly matched to review questions. | Papers with empirical findings are clearly described, with a rich description of the process and context. | Papers that include a clear and detailed methodology for data collection and research process are well-documented, which supports trustworthiness and high-quality reporting. | | High Criteria | Papers that have high relevance—framing of research and research questions and are highly matched to review questions. | Papers with very rich descriptions of their empirical findings, the process and context are clearly described with the potential to populate the CMO configuration. | Papers with a well-described methodology for data collection and research processes, that can be used to refine the theory and build the CMO configuration. | | Moderate Criteria | Papers that have a moderately relevant framing of research and research questions, and might or might not match the review questions, but report on similar outcomes and populations and have the potential to populate CMOCs. | Papers with somewhat rich descriptions of their empirical findings, the process and context, are somewhat described with the potential to populate or contribute to the CMO configuration. | Papers with some description of the methodology for data collection and research process, which can be used to refine the theory and build or populate some aspects of the CMO configuration. | | Low Criteria | Papers that met the inclusion criteria but had little description of context and mechanism, with little information about the context and mechanism or outcomes that can be used to refine theory and build the CMO configuration. | Papers with little or no descriptions of their empirical findings, the process and context are not described, with no potential to populate or contribute to the CMO configuration. But it can contribute to the literature to support the outcome of the CMO configuration. | Papers with no description of the methodology for data collection and research process cannot be used to refine the theory or build or populate any aspects of the CMO configuration. But it can contribute to the literature to support the outcome of the CMO configuration. | | If High | Assess the source for richness | Take the source forward and assess for rigour | Extract and report the CMO configuration/theory to support the research question. | | If Medium | Assess the source for richness | Take the source forward and assess for rigour | Extract and report the CMO configuration/to support the research question | | If Low | Retain for future incorporation into the CMO configuration/theory development, and search for additional data to explain/refine/refute the theory and report it. | Retain for future incorporation into the CMO configuration/theory development, and search for additional data to explain/refine/refute the theory and report it. | Retain for future incorporation into the CMO configuration/theory development, and search for additional data to explain/refine/refute the theory and report it. | * Topic area refers to evidence related to the practice of adult social care in the UK, drawn from credible and relevant sources focused on evidence-based practice. ** Theory here refers to evidence that informs or reflects models of social work practice in delivering care to service users. This evidence contributes to refining the initial programme theory and developing a middle-range theory. iii. Data extraction and synthesis We will develop bespoke Excel data extraction forms, which will be co-piloted by the study team, social care experts and the advisory group members, ensuring that all information is required to build and refine the initial theory and develop the CMOCs. Data extraction will be undertaken by two reviewers concurrently. The data extraction form will capture the characteristics of the included documents and information required for the CMO configurations. We will collect information on publication type, age of adults using or requesting social care services, the circumstances under which adult service users' requires or using social work services, settings, stage of care in social work services, the specific UK nation involved, and how contact with social workers works, including the frequency of contact, mode of contact and purpose of contact, total number of study participants, the service users outcomes (whether improves or not), type of model of practice, cost implication (and who pays) if available; and any other service users outcomes reported. The effect of contact with social workers, as presented in the included sources, will be assessed based on the credibility and robustness of evidence, rather than repetitive patterns, to support the identification of the underlying mechanism that generates the outcomes within a specific context. The reviewers will read all included data sources and highlight sections which provide evidence that supports and can contribute to the building of the CMOCs and refining of the initial programme theory and development of the middle-range theory. We will locate data or information within a range of sections within the evidence documents (methods, theoretical framework, study findings, researchers’ reflections). The evidence will be checked, and we will identify CMOCs and recurring patterns of contexts, mechanisms, and outcomes across the findings to develop the CMOCs. We will identify the components of the generated CMOCs using an interpretative cross-case comparison approach to understand and explain to whom, how, and when observed outcomes occur39. Our coding and synthesis will be abductive, and we will be guided by (a) Whether the data to be extracted refers to a context, mechanism or outcome, (b) What works to generate the outcomes, in what context and what mechanism, what does not work (unexpected outcomes) and other key outcomes (as reported in the documents) (c) Whether the data informs complete or partial CMOCs and is relevant to social workers' contact with adult social care service users (older populations and/or working adult populations), and (d) The quality of the information (quality appraisal). We will code and organise the extracted data in a table, mapping out the CMOCs for each included study. We will develop if-then statements for each CMO configuration to elucidate the relationship between context, mechanism, and outcomes. Following Pawson’s (2005) approach, conclusions will be presented as a series of contextualised decision points, e.g. if an older population (age 65+) faces challenge X (mechanism), then contact with a social worker under specific circumstances may lead to Y outcomes40. How context has influenced the outcome patterns reported in the included documents and the similarities and differences among the CMO configurations will be analysed, refined and presented. We will conduct an advisory group meeting to understand and incorporate their opinions and inputs about the overall relevance and plausibility of the CMOCs. We will refine the initial programme theory from the CMOCs and present a narrative synthesis describing the CMOCs, the middle-range theories and the strength of evidence. Finally, we will interpret the pattern of findings articulated in the middle-range theory by referring to existing literature and theory, for example, referring to the model of practice of delivering, supporting and coordinating service users' care, to understand how we can expand and build on current understanding. All the activities and processes of data extraction and analysis will be iterative, ensuring the consideration and incorporation of new insights and interpretations. As the review progresses, we anticipate refining our processes and further developing the middle-range theory through ongoing discussions within the review team and with advisory group members. Throughout, we will ensure that our approach to evidence synthesis is rigorously documented. All coding and data extraction will be carried out using NVivo, with sources of article selection managed using EndNote. We will consult with the advisory group members to derive recommendations from our review findings and explore their application to social care policy, service delivery modifications, and care pathways managed by social workers. To disseminate our findings, we will publish in a peer-reviewed scientific journal, issue press releases to both generalist and specialist audiences, and present our results to adult social worker networks. Continuous engagement with social worker networks will facilitate both input into the new program theory and our dissemination activity. We will employ various methods to raise awareness, including notifying the advisory group members and social media broadcasts. The early and ongoing involvement of field experts with leadership roles in social care and social work networks and people with lived experience of using social care services will strengthen our dissemination efforts. We will seek advice from topic experts on presenting our results at relevant conferences and meetings. Additionally, we will develop knowledge translation products to improve care pathways for adult social care service users, informed by our review findings. To the best of our understanding, no prior review has systematically investigated this topic or closely related areas. Therefore, this realist review aims to examine how contact with social workers at various stages of care, as well as the complexity and diversity of care needs, influence the quality of life and well-being of adult social service users. By exploring the complexities of initiating and sustaining contact within real-world social care settings, this review seeks to elucidate the mechanisms through which social workers contribute to health and social care outcomes. The review findings will inform evidence-based recommendations for social work practice and social care policy. We recognise that the policy and practice context vary across the four nations of the United Kingdom, with different structures and approaches in place. These variations will be considered within the CMOC development. Furthermore, understanding how adult social workers deliver care across all four nations is essential, as most research tends to focus on a single nation, particularly England. Ethical approval for the study is not required because no primary data collection is involved. This project contains the following underlying data: Figshare: Additional File 1 .docx. ((Full search strategy for Medline) - 10.6084/m9.figshare.28776881) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Figshare: Additional File 2: PRISMA-P checklist for ‘Social workers' contact with service users and outcomes' - 10.6084/m9.figshare.28776899) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). We acknowledge the contribution and collaboration of the following relevant stakeholders who are advising and will be advising the design, conduct, interpretation and dissemination of the review. These include Professor Jason Schaub, University of Bristol, Bristol, UK, the Social Care Expert Academic experts led by Dr Denise Tanner and Professor Robin Miller, the social workers and the PPI members, composed of individuals with lived experience in adult social care, either as current or former recipients of social care services and people working as adult social workers. Faculty Opinions recommendedReferences - 1. 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PubMed Abstract | Publisher Full Text Author details Author details 1 University of Birmingham School of Social Policy, Birmingham, England, UK 2 Applied Health Sciences, University of Birmingham, Birmingham, UK 2 Applied Health Sciences, University of Birmingham, Birmingham, UK Olamide Todowede Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Janette Parr Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Review & Editing Sarah Damery Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Validation, Writing – Review & Editing Naila Dracup Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Rachel Court Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Resources, Software, Writing – Review & Editing Jon Glasby Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Review & Editing Amy Grove Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This review is being funded by the NIHR Evidence Synthesis Programme (Award ID - NIHR153453). AG and SD are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands (Award ID - NIHR200165). JG is supported by the National Institute for Health and Care Research (NIHR) School for Social Care Research and by the ESRC/Health Foundation for IMPACT (ES/V001035/1P). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright © Crown copyright, 2025 Todowede O et al.. This open access work is licensed under the Open Government Licence v3.0 metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Todowede O, Parr J, Damery S et al. Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.14104.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 17 Oct 2025 Views 0 How to cite this report: Smith N. Reviewer Report For: Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.15337.r37943) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-37943 https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-37943 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 27 Dec 2025 Approved with Reservations VIEWS 0 Summary of the Article The manuscript presents a realist review protocol entitled “Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close The manuscript presents a realist review protocol entitled “Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for ... Continue reading Summary of the Article The manuscript presents a realist review protocol entitled “Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom?” The protocol outlines a research plan to synthesise evidence about how interactions (“contact”) between adult social workers and service users shape wellbeing, quality of life, and other care-related outcomes across the UK. Grounded in realist methodology, the review aims to understand the mechanisms through which contact affects outcomes, the contexts in which these mechanisms operate, and the populations for whom they are most significant. Key components of the protocol include a detailed rationale that outlines the growing complexity of adult social care and highlights the persistent lack of evidence about the impact of social worker–service user contact. The review is structured according to the five iterative stages recommended by Pawson et al., and it offers clear definitions of realist concepts such as context, mechanism, and outcome, alongside a working definition of “contact.” The authors propose to develop an Initial Programme Theory (IPT), which will then be refined into context–mechanism–outcome configurations (CMOCs) using evidence drawn from both academic and grey literature. The protocol sets out a comprehensive and iterative search strategy, covering the period from 1990 to 2025 and drawing on multiple databases, grey literature sources, and CLUSTER methods. Public and practitioner involvement is embedded throughout the process and has already contributed to the refinement of key definitions and assumptions, including the shift from “regular contact” to the broader concept of “any contact.” The authors also describe a robust plan for data extraction and appraisal based on relevance, rigour, and richness, as well as for the synthesis of findings. Finally, the protocol includes a clear dissemination strategy aimed at practitioners, policy-makers, and other stakeholders. Overall, the protocol is well developed, methodologically appropriate, and highly relevant to current social care policy and practice. Is the rationale for, and objectives of, the study clearly described? Overall answer: PARTLY The rationale and objectives are generally well described, and the suggestions below are relatively minor. The introduction provides a comprehensive and well-referenced overview of increasing demand for adult social care, the role of social workers, and theoretical models of practice. The rationale clearly identifies a documented evidence gap, namely, the lack of understanding of what social worker contact achieves in relation to outcomes such as wellbeing and quality of life. However, this section could be more explicit about (a) exactly what is unknown about social worker contact, and (b) the justification for focusing on the listed outcomes. Both wellbeing and quality of life are important, but their selection could be strengthened by grounding them in conceptual frameworks or policy priorities. The aim of the research and its four objectives are clearly laid out and logically connected to the realist methodology. The authors may also wish to revisit the Initial Programme Theory (IPT). Although Figure 2 presents multiple elements organised around context, mechanism, and outcome and indicates relationships through arrows, these relationships are not always clear to the reader. For example, it is not obvious how the model of practice interacts with other elements of the IPT. A short explanation is provided in the text, but expanding this would help clarify the authors’ approach. It may also be helpful to include a brief discussion of how mechanisms might differ across populations (e.g., whether mechanisms differ for older adults compared with working-age adults) and how contact may trigger mechanisms such as reassurance, trust, or autonomy. A hypothetical example CMOC could further support reader understanding. Is the study design appropriate for the research question? Overall answer: YES A realist review is well suited to examining complex, relational, and context-dependent interventions such as social worker contact. The design aligns well with realist principles and the research question. Strengths include, the use of realist methodology appropriate to the complexity and heterogeneity of social work practice, a structured plan following RAMESES standards, valuable advisory group contributions that enhance context-sensitivity and plausibility. Given that the review includes England, Wales, Scotland, and Northern Ireland, the protocol could clarify whether and how national policy differences will be treated as contextual layers within CMOCs. Are sufficient details of the methods provided to allow replication by others? Overall answer: PARTLY The protocol describes the methodology in considerable detail, including a comprehensive database list and rationale for the time range (post-1990), a clear explanation of iterative searching, inclusion of grey literature and CLUSTER methods, well-defined inclusion/exclusion criteria (PICOS), a detailed plan for data extraction and appraisal (relevance, rigour, richness), and a sound approach to analysis through cross-case comparison and abductive reasoning. However, there are areas where additional detail would improve replicability: The manuscript presents a realist review protocol entitled “Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom?” The protocol outlines a research plan to synthesise evidence about how interactions (“contact”) between adult social workers and service users shape wellbeing, quality of life, and other care-related outcomes across the UK. Grounded in realist methodology, the review aims to understand the mechanisms through which contact affects outcomes, the contexts in which these mechanisms operate, and the populations for whom they are most significant. Key components of the protocol include a detailed rationale that outlines the growing complexity of adult social care and highlights the persistent lack of evidence about the impact of social worker–service user contact. The review is structured according to the five iterative stages recommended by Pawson et al., and it offers clear definitions of realist concepts such as context, mechanism, and outcome, alongside a working definition of “contact.” The authors propose to develop an Initial Programme Theory (IPT), which will then be refined into context–mechanism–outcome configurations (CMOCs) using evidence drawn from both academic and grey literature. The protocol sets out a comprehensive and iterative search strategy, covering the period from 1990 to 2025 and drawing on multiple databases, grey literature sources, and CLUSTER methods. Public and practitioner involvement is embedded throughout the process and has already contributed to the refinement of key definitions and assumptions, including the shift from “regular contact” to the broader concept of “any contact.” The authors also describe a robust plan for data extraction and appraisal based on relevance, rigour, and richness, as well as for the synthesis of findings. Finally, the protocol includes a clear dissemination strategy aimed at practitioners, policy-makers, and other stakeholders. Overall, the protocol is well developed, methodologically appropriate, and highly relevant to current social care policy and practice. Is the rationale for, and objectives of, the study clearly described? Overall answer: PARTLY The rationale and objectives are generally well described, and the suggestions below are relatively minor. The introduction provides a comprehensive and well-referenced overview of increasing demand for adult social care, the role of social workers, and theoretical models of practice. The rationale clearly identifies a documented evidence gap, namely, the lack of understanding of what social worker contact achieves in relation to outcomes such as wellbeing and quality of life. However, this section could be more explicit about (a) exactly what is unknown about social worker contact, and (b) the justification for focusing on the listed outcomes. Both wellbeing and quality of life are important, but their selection could be strengthened by grounding them in conceptual frameworks or policy priorities. The aim of the research and its four objectives are clearly laid out and logically connected to the realist methodology. The authors may also wish to revisit the Initial Programme Theory (IPT). Although Figure 2 presents multiple elements organised around context, mechanism, and outcome and indicates relationships through arrows, these relationships are not always clear to the reader. For example, it is not obvious how the model of practice interacts with other elements of the IPT. A short explanation is provided in the text, but expanding this would help clarify the authors’ approach. It may also be helpful to include a brief discussion of how mechanisms might differ across populations (e.g., whether mechanisms differ for older adults compared with working-age adults) and how contact may trigger mechanisms such as reassurance, trust, or autonomy. A hypothetical example CMOC could further support reader understanding. Is the study design appropriate for the research question? Overall answer: YES A realist review is well suited to examining complex, relational, and context-dependent interventions such as social worker contact. The design aligns well with realist principles and the research question. Strengths include, the use of realist methodology appropriate to the complexity and heterogeneity of social work practice, a structured plan following RAMESES standards, valuable advisory group contributions that enhance context-sensitivity and plausibility. Given that the review includes England, Wales, Scotland, and Northern Ireland, the protocol could clarify whether and how national policy differences will be treated as contextual layers within CMOCs. Are sufficient details of the methods provided to allow replication by others? Overall answer: PARTLY The protocol describes the methodology in considerable detail, including a comprehensive database list and rationale for the time range (post-1990), a clear explanation of iterative searching, inclusion of grey literature and CLUSTER methods, well-defined inclusion/exclusion criteria (PICOS), a detailed plan for data extraction and appraisal (relevance, rigour, richness), and a sound approach to analysis through cross-case comparison and abductive reasoning. However, there are areas where additional detail would improve replicability: - The protocol could specify how disagreements in study selection and data extraction will be resolved. While two reviewers are mentioned, the procedure for managing disagreement (e.g., discussion, third-reviewer arbitration) needs to be made explicit. - The study’s iterative, flexible, theory-driven approach to searching is appropriate, but may limit strict replicability. It may be helpful for the authors to acknowledge this explicitly and clarify how transparency will be maintained (e.g., documenting search amendments). - Is the rationale for, and objectives of, the study clearly described? Partly - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Partly - Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Social care, outcomes. CITE HOW TO CITE THIS REPORT Smith N. Reviewer Report For: Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.15337.r37943) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-37943 https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-37943 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: Becker T. Reviewer Report For: Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.15337.r38241) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-38241 https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-38241 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 22 Nov 2025 Thomas Becker, University of Leipzig Medical Center, Leipzig, Germany Approved with Reservations VIEWS 0 This article is a review (or study) protocol of a project funded by NIHR that aims to explore the impact of contact with social workers on the quality of life and other outcomes of people who use the service provided ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close This article is a review (or study) protocol of a project funded by NIHR that aims to explore the impact of contact with social workers on the quality of life and other outcomes of people who use the service provided by adult social workers. Also, the authors aim to develop what they refer to as "middle-range theory" that may be helpful to better understand mechanisms of action (and relationships with context) of adult social work. The article is clearly written, and the structure it follows is clear. The overall study theme is highly relevant. The idea of using a "realist review" method is appealing. A PRISMA checklist is provided (as an additional file) The text makes easy reading, and a lay language summary is provided by the authors. The abstract is sufficiently clear, the project intends to focus on contact and interactions. The authors want to also focus on context-mechanism-outcome configurations, and that choice is convincing. The sections on stakeholder involvement and PPI are clear and adequate to the aims of the project. The Introduction section, section on Research aims and PPI are all clear. Service user involvement will be an integral part of this project.

The section on the Review process, Step 1 is fine. This reviewer misses a few elements in the section on the review process (as part of the Methods section): The authors describe a "realist syynthesis" as a "systematic theory-driven interpretative approach ... to make sense of different evidence about complex interventions", and in the sub-section on Step 2 they refer to the "complexity" both on the side of "user needs" and "social worker-related behaviour". The authors provide Fig. 2 on "Initial Pogramme Theory". To this reviewer, figure 2 only presents a few relevant keywords such as "complexity", "stage of contact" and "mediators" but these are not related in any straight-forward way, there is no information substantiating the relationships between boxes, giving detail about agency, power or whatever, "boxes with words" are (that is the reading of this reviewer) simply presented "next to each other". This is too little. The Introduction of the paper refers to solution-focused, relationship-based, and strengths-based approaches in adult social work. Relevant references are given, and the capabilities approach is also referred to. When we think of such "approaches" we may also think of whether they refer to the "social worker" as a "primary or sole agent" or "partner in one-to-one relationship" or "part of a network structure" or "agent and broker" (and there are probably other ways of putting this). As the authors explicitly refer to middle-range theory and "programme theory" they should be more explicit about "WHERE the action is." To give an example: if social workers were to refer, in a South Asian context of homeless and marginal people in Mumbai, to the work of the "Alliance" (see added citation, work by Appadurai 2001), the social worker would be "using" a grassroots approch's "theory", "mode of action" and power that has developed over decades. If, on the other hand, the social worker were to rely mostly on one-to-one relationships the authors might want to talk more on the THEORY behind that (and whether it is related to theoretical models relevant elsewhere, e.g. in psychotherapy research). The capabilities approach is about "social and collective choice", and this has implications. Given that the authors explicitly refer to "middle-range theory" why are they not more specific? Why does Fig 2 (or various versions of Fig 2 referring to different "theories" of social work) not give more detail and make it a lot clearer that there ARE, in the literature, specific concepts of action in and around social work? In other words, this reviewer believes that reference to concepts and theories can be more explicit. With that information at hand, the authors could also give more detail about (examples of) the kinds of outcomes they expect and how those will be analysed following data extraction. For instance, the authors already state in the present version of the text that there is "limited evidence on impact" of the relationship-based approach while outcomes relevant to the strengths-based approach may be about "independence, resilience, and self-determination". That way, the reader may understand better how the authors will go about "identifying components of the generated CMOCs using an interpretative cross-case cpmparison approach" (as part of Step 4). Step 5 is clear, to this reviewer. The Discussion could be slightly longer and actually refer to the field covered in more conceptual or "theoretical terms". Social work activity might profit from strong grassroots work in an area (i.e., something related to the wider community, not to the specifics of the social worker other than their capacity to liaise with such organisations), social work could use elements of grassroots political work (see "politics without parties" in Appadurai 2001, doi provided below). So, the centre of gravity, in such ways of social work with marginalised people may vary. Of course, there is relevant theory on relationship. This reviewer thinks that the authors, at the outset of their impressive work, could do more to provide CONCEPTUAL CLARITY and produce a more explicit figure of their initial theory. Practical (and modest) additions to the paper that this reviewer suggests refer to the Introdution section of the paper and to the Methods Step 2 (IPT) section. Also, the Discussion could be extended slightly (see above). The abstract is sufficiently clear, the project intends to focus on contact and interactions. The authors want to also focus on context-mechanism-outcome configurations, and that choice is convincing. The sections on stakeholder involvement and PPI are clear and adequate to the aims of the project. The Introduction section, section on Research aims and PPI are all clear. Service user involvement will be an integral part of this project.

The section on the Review process, Step 1 is fine. This reviewer misses a few elements in the section on the review process (as part of the Methods section): The authors describe a "realist syynthesis" as a "systematic theory-driven interpretative approach ... to make sense of different evidence about complex interventions", and in the sub-section on Step 2 they refer to the "complexity" both on the side of "user needs" and "social worker-related behaviour". The authors provide Fig. 2 on "Initial Pogramme Theory". To this reviewer, figure 2 only presents a few relevant keywords such as "complexity", "stage of contact" and "mediators" but these are not related in any straight-forward way, there is no information substantiating the relationships between boxes, giving detail about agency, power or whatever, "boxes with words" are (that is the reading of this reviewer) simply presented "next to each other". This is too little. The Introduction of the paper refers to solution-focused, relationship-based, and strengths-based approaches in adult social work. Relevant references are given, and the capabilities approach is also referred to. When we think of such "approaches" we may also think of whether they refer to the "social worker" as a "primary or sole agent" or "partner in one-to-one relationship" or "part of a network structure" or "agent and broker" (and there are probably other ways of putting this). As the authors explicitly refer to middle-range theory and "programme theory" they should be more explicit about "WHERE the action is." To give an example: if social workers were to refer, in a South Asian context of homeless and marginal people in Mumbai, to the work of the "Alliance" (see added citation, work by Appadurai 2001), the social worker would be "using" a grassroots approch's "theory", "mode of action" and power that has developed over decades. If, on the other hand, the social worker were to rely mostly on one-to-one relationships the authors might want to talk more on the THEORY behind that (and whether it is related to theoretical models relevant elsewhere, e.g. in psychotherapy research). The capabilities approach is about "social and collective choice", and this has implications. Given that the authors explicitly refer to "middle-range theory" why are they not more specific? Why does Fig 2 (or various versions of Fig 2 referring to different "theories" of social work) not give more detail and make it a lot clearer that there ARE, in the literature, specific concepts of action in and around social work? In other words, this reviewer believes that reference to concepts and theories can be more explicit. With that information at hand, the authors could also give more detail about (examples of) the kinds of outcomes they expect and how those will be analysed following data extraction. For instance, the authors already state in the present version of the text that there is "limited evidence on impact" of the relationship-based approach while outcomes relevant to the strengths-based approach may be about "independence, resilience, and self-determination". That way, the reader may understand better how the authors will go about "identifying components of the generated CMOCs using an interpretative cross-case cpmparison approach" (as part of Step 4). Step 5 is clear, to this reviewer. The Discussion could be slightly longer and actually refer to the field covered in more conceptual or "theoretical terms". Social work activity might profit from strong grassroots work in an area (i.e., something related to the wider community, not to the specifics of the social worker other than their capacity to liaise with such organisations), social work could use elements of grassroots political work (see "politics without parties" in Appadurai 2001, doi provided below). So, the centre of gravity, in such ways of social work with marginalised people may vary. Of course, there is relevant theory on relationship. This reviewer thinks that the authors, at the outset of their impressive work, could do more to provide CONCEPTUAL CLARITY and produce a more explicit figure of their initial theory. Practical (and modest) additions to the paper that this reviewer suggests refer to the Introdution section of the paper and to the Methods Step 2 (IPT) section. Also, the Discussion could be extended slightly (see above). - Is the rationale for, and objectives of, the study clearly described? Yes - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Partly - Are the datasets clearly presented in a useable and accessible format? Not applicable

1. Appadurai A: Deep democracy: urban governmentality and the horizon of politics. Environment and Urbanization. 2001; 13 (2): 23-43 Publisher Full TextCompeting Interests: No competing interests were disclosed. Reviewer Expertise: Mental health services research, social psychiatry CITE HOW TO CITE THIS REPORT Becker T. Reviewer Report For: Exploring the Influence of Contact with Social Workers on the Quality of Life and Wellbeing Outcomes of Adult Social Care Service Users: How, why, and for Whom? - A realist review protocol [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2025, 5:103 (https://doi.org/10.3310/nihropenres.15337.r38241) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-38241 https://openresearch.nihr.ac.uk/articles/5-103/v1#referee-response-38241 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | || |---|---|---| | 1 | 2 | | | Version 1 17 Oct 25 | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' - Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. - You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. - You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). - You work at the same institute as any of the authors. - You hope/expect to benefit (e.g. favour or employment) as a result of your submission. - You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' - You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. - You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. - You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with NIHR Open Research Already registered? Sign in close Error If you are a previous or current NIHR award holder, sign up for information about developments, publishing and publications from NIHR Open Research. We'll keep you updated on any major new updates to NIHR Open Research Sign In If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. Email us for further assistance. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here. If you still need help with your Google account password, please click here. You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here. If you still need help with your Facebook account password, please click here. Code not correct, please try again Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait...