A brief introduction to realist synthesis Geoff Wong

Overview Objectives What is realist synthesis / review? Why do we need ‘yet another’ approach? What assumptions underpin realist synthesis? Summary

Objectives By the end of this presentation I hope you will have an understanding of: what a realist synthesis is what assumptions underpin realist synthesis when you might use realist synthesis.

What is a realist synthesis? Realist Synthesis - Theory driven systematic review (secondary research) Goal is more explanation and understanding than judgment and summation More a “logic of enquiry”- a way of analysing and making sense of data using a realist lens.

Why do we need ‘yet another’ research review method? Because of ‘complex interventions’ – a realist perspective: Volitions: Reliant on people to make choices Implementation: Long implementation chains Context: Outcomes change under differing contexts Time: What has happened previously shapes what will happen next Outcomes: multiple, planned and unplanned and even contested Rivalry: Interventions ‘compete’ with one another in the real world Emergence: interventions begets change which causes more change

A simplified diagram of a complex intervention! H J A B C D E G I K Intervention M

Assumptions underpinning realist synthesis Ontologically – how we believe the world to be constituted: Developed from critical realism A stratified and ‘filtered’ world About identifying, understanding and explaining causation through generative mechanisms All this may be explained by one or more (middle-range) theories Context influences which mechanism(s) ‘fires’ Mechanism(s) B A

Assumptions underpinning realist synthesis Epistemologically – what counts as knowledge and how can we come to know it: Knowledge is built up gradually, is partial and conditional but corrigible Knowledge should be judged by assessing the processes and assumptions by which it is produced Theories are ‘right’ because they are (for example) coherent, plausible and repeatedly successful

Assumptions underpinning realist synthesis Methodologically: Uses a realist ‘lens’ to analyse and make sense of data Theory-driven: Realist programme theory Middle-ranged theories to explain outcomes of interest Requires focussing and prioritisation of what to study Making and testing inferences from the data Uses any data that can inform inferences Iterative

Summary Realist research is based on a explicit philosophy of science. Ontologically: Stratification – the world has ‘depth’ Generative causation through mechanisms Epistemologically: Partial and corrigible knowledge, built up gradually and judged by assessing the processes and assumptions by which it is produced Methodologically Ontology and epistemology should inform methodology (and not the other way round) You first have to acknowledge that the world can be constituted in different ways. Ontological: Realist assume that to make sense of any phenomenon we need to understand what is causing it to happen. The concept of a ‘mechanism’ used to explain causation. So if I do X, Y happens BECAUSE of mechanism Z. In any complex intervention, context matters because it influences whether or not a mechanism fires. In addition, there may be mutiple competing, reinforcing or non active mechanism present that interact. Whether or not the outcome of interest occurs depends on the exact contextual milieu. So ontologically, realism has a coherent model to explain causation, the place of context within this model its model of causation and a conceptualisation of ‘complexity’ might arise. Epistemological: Like all other methods realism has to contend with the problem of the underdetermination of theory – i.e. which competing theory is more right/likely. In realism we are ‘proving theories’ – but there is the added complication that we are dealing with a ‘complex’ system – interacting mechanisms sensitive to contextual influences. Inter-twining of method and epistemology here, but the above means that it is neither possible nor desirable to resort to controlled trials as the only means of determining if one theory is more likely. Controlled trials ‘petrify’ an important ontological element – context, thus limiting learning about the intervention. More importantly, it may not be possible to control all context uniformly. Have to rely on other processes – such as coherence, plausibility and repeated success. Methodological: Any research method used should be based on explicit ontology and epistemology – BOTH and not just one or the other as all three and intertwined.

Realism is a way of looking at and making coherent sense of this ‘messy’ world we live in.

Thanks for your attention Suggested readings: Pawson R. Evidence-based Policy. A Realist Perpective. London: Sage, 2006. Pawson, R., Greenhalgh, T., Harvey, G., and Walshe, K. Realist Synthesis: an introduction. http://www.ccsr.ac.uk/methods/publications/documents/RMPmethods2.pdf . 2004. ESRC Research Methods Programme. Wong G, Greenhalgh T, Westhorp G, Pawson R. Realist methods in medical education research: what are they and what can they contribute? Medical Education 2012, 46:1, 89–96 Wong G, Greenhalgh T, Pawson R. Internet-based medical education: a realist synthesis of what works, for whom and in what circumstances BMC Medical Education 2010, 10:12 (2 February 2010) Wong, G., Pawson, R., Owen, L. Policy guidance on threats to legislative interventions in public health: a realist synthesis BMC Public Health 2011, 11, 222 Klee R. Introduction to the philosophy of science. Cutting nature at its seams. New York: Oxford University Press, 1997 If you are interested in undertaking a realist synthesis please email me: grckwong@gmail.com Or Join us on the RAMESES Project www.jiscmail.ac.uk/RAMESES