Thanks Ceri - but didnšt we all argue about the difference between a
context and a mechanism at the time???
Trish Greenhalgh
Professor of Primary Health Care and Dean for Research Impact
Barts and the London School of Medicine and Dentistry
58 Turner St
London E1 2AB
UK
+44 20 7882 7325
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@trishgreenhalgh
On 10/07/2014 08:58, "Butler, Ceri" <[log in to unmask]> wrote:
>Dear all
>
>Apologies if Trish or others have already shared this article, but this
>might be of interest to some of you interested in undertaking a realist
>evaluation of a service transformation:
>
>Trisha Greenhalgh, Charlotte Humphrey, Jane Hughes, Fraser Macfarlane,
>Ceri Butler, and Ray Pawson. How Do You Modernize a Health Service? A
>Realist Evaluation of Whole-Scale Transformation in London. Milbank Q.
>Jun 2009; 87(2): 391-416.
>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881448/
>
>It is a few years old now but is still highly relevant, particularly
>looking at both the context and mechanisms of change in detail.
>
>Best wishes
>
>Ceri
>
>
>Ceri Butler
>
>Academic Lead, PG Programmes
>UCL Medical School
>University College London
>Room GF/664
>Royal Free Hospital
>London NW3 2PF
>
>Tel: 020 3108 9214 (via Jeannine Attreed - Postgraduate Scholarship
>Administrator)
>
>UCL Medical School Postgraduate Activities:
>http://www.ucl.ac.uk/medicalschool/postgraduate/postgraduate-activities/
>
>UCL Medical School Education Consultancy:
>http://www.ucl.ac.uk/medicalschool/education-consultancy
>
>
>
>
>-----Original Message-----
>From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards
>[mailto:[log in to unmask]] On Behalf Of Sandy Oliver
>Sent: 10 July 2014 07:10
>To: [log in to unmask]
>Subject: Re: A new particiant question regarding mechanisms
>
>Dear Gill
>
>Thank you very much for explaining how you identify mechanisms in a
>theory building realist review. That's helped me clarify my thinking for
>a couple of pieces of work: primary research about institutional
>mechanisms for producing policy-relevant reviews; and a review about
>effective and efficient committees.
>
>Best wishes, Sandy
>
>Sandy Oliver, PhD, Professor of Public Policy Social Science Research
>Unit and EPPI-Centre, Institute of Education, University of London.
>
>Public engagement with academic research: outsiders bring
>(a) independence for oversight
>(b) experiential knowledge for designing studies
>(c) practical and problem solving skills for data collection and
>analysis, and
>(d) an inquiring mind for research informed citizenship.
>http://bit.ly/YeT0w2 Twitter @profsandyoliver
>________________________________________
>From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards
>[[log in to unmask]] On Behalf Of Gill Westhorp
>[[log in to unmask]]
>Sent: 10 July 2014 02:10
>To: [log in to unmask]
>Subject: Re: A new particiant question regarding mechanisms
>
>Hi all
>
>I think there are a couple of things to keep clear in this discussion.
>
>One is the distinction between realist synthesis and realist evaluation.
>It's certainly possible to do both in the same study, but they're quite
>separate things and they can require quite different processes to identify
>mechanisms. So - with thanks for the kind words Justin - the link we
>just
>posted is to a theory-building realist synthesis (rather than a realist
>evaluation). By that I mean - a realist synthesis where we could not,
>because of the terms of the contract and the stage of development of
>existing theory - posit the mechanisms in advance and investigate a
>little segment of program theory in depth. Rather, we had to begin the
>process of building realist theory from the existing literature and the
>focus was on breadth rather than depth.
>
>So my first question for you Barbara is - are you undertaking a realist
>evaluation or a realist synthesis, or both?
>
>The second thing I think we need to keep clear is the two uses of the
>term mechanism. It's unfortunate but the word was already used in much
>research and evaluation to mean 'program strategy' or 'feature of the
>intervention'.
>Realists of course mean 'underlying causal process'.
>
>That second one gets intricate for two reasons. Firstly, there are
>multiple different ways of thinking about and understanding underlying
>causal processes, of which Pawson and Tilley's 'reasoning and resources'
>is just one. Secondly, using P&T's construct, features of the
>intervention can in some cases be the resource, or provide the resource,
>in response to which the participant (or other decision-maker) reasons.
>
>Consequently, features of the intervention can concurrently be 'strategy'
>and 'context' and 'mechanism'. It all depends which particular little
>piece of the analysis you're doing at a particular moment in time. My
>mental trick for this is to start by identifying the current outcome of
>interest (which may of course be an immediate, short term, intermediate
>or long term outcome); work back from that to identify the mechanism(s)
>(it or they were underlying causes of the outcome), and then identify
>features of context that affect that mechanism.
>
>Context can of course influence outcomes in many ways. The 'purist'
>realist view is that it affects which mechanisms 'fire'. It also
>influences implementation, of course (which in turn can influence which
>mechanisms can
>fire) and it influences whether or not participants are able to put
>intended decisions into action or maintain them (implementing the
>decision may or may not be included in the description of the mechanism,
>depending on which construct of mechanism one is using).
>
>But in direct answer to your question Barbara - my perspective would be:
>yes, there are very many studies that are stronger on context than
>mechanism. However from a 'pure' realist perspective - it's a bit
>difficult to say that context has been dealt with 'well' if mechanism
>hasn't been, because the focus is supposed to be on how context affects
>mechanisms.
>
>I certainly wouldn't put it up as an exemplar of good realist practice
>but I attempted a realist evaluation of a pilot program for which the
>report is
>publically available: http://familybyfamily.org.au/ It does at least
>provide a CMOC table! Again, this was as much realist theory building as
>theory testing. We're hoping that future evaluations of this program may
>get a little further on theory testing.
>
>Cheers
>Gill
>
>-----Original Message-----
>From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards
>[mailto:[log in to unmask]] On Behalf Of Jagosh, Justin
>Sent: Thursday, 10 July 2014 10:02 AM
>To: [log in to unmask]
>Subject: A new particiant question regarding mechanisms
>
>Dear Barbara,
>
>Your observation about realist evaluations emphasizing context over
>mechanism is something that I've noticed and thought about as well. There
>are indeed good examples out there. Purva's is one. Gill Westhorpe just
>posted a link to her recent realist evaluation in which the mechanisms
>are quite well defined.
>Yet there really is no set way of doing the analysis. It maybe the case
>that the research team decides that exploring contextual determinants is
>more useful than exploring mechanisms. Perhaps that is just fine -
>especially if we approach research with the realist principle that all
>research produces partial knowledge at best.
>
>Personally, my research orientation is to begin synthesis by searching
>for, and theorizing upon the mechanisms - that is, the range of intended
>and unintended resources created + stakeholder responses, for the program
>in question, or the cohort of programs. The idea here is that an
>understanding of contextual factors can then be built subsequently from
>an initial exploration into how the program works. In other words, first
>to 'break down' the program into its underlying mechanisms, and then ask
>the question:
>what contextual factors do we see impacting these mechanisms?
>
>Doing it the other way around (i.e., starting with studying context),
>might not yield the same analysis. An additional point is that
>contextual determinants can seem endless. Having a grasp of the candidate
>mechanisms can help focus and pull out the relevant aspects of context
>that would seem to make sense. The overall picture of the CMO
>configuration process can then inform the theoretical output of the
>research.
>There is no one way to tackle this, but it's what makes sense to me. I'd
>be interested in hearing other thoughts.
>
>sincerely,
>Justin
>
>
>Justin Jagosh, Ph.D
>Senior Research Fellow
>Centre for Advancement in Realist Evaluation and Synthesis (CARES)
>University of Liverpool, United Kingdom
>
>Phone:
>(in Canada)
>00-1-604-822-3814 (w)
>00-1-778-846-4589 (m)
>
>________________________________________
>From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards
>[[log in to unmask]] on behalf of Barbara Maxwell [[log in to unmask]]
>Sent: July 8, 2014 23:59
>To: [log in to unmask]
>Subject: A new particiant question regarding mechanisms
>
>Dear fellow RAMESES participants,
>this is my first post on the list serve ( oh my, that does sound like an
>introduction at an AA meeting) and I was hoping for a little advice.
>I am engaged in a study of interprofessional clinical education for
>pre-qualification healthcare professional students and am attempting to
>conduct a realist evaluation. The design is structured around the
>application of the realist cycle. In reviewing the literature where a
>realist evaluation has been stated as being used in IPE evaluative
>studies, I have noticed that context is dealt with well in the majority
>of studies, but mechanisms are not. It appears that many studies elude to
>mechanisms but the items they identify are more characteristic of
>features of the program design, or could be argued to be context items,
>and do not describe the interaction of resources and reasoning. The
>studies also do not appear go to the stage of identifying CMOC theories.
>I wanted to ask if this a common issue in realist evaluation studies and
>ask for some recommendations for studies that the RAMESES community would
>recommend as exemplars of realist evaluation.
>
>
>Barbara Maxwell
>Professor & University Director of Interprofessional Education &
>Collaboration A. T. Still University
>5850 E Still Circle
>Mesa AZ 85142
>USA
>[log in to unmask]
>480 219 6109
>
>The Institute of Education: Number 1 worldwide for Education, 2014 QS
>World University Rankings
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