Hi Sue

Great to hear you enjoy Justin's course and feel brave enough to post here - welcome!

I have two immediate ideas in response to your question.  First - yes - that is incredibly complex and it's not always easy to connect the macro, meso and micro levels together.  One solution is to use Gill Westhorp's strategy of combining complexity theory with a realist philosophy of science to  'layer theories'  in order to explain how mechanisms firing at one level can influence those that fire at another level - from the micro up to the macro.

http://evi.sagepub.com/content/18/4/405.short

In a similar vein to this idea - I worked with Ray Pawson last year on a realist review of demand management for planned care.  From an analysis of the programme theories underlying the different demand management interventions, we also found that system change is layered but that different interventions are often directed at one particular 'layer' of the system.  However, what happens at one 'layer' of the system can be hindered or supported by what happens in other layers of the system. Successful change required integrated change at all levels of the system:

http://www.sciencedirect.com/science/article/pii/S0277953614003268

Hope this helps and good luck with you project

Best wishes
Joanne 
Dr Joanne Greenhalgh
Associate Professor
School of Sociology and Social Policy
University of Leeds
Leeds LS2 9UT
Twitter: @Greenhalgh_Jo



-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Suemann
Sent: 09 March 2015 13:06
To: [log in to unmask]
Subject: Mechanisms in realist evaluation of systems

First to say thank you to justin Jagosh for very stimulating course in liverpool last week - and for inspiring me to be brave enough to post here.  

I am a relatively new recruit to realism and have been plunged into a complex realist evaluation of a health systems research project designed to design, implement and evaluate a range of (different) post partum care packages in four African countries.  I am drawing  on trish  greenhalgh's methodology for evaluating the south london modernisation initiative.  I have found the approach of looking at supportive/ unsupportive contexts for the mechanisms fits well here but I am unsure how the overarching selected mechanisms for systems are related to the way we look at individual level evaluations and individual level reactions such as fear, empowerment or motivation etc. 
Can anyone advise ( I hope this makes sense!).  

Finally to say we are starting a small skype-based journal club as a way of building skills for some of us earlier on in using the methodology.  If any of you experts out there would be happy to join us occasionally that would be fantastic.  

Thanks for any help 

Best wishes
Sue Mann
UCL NIHR knowledge mobilisation fellow

Sent from my iPhone