How to develop a realist programme theory using Margaret Archer’s structure–agency–culture framework: The case of adolescent accountability for sexual and reproductive health in urban resource-constrained settings

Realist evaluation is in essence a theory-building and testing approach. We argue that in practice, the theory-building potential of realist evaluation, review and research is not fully exploited in the field of global health. Our assumption is that the Structure-Agency-Culture explanatory framework of critical realist Margaret Archer could stimulate realist evaluators to conceptualize and systematically explore how structural and cultural conditions interact with programmes that aim at introducing social change. We propose step-wise guidance towards integrating the Structure–Agency–Culture framework into the development of realist programme theories. We present a worked example from an urban adolescent health study in poor neighbourhoods of Kampala, Mumbai, New Delhi and Cotonou. The guidance aims to bring to the fore the role of agency and context through the analysis of the interactions between structure, culture, agency and mechanisms. This is helpful in realist research in general, and in evaluations of complex interventions oriented towards social change.