It’s great to suddenly be in fashion. For years, having been judged as niche, obscure or variously a bit of an oddball, suddenly everyone seems to want to come to the realist party.
Approaches, notably the Medical Research Council framework for Complex Interventions (Craig et al 2008), that invoke key realist concepts – including mechanisms and context – have never been more popular, frequently cited and used. Quality assurance frameworks now exist to help us accord with realist principles and practices when doing reviews (Wong et al 2013). Around a quarter of the academics I know now speak of wanting or doing forms of realist evaluation. Those of us who have, for years, toiled in relative realist obscurity now find ourselves surrounded by old colleagues making new chatter about “Pawson & Tilley”, “mechanisms” and “what works for whom, when and why.”
We should be pleased. Critical realism may not have come to the mainstream of health services research, but the mainstream has come to this realism.
Much of this makes sense. As someone who has been engaged in realist-driven work, including realist evaluation, since 2000, I truly know the heady excitement of not only thinking of interventions differently, but also of asking different and new questions on a fundamentally different ontological basis (Clark et al 2010). Questions that were once the most sensible and pressing (“Does this intervention work?”) are suddenly rendered laughably simplistic and foolish (Clark et al 2012a). Whole new doors of inquiry open to understand and explain intractable old problems in promising new ways (Clark et al 2012b). Our party indeed has an alternative vibe. It promises much to those looking in.
Yet, this does not always sit well. Is realism ready for the scrutiny that this new popularity brings? Why did some who so readily come to realism now, dismiss so much in the past? I guess that’s progress – but do you fully understand what you are getting into?
Hopefully this webinar will help. In the meantime, and for the future, for all party go-ers, I make the following suggestions:
Seasoned realists identify with the enthusiasm of the newly acquainted realist. We have been there too – we get it. We think it’s good. But also, it’s only just the start. Don’t think reading parts of ‘Realistic Evaluation’ (Pawson & Tilley 1997) will suffice? Realist evaluation is not about method but ontology (Porter 2015). Read Bhaskar’s earlier philosophical works, or the great concise overview from Collier (1994). Become familiar with key arguments relating to critical realist epistemology; the mind dependence and mind independence of our worlds. You won’t regret it, and will understand far more the potential of realism if you do.
There’s more to realism than mentions of methods of mechanisms, context and “what works for whom, when and why.” Yes, that is neat and helpful – but can also be vague and messy, particularly when you are working with all-too-real quantitative and qualitative data. Too much supposed ‘realist-driven’ research includes only the most superficial of realist conceptions or ignores fundamentally central facets, notably context (Marchal et al 2012). Make sure you include all concepts necessary to the realist project in your work, define these clearly (e.g. “what are mechanisms?), and be transparent and consistent regarding how and when you will infer them from data.
It’s easy to be caught up with new and beguiling waves. Yet, don’t merely follow the realist fashion – seek to shape its future too. Rather than ignoring the challenges of using realism in real research (Marchal et al 2012), contribute to the all-too-few published examples of realist work. Describe the unique and distinctive methodological challenges in doing this challenging work. Be part of the emerging critical scholarship that seeks to improve the use and application of critical realism and realist evaluation (Porter 2015).
Enjoy yourself and this webinar…this party is just starting. You are part of it. Who know’s where it will go?
Alex Clark PhD FCAHS
Professor & Associate Dean (Research)
University of Alberta, Canada
Co-Editor International Journal of Qualitative Methodology
Clark, A.M., Redfern, J., Thirsk, L, Neubeck, L., & Briffa, T. (2012a). What football can teach us about researching complex interventions. British Medical Journal, 345(e8316).
Clark, A.M., & Thompson, D.R. (2012b). Heart failure disease management programmes: a new paradigm for research. Heart, 302572.
Clark, A. M., & Thompson, D. R. (2010). What type of heart failure program is best? Wrong question, wrong assumption. European Journal of Heart Failure, 12, 1271-1273.
Collier, A. (1994). Critical Realism: An introduction to Roy Bhaskar’s Philosophy. London: Verso.
Craig, C., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: new guidance. London: Medical Research Council.
Marchal, B., van Belle, S., van Olmen, J., Hoerée, T., & Kegels, G. (2012). Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research. Evaluation, 18(2), 192-212
Pawson, R., Tilley N. (1997). Realistic Evaluation. Sage, London.
Porter, S. (2015) The uncritical realism of realist evaluation. Evaluation. 21: 65-82.
Wong, G., Greenhalgh, T., Westhorp, G., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC Medicine, 11, 21.