Just a quick "thanks" for sharing these insights and for the posts in general.  They've really been quite helpful as I work through my realist synthesis.

Best,

Dave



David R. Baker, DrPH, MBA

Assistant Professor

 Center for Leadership and Improvement  

 The Dartmouth Institute for Health Policy and Clinical Practice

Senior Curriculum Specialist

  Master of Health Care Delivery Science Program

  Dartmouth College

  410.913.5409

  Skype: davebaker777

  http://mhcds.dartmouth.edu

 



-----Original Message-----

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Gill Westhorp

Sent: Monday, July 11, 2011 5:24 AM

To: [log in to unmask]

Subject: Re: Reaction to messges about realis review retention studies



Hi Marjolein (et al)

A few odd passing thoughts in response to your email.  



I agree that different mechanisms firing can end up with programs having a positive, negative or net-zero outcome.  However, any half decent outcomes evaluation can tell you that - that doesn't require a realist approach.  The beauty and interest of a realist approach from my perspective is that it unpacks and concentrates on the differences within the net sum result, and how/why they ended up that way.  I agree with Nick T and Ray P, as they have argued all along, that that's more policy- and program-useful than the net sum result. 



I also agree that one of the difficulties of this work is explaining the concept of mechanisms to the uninitiated - and I confess to having used the word 'responses' on a few occasions in much the same way as you have used 'reactions'.  I discussed this with Nick (Tilley) one day and he didn't like it, because it wasn't specific enough ('reasoning' implies more about the process of decision-making than 'response' or 'reaction').  I also discovered when I was using 'responses' that I ran into some of the problems I identified in my initial response to your review - e.g. responses that are responses but don't generate outcomes, so aren't mechanisms; not being specific about the specific resources within a program that prompt particular reasoning-decisions-behaviours...etc etc etc.  



I've gone back to using the term 'mechanism' and explaining it as having three necessary elements: a program mechanism must involve a) identifying the particular resource or opportunity offered by the program;  b) identifying the 'change inside people's heads'  -  be that reasoning in the sense of logic-in-use,  affect, values, whatever -  in response to the resource or opportunity; and  c) explaining the 'logic' that links that change inside their heads to different decisions that generate different behaviours that generate different outcomes.  



My experience so far is that people find that understandable, but still grapple with two things once they try to apply it.  The first is that "the particular resource or opportunity offered by the program" can be unpacked at different levels of abstraction - deciding the 'right' level of abstraction / detail is tricky. The second is that 'the change inside people's heads' could be so diverse.  Again, it's an issue of picking the right level of abstraction - but it also, almost invariably, runs into consideration of context (what is it that's causing the patterns in the reasoning for different sub-groups?) and then people struggle to identify the boundaries between mechanism and context.  



As to the various ways of thinking about mechanism that I described in the last email - (This should really be a discussion over a bottle of red…)  The background to the comment was that I'm working up a rough typology of ways of thinking about mechanisms  -  NB not a typology of mechanisms themselves.  It pulls together four ways of conceptualising mechanisms that I've seen in the literature and tries to explain each of them as a key idea and with examples at different 'levels' of reality.  The four categories are 1. as a force (forces are external to the subject and push or pull); 2. an interaction (interactions involve an exchange between the subject and someone or something else, where the interaction creates changed states);  3. inherent powers and liabilities (inherent to the subject, whether currently exercised or not) and 4. a process (sequences of smaller elements, often interactions, where later elements are dependent on earlier ones).  The four levels of reality are material/natural; cognitive/psychological; social; and institutional (the latter implying large systems).  I have this set out as a little set of PowerPoint slides with an example in each category.  Examples are named but not described/explained as yet - that's work I hope to get to in future.  My suspicion is that different ways of thinking about mechanisms are likely to be more or less useful for different analytic tasks - but I'm yet to test that.  I also think that different people find different ways of thinking about mechanism easier or harder, and that having different ways of getting at the idea can be useful.  Mind you I haven't yet presented these slides in public yet so I don't know - they might just confuse people!



So all that was playing in the background as I wrote, and I was wondering whether different ways of conceptualising mechanism would make much difference to the analysis that we produce when we're undertaking realist evaluations or realist syntheses  - that's all. 

  

Cheers

Gill