Barend and Marjolin said

" Concerning the MRT: we only made the MRTs retrospectively as from the
literature we could not define MRTs (or program logic) for most of the
programs as too little information was given in the articles. Staying close
to the literature was exactly what we wanted, not using our assumptions of
what the authors had as their MRT as theory building. "

This is an interesting issue which I've encountered in realist evaluation
too.  In my experience people who are "doing stuff" don't have a theory
which they can articulate (that's 'theory' in both senses - they don't have
a mechanism of action and they certainly don't a middle-range theory).  But
I'm not sure that it's necessarily good science to keep faithful to this
lack of espoused theory when interpreting other authors' work.  It MIGHT be
OK (indeed, it might be good practice) to use systematic reflection and
deliberation to impugn the theory/ies that are implicit in authors' actions.
There's a parallel here in ethnography - human actors are often not very
good at articulating what they're up to but they're very good at (say) doing
their jobs. By using systematic ethnographic techniques one can often build
up a robust picture of social action EVEN THOUGH the actors themselves
haven't expressed their actions in those terms. One aspect of validity here
is whether the actors recognise and engage with the explanations...

Comments Gill?  (and others...)


Trisha Greenhalgh
Professor of Primary Health Care and Director, Healthcare Innovation and
Policy Unit
Centre for Primary Care and Public Health
Blizard Institute
Barts and The London School of Medicine and Dentistry
Yvonne Carter Building
Turner Street
London E1 2AT
t : 020 7882 7325 (PA) or 7326 (dir line)
f : 020 7882 2552
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http://www.icms.qmul.ac.uk/chs/staff/trishagreenhalgh.html


-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards
[mailto:[log in to unmask]] On Behalf Of Marjolein Dieleman
Sent: 08 July 2011 13:29
To: [log in to unmask]
Subject: Reaction to messges about realis review retention studies

We greatly thank Mark and Gill for their reactions to our realist review and
for taking the time to read it and write such elaborative reactions. We took
quite some time to react, as it is for us at the moment a luxury to take
time and think- and of course it is not easy to respond either.

In particular the way we have operationalised "mechanisms" and the way that
Mark and Gill responded to our operationalisation gave us food for thought.
We called mechanisms reactions and understood it in the way Gill explained:
"changed reasoning in response to resources or opportunities provided by the
program, leading to changed behaviours, in turn causing changed outcomes".
However, we believe that a program can trigger several mechanisms and their
sum can have a positive, negative or a net-zero outcome. Reactions were for
us a result of the trigger, and hence are mechanisms that make a program or
intervention work or not work.

Gill described the different ways of conceptualising mechanisms- and it
would be interesting to find more examples to describe these levels, as for
us it was not very clear how these were different. The example from the text
that Gill provided triggered another thought on our side: in Ecuador apathy
and resentment caused two different types of outcomes:- poor quality but
also less likely to be retained- so in fact in this case the sum of the
mechanisms caused two different outcomes.

We really would like to be able to explain this to outsiders in an
understandable way without compromising the concept of mechanism- any
suggestions?

Concerning the MRT: we only made the MRTs retrospectively as from the
literature we could not define MRTs (or program logic) for most of the
programs as too little information was given in the articles. Staying close
to the literature was exactly what we wanted, not using our assumptions of
what the authors had as their MRT as theory building. For testing the
retrospectively created theories, 'our' MRTs, was not enough time and
resources available but would have been of course the most ideal.

Looking forward to your reactions!
Barend and Marjolein