Thank you, Andy. That's a really helpful passage. I'm still struggling with all the different interpretations of the same terms....
V.
-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Peter O'Halloran
Sent: 07 September 2015 18:26
To: [log in to unmask]
Subject: Re: RE & CR
Andrea,
That sounds like a very interesting paper. I will look forward to reading it! I like Archer, too. Here's a good passage: ‘Agents possess properties and powers distinct from those pertaining to social forms. Among them feature all those predicates, such as thinking, deliberating, believing, intending, loving and so forth, which are applicable to people, but never to social structures or cultural systems.’ (Archer, M.S., 2003. Structure, Agency and the Internal Conversation, Cambridge University Press. P. 2)
Andy,
If you want to see a philosophical discussion/critique on RE and agency try Sam's papers (attached to an email from Geoff Wong in this list, I think):
Porter, S., 2015. The uncritical realism of realist evaluation. Evaluation, 21(1), pp.65–82. Available at: http://evi.sagepub.com/cgi/doi/10.1177/1356389014566134.
Porter, S., 2015. Realist evaluation: an immanent critique. Nursing Philosophy, 2009, p.n/a–n/a. Available at: http://doi.wiley.com/10.1111/nup.12100.
Yours,
Pete
Dr Peter O'Halloran
Lecturer
School of Nursing and Midwifery
Queen's University Belfast
Medical Biology Centre
97 Lisburn Road
Belfast BT9 7BL
Tel 028 9097 2490
Fax 028 9097 2328
email: [log in to unmask]
Web page: Peter O'Halloran
-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Herepath, Andrea
Sent: 07 September 2015 17:17
To: [log in to unmask]
Subject: Re: RE & CR
Really great debate guys!
These issues have been addressed in depth in...
Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: Applied learning for alternative contexts from a multisite case study. Health Serv Deliv Res 2015;3(X)
...with a new conceptualisation as I-CMAO developed; harnessing P&T, CR (via Archer not B) and institutional theory.
The report of this study is still embargoed but is now in the final stages of proofing prior to publication and will (hopefully) be available from the NIHR website by the end of September.
Please see:
http://www.journalslibrary.nihr.ac.uk/hsdr#hometab1
Best wishes,
Andrea
Andrea Herepath PhD MBA PhD FCMI FHEA
Lecturer in Strategic Management
Sir Rowland Smith Centre for Strategic Management Department of Entrepreneurship, Strategy & Innovation Lancaster University Management School B4a, Lancaster, LA1 4YX
T: +44 (0)1524 510760
________________________________________
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [[log in to unmask]] on behalf of Andrew Harding [[log in to unmask]]
Sent: 07 September 2015 16:44
To: [log in to unmask]
Subject: Re: RE & CR
Another very interesting and, for me, timely discussion!
As an RE newbie, while thinking about programme theory for my own PhD study (relating to a telephone information and advice service), it's pretty clear that a person's agency is a critical consideration. For example, the service is a reactive one that responds to callers. On this basis, active agency, and what is behind this, is a prerequisite of being imparted with a resource mechanism - perhaps more so than other health interventions where access to mechanisms tends to be based on the rationality of another agent (i.e. a doctor).
For my study at least, it makes me wonder whether the CMO formulas I have seen can be developed further, which seems to be the implication of some of this discussion...?
My wider reading in my own field tends to support the thrust of what's been said in this thread - particularly Peter's point about exploring structure and agency as a means of helping get to the bottom of what's going on, why and in what context etc. This, it seems to me, is all very Bourdieu ('habitus')/Giddens (structuration theory)? Although I'm sure 'habitus' as a standalone answer for any RE is inadequate!!!
Peter, you seem to reference a lack of, but is anyone aware of any work around RE and agency theory?
Andy
Doctoral researcher
Bournemouth University - Faculty of Health & Social Sciences Bournemouth House, B112a
19 Christchurch Road
Bournemouth
BH1 3LH
@AndrewJEHarding
Office - 01202 963025
Mobile - 07808794141
________________________________
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards <[log in to unmask]> on behalf of Peter O'Halloran <[log in to unmask]>
Sent: 07 September 2015 11:45
To: [log in to unmask]
Subject: Re: RE & CR
Sam, Justin,
Thanks for the responses. Let me try to respond to you both at once. Sam’s phrase defining the, ‘analytically separate but dialectically engaged roles of structure and agency in the causation of outcomes’ is very helpful. I am going to accept that I have identified mechanisms too closely with agency alone. Following Sam, I think it would be better to say that mechanisms as causative powers should be located in the interaction of structure and agency. Justin, I accept the complexity you are describing but I still think we should attempt to distinguish structure and agency when describing a mechanism. Why? Because it increases the explanatory power and therefore the usefulness of our evaluations. To take your example of the peer-to-peer health education strategy, if we are able to identify the cognitive and affective experiences that are more likely to lead to a desired response, and the contexts (social structures) in which this is more or less likely to happen, and how our intervention has changed that context to make it more conducive, then we have provided others with the opportunity to adopt a more targeted approach. I know that is the whole purpose of realist evaluation, but I’m saying conceptual clarity will make that easier in practice.
A couple of other benefits of careful use of the concepts structure and agency:
1. There is a whole body of psychological and organisational research (largely but not only centred on social cognitive theory) which makes use of agency and structure as key concepts. Given our recognition of the importance of agency and the fact that most of our evaluations are of organisational interventions, you would think that there would be some engagement with this body of knowledge. However, most realist evaluations in health care do not formally acknowledge the concepts of structure and agency and make no link with this (or other) social theory, which obviously limits the explanatory power of the studies. Careful use of the concepts would help us to make those links
2. I think recognising mechanisms as arising from the interaction of structure and agency, and acknowledging that programs work by changing context, would push us to more careful definition and description of context – context before the intervention and how it has been changed by the intervention and how it interacts with agency to produce outcomes. I have some thoughts on outcomes but that’s for another post……
Thanks for the conversation – I’m finding it is clarifying things for me. And Sam, given the nonsense we usually talk over coffee, this is a good discipline!
Pete
Dr Peter O'Halloran
Lecturer
School of Nursing and Midwifery
Queen's University Belfast
Medical Biology Centre
97 Lisburn Road
Belfast BT9 7BL
Tel 028 9097 2490
Fax 028 9097 2328
email: [log in to unmask]
Web page: Peter O'Halloran<http://www.qub.ac.uk/schools/SchoolofNursingandMidwifery/ContactUs/StaffProfile/?school=planning&ns=584b6b0124f0c8532af0dddf25f85786cdb3b0375788ad86a56f03cf8e4ccc9f>
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Sam Porter
Sent: 05 September 2015 12:20
To: [log in to unmask]
Subject: Re: RE & CR
You’re right, Carter, Bhaskar's quotation is eerily familiar, but I don’t mind that because, for my money, he is appropriating pure class (if you pardon the pun). Who else but Marx could follow up a starkly didactic explanation of the relationship between structure and agency with poetry of such sonorous gloom that it could have come straight from the pages of William Blake? It may be sexist, it may be overly pessimistic, but they just don’t make social theory like that any more.
That said, the quotations from Pawson and Tilley and Bhaskar that Pete uses in his discussion with Justin are right on the nail, and I am in agreement with the argument you put forward on their basis, Pete, apart from one cavil that relates to the bit where you say:
'I guess this hinges on what we think a mechanism is. Is it a property of a program (an idea, some resources of people, time or money)? Or is it something that happens inside a person or persons (like trust, or fear, or confidence, or affection, or reasons, or rationale, or legitimation, or recognition of authority) that moves them to action? I still want to say – especially if we are sticking with plain CMO – that it is the latter’
Let me try to ground my argument in your quotations of P&T and B. From the one from Pawson and Tilley, we can derive a definition of mechanisms as causal powers that (tend to) generate regularities of events. The question then becomes where are those causal powers located? Your tentative answer puts them inside individuals. This is where the Bhaskar quotation comes in. If we accept his argument, to say that mechanisms operate exclusively inside a person or persons is to commit ‘the error of voluntarism’, just as to say that they reside exclusively in the property of a program (i.e., at the level of the social) would involve the ‘error of reification’. Which brings us right back round to the Eighteenth of Brumaire. As you observe, Carter, the classic realist position sees the relationship as one of a dialectic between the causal powers embedded in social structures and those embedded in human agents. That’s why I've argued that sticking to the plain CMO doesn’t allow us to recognise sufficiently the analytically separate but dialectically engaged roles of structure and agency in the causation of outcomes.
I have to say that discussing this kind of stuff with Pete over the internet rather than a cup of coffee seems a bit strange to me, given we work and write together, but hopefully it’s not too incestuous and there's something of use here for others.
Sam
From: Carter <[log in to unmask]<mailto:[log in to unmask]>>
Reply-To: Realist and Meta-narrative Standards <[log in to unmask]<mailto:[log in to unmask]>>, Carter <[log in to unmask]<mailto:[log in to unmask]>>
Date: Fri, 4 Sep 2015 11:35:37 -0400
To: Realist and Meta-narrative Standards <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: RE & CR
Everyone,
That Bhaskar quote always sounds eerily familiar.
This is from Marx's intro to the 18th Brumaire of Louis Bonaparte. It is cited as an example of dialectics, as well as structure and agency.
Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past. The tradition of all dead generations weighs like a nightmare on the brains of the living.
What I like about realist evaluation is that it finds a way to link those macro structures and grand theorizing with everyday practice by focusing on middle range theory. But, while I had an intuitive sense of what that was, Pawson's article "middle range realism" from 2000 really clarified it and linked it to context mechanism and outcomes.
Justin (and everyone),
Thanks for your response. I had already read your paper (1) with interest – especially the ‘ripple effect’ concept (well-named!), which we have noted, too.
You are right that agency contributes to structure, in that groups of people express their agency in settled patterns of behaviour which help constitute the social framework for an intervention or program. So agency is at work in a context (helping to produce structures) before an intervention is introduced (through the agency of another player!) Bhaskar describes this in his transformational model of social activity:
‘People do not create society. For it always pre-exists them and is a necessary condition for their activity. Rather society must be regarded as an ensemble of structures, practices and conventions which individuals reproduce and transform, but which would not exist unless they did so. Society does not exist independently of human activity (the error of reification). But it is not the product of it (the error of voluntarism)’ (Bhaskar, R., 1998. The Possibility of Naturalism: A Philosophical Critique of the Contemporary Human Sciences, Routledge, p.36)
Pawson and Tilley speak in a similar way, specifically evoking structure and agency in ‘Realistic Evaluation’: ‘The basic task of social inquiry is to explain interesting, puzzling, socially significant regularities (R). Explanation takes the form of positing some underlying mechanism (M) which generates the regularity and thus consists of propositions about how the interplay between structure and agency has constituted the regularity. Within realist investigation there is also investigation of how the workings of such mechanisms are contingent and conditional, and thus only fired in particular local, historical or institutional contexts.’ (Pawson and Tilley, 1997 p. 71).
It is useful to speak about programs, mechanisms and context because it helps to distinguish what is already present from what is changed by an intervention but – as is evident from our discussion – that is an abstraction from reality and a simplification. My colleague Sam Porter has made a valiant attempt to address this by writing about Contextual Mechanisms + Programme Mechanisms + Agency = Outcome (CM + PM+A=O) (2). I guess this hinges on what we think a mechanism is. Is it a property of a program (an idea, some resources of people, time or money)? Or is it something that happens inside a person or persons (like trust, or fear, or confidence, or affection, or reasons, or rationale, or legitimation, or recognition of authority) that moves them to action? I still want to say – especially if we are sticking with plain CMO – that it is the latter.
If I may use an example from your paper and put an ‘A’ next to agential aspects, one of your mechanisms is described like this: ‘Partnership stakeholders felt inspired (A) to work on unrelated projects, while relying on (A) expertise and research savvy gained in the former experiences as well as in developing relationships with other community and academic members. In the process of partnering, community members may have gained a sense of empowerment (A) and an appreciation (A) of the value of research and evaluation……’ (p.8)
Or, let me use a CMO from our work on long-term sickness absence (LTSA) (3). We found that early intervention in the form of regular contact with absent staff initiated by employers indicated to staff that they were valued and supported by their managers and also provided the opportunity to identify any barriers to an early return to work. This prevented feelings of isolation from the workplace, helped to motivate staff to return to work and gave them the confidence to do so, leading to an earlier return to work. These mechanisms were less likely to occur in a context where there was long waiting times for medical treatment , non-compliance with organisational procedures, inadequate training of line managers and poor communication between people with responsibility for managing LTSA.
Looking at that with my present understanding, I would say that the intervention changed the context of their sickness absence for the member of staff by introducing evidence and assurances that they were valued and supported by their line manager and wanted back at work, and by allowing the line manager to directly change the context (‘identify any barriers’). However, there would be no earlier return unless the person was motivated to return and had the confidence to do so i.e. unless there is a mechanism at work- that is, they exercise agency. Some aspects are labelled context not because they are free of human agency but because they were there before the intervention was introduced and have an effect on the ability of the intervention to change the context. I might add that we came to see agency as a the central ingredient of ‘mechanisms’ by seeing it in our data, rather than drawing it from theory.
Therefore, perhaps it would be better to say that agency is in play in any structured social system, modifying and being modified; that an intervention changes the social system in some way, thus creating a different set of circumstances for agents to exercise their agency; but that there will be no outcomes (in the form of changed patterns of human behaviour) without the exercise of agency. That’s why I want to maintain the connection between agency and mechanism, and say that programs work by changing context. It is still important to identify how a program works but I think this should be a theory about how a program changes the context and thus either facilitates or hinders the exercise of agency (‘triggers mechanisms’) in particular ways amongst groups and individuals.
What do you think?
Pete
(1) Jagosh, J. et al., 2015. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health, 15(1), p.725. Available at: http://www.biomedcentral.com/1471-2458/15/725.
(2) Porter, S., 2015. Realist evaluation: an immanent critique. Nursing Philosophy, 2009, p.n/a–n/a. Available at: http://doi.wiley.com/10.1111/nup.12100.
(3) Higgins, A., O’Halloran, P. & Porter, S., 2015. The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods. Journal of occupational rehabilitation, 25, pp.451–470.
Dr Peter O'Halloran
Lecturer
School of Nursing and Midwifery
Queen's University Belfast
Medical Biology Centre
97 Lisburn Road
Belfast BT9 7BL
Tel 028 9097 2490
Fax 028 9097 2328
email: [log in to unmask]<mailto:[log in to unmask]>
Web page: Peter O'Halloran<http://www.qub.ac.uk/schools/SchoolofNursingandMidwifery/ContactUs/StaffProfile/?school=planning&ns=584b6b0124f0c8532af0dddf25f85786cdb3b0375788ad86a56f03cf8e4ccc9f>
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Jagosh, Justin
Sent: 04 September 2015 00:33
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: RE & CR
David and Peter you've raised some crucial points here and I'm quite appreciating this on-going discussion. The ambiguity of C-M-O categories is something that I too have experienced, as I think many have. What could go into the 'c', could also fit into the 'm' or the 'o'.
I see this ambiguity as the strength rather than the weakness of realist evaluation. This is because the overall goal is to produce, challenge or test theory against collectible evidence to see how much ontological depth we might be able to garner about causative forces. As such, CMO congifurations are not the be-all, end-all of the methodology. They are simly the tools to help build and test those theories of causative force. When we prioritize that logic, the confusion about what is 'c' and what is 'm' minimized and the focus then becomes: what is really going on in this situation and how can we theorize on that to produce insightful, context-sensitive claims about the nature of the given programing?
In my opinion, I wouldn't loosely equate context with structure and mechanism with agency. There is structure-agency in context as well as mechanism. For example, you might identify that one of the contextual factors that contrains a person's ability to manage their diabetes is pressure from family members to remain locked into entrenched family dynamics. Such entrenched patterns can be seen as structure, but which is maintained by the agency of the people involved. So, although structure-agency is there in the context, I'm not sure if the explication of such is productive because just rolls on endlessly. Mechanisms - as resources and reasonings also have structure-agency entanglements. So I don't find that equation to be particilarly productive. For me, the CMO configuration is about theorizing upon ontological depth, rather than structure-agency.
So if I were to use the example of participatory research - academic-community partnerships, One might ask in a positivistic sense: do such partnerships work? or one might as a realist question demanding ontological depth: what is it about such partnerships that makes them work? and in our research we found that TRUST amongst partners was essential to the functioning of the partnership. But trust was a context, a mechanism, and an outcome. And it could be seen as a pre-existing structure, such as with the mistrust of researchers by historically colonized people, and a form of agency in the way that academic partners demonstrated trustworthiness and their counterparts became trusting of them. Once we became comfortable with that conceptualization, we were able to demonstrate how the achievability of results in academic-community partnerships grew over time as trust relationships became strenghened through productive conflicts and negotiations. We've written about it extensively and am happy to pass along published papers if requested.
Looking forward to hearing what other people think....
Justin
Justin Jagosh, Ph.D
Senior Research Fellow
Centre for Advancement in Realist Evaluation and Synthesis (CARES) University of Liverpool, United Kingdom www.liverpool.ac.uk/cares<http://www.liverpool.ac.uk/cares>
________________________________
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [[log in to unmask]<mailto:[log in to unmask]>] on behalf of Daniel Hind [[log in to unmask]<mailto:[log in to unmask]>]
Sent: September 3, 2015 12:38
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: RE & CR
Hello and thanks for sharing everybody - always instructive.
An observation (which, you can tell, I've been holding in for a while) from someone who is not a committed "Pawson & Tilley" Realist, but has attended one of Justin's well-organised and thought-provoking workshops.
At that workshop, when given the source material behind one of Tilley's classic studies and asked to identify C's, M's and O's there was fairly widespread confusion within and between participating researchers, especially in distinguishing C's from M's, on the one hand, and M's from O's on the other. I understand this is quite common.
At the time, this suggested to me (as a pantomime-baddie "positivist"* and accepting there might be learning curves**) that the definitions of C's M's and O's that we were given to work with*** might have problematic "face validity" (a concept is recognised in the way its originator requires) and "inter-rater validity" (different people recognise when the concept is and isn't there).
It's for this reason, that Peter's post chimed with me and I popped my head up. It did seem, on the day, with a small sample, that clarity was somewhat lacking.
All the best,
Dan.
* I've never been entirely comfortable with the idea that there've been any positivists since the 1940's - Popper denied he was one. Isn't the term just a boundary-work boo-word (Morgan DL. J Mixed Methods Research 2007 1(1):48-76)?
** ... if you're all right, that there's some external truth to the existence of mechanisms, that they're not just metaphysical and it doesn't all just come down to competing fields of discourse. If mechanisms exist and can be identified, then some newbies will get better at distinguishing them from other "constructs" in time. Presumably not all of them, though, if skill is unequally (but mechanistically) apportioned by an indifferent universe.
*** No reflection on Justin this - straight out of the book.
On 3 September 2015 at 17:26, Peter O'Halloran <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hello everyone,
With apologies to Vanessa, I would like to add to the confusion by making a few points.
It seems to me that in ‘Realistic Evaluation’ one of the things Pawson and Tilley did was to appropriate and re-label the ideas of structure and agency for evaluators. Broadly, structure = context; mechanism = agency. But in relabelling clarity has been lost – principally by misunderstanding programs or interventions as being, or carrying, mechanisms (hence the – arguably unhelpful – term, ‘program mechanisms’). Programs may ‘work’ by introducing ideas, opportunities and resources. But this raises the question: How do they work? The answer is that ideas do not of themselves change anything until someone understands them and chooses to act on them; an opportunity is missed until someone takes it; a resource lies dormant until someone uses it. In other words it is human beings exercising agency that actually produce the change in patterns of human behaviour that we label an outcome. Human agency in its many forms is the principle mechanism at work.
So, if programs do not bear or embody mechanisms, what do they do? It appears they ‘work’ by changing the context for the people exercising agency within that context. After all, as Pawson and Tilley argue, in any given context people are already acting, so certain mechanisms (the reasoning, beliefs, feelings, motivations, and choices of individuals and groups – expressed in agency) are already in play and already conditioned by that context. The intervention changes the context (by providing further reasoning, opportunities, permissions, legitimations, authorisations, and limitations), so presenting agents with a different set of circumstances in which to exercise agency, leading to a different set of behaviours (outcomes). Of course this is an interactive process and people will both reproduce and transform their new context, potentially producing a range of outcomes, some of them unintended by those devising the program.
What do you think?
Pete
Dr Peter O'Halloran
Lecturer
School of Nursing and Midwifery
Queen's University Belfast
Medical Biology Centre
97 Lisburn Road
Belfast BT9 7BL
Tel 028 9097 2490
Fax 028 9097 2328
email: [log in to unmask]<mailto:[log in to unmask]>
Web page: Peter O'Halloran<http://www.qub.ac.uk/schools/SchoolofNursingandMidwifery/ContactUs/StaffProfile/?school=planning&ns=584b6b0124f0c8532af0dddf25f85786cdb3b0375788ad86a56f03cf8e4ccc9f>
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]<mailto:[log in to unmask]>] On Behalf Of Vanessa Abrahamson
Sent: 01 September 2015 15:31
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: RE & CR
Thank you very much for your reply. I am a long way from perfecting my understanding so that is somewhat reassuring! I look forward to reading your riposte.
Best wishes,
Vanessa.
From: Raymond Pawson [mailto:[log in to unmask]]
Sent: 01 September 2015 15:25
To: [log in to unmask]<mailto:[log in to unmask]>; Vanessa Abrahamson
Subject: Re: RE & CR
Hi Vanessa
Welcome to the 'disputatious community of truth seekers'.
There is a common root to all of your realisms (generative causation, social morphogenesis). But by my reckoning 'realist evaluation' is closer to 'subtle realism' than it is to 'critical realism'.
Sam Porter has provided you with a couple of references on his critical realist take on realist evaluation. Needless to say, I disagree.
I've already responded to his:
'The Uncritical Realism of Realist Evaluation'
with paper entitled:
'The Ersatz Realism of Critical Realism' .
It will be published in the same journal (Evaluation) but alas there is a bit of a backlog - I think it will be out Issue 1, 2016.
It is a splendidly spirited debate so I hope you enjoy reading it. But my advice, for what it is worth, is that it is not necessary for PhD students to perfect their understanding of ontology and epistemology prior to undertaking empirical work. If you work out some sensible ways to answer your research questions you'll find yourself well on the way to a broader understanding of how the world is put together.
Ray
________________________________
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Vanessa Abrahamson <[log in to unmask]<mailto:[log in to unmask]>>
Sent: 28 August 2015 09:24
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Defining mechanisms/PhD newbie questions
Dear All,
I’ve been following the discussions from PhD students but was reticent to join in and thus demonstrate my lack of understanding. However I am really struggling to differentiate between realism, subtle realism (Hammersley), critical realism (Sayer, Bhaskar) and realist evaluation (Pawson & Tilley). I’m leaning towards CR but still not sure of the exact differences in philosophy this involves or how it influences my method & data analysis. For example, in one email (2nd Jul) Gill made the point that interviews will only be realist if they are building, testing &/or refining realist theory and that needs to cover context, mechanism and outcome. I don’t think this suits my research question but the basic realist philosophy appeals. I’m using a case study design, 2 areas, looking at a particular policy recommendation that states people who have had a stroke should be reviewed at 6 weeks, 6 months and yearly thereafter. Most people are still under the acute sector for the 6 month review, provision of the 6 month review is patchy, and few fund a yearly review. I’m mainly using interviews with some observation (where ethics allows) and document analysis. My research question:
‘How does the review process support adults with long term need post-stroke?’ & objectives:
1. What is the purpose of the review process from the perspective of patient, carer, provider and commissioner?
2. What are the intended and/or unintended outcomes of the review process from the perspective of patient, carer, provider and commissioner?
3. By what mechanisms does the review process achieve the intended outcomes? What are the enablers and barriers?
By mechanisms, I was using it in the lay sense….but still not sure how critical realism would define versus Pawson & Tilley?
With different perspectives (patient, carer, provider, commissioner) and an over-reliance on interviews I can’t imagine that I can achieve clarity with the mechanisms and outcomes at this stage – it is more exploratory (but I’m not keen on using interpretivism either). So can I frame as a critical realist approach without tying myself in knots with CMO configurations that I won’t have the time/resources to test and refine? And how do I ensure/demonstrate that this informs my method & data analysis.
I’d be very grateful for your suggestions,
Vanessa.
V. Abrahamson
ESRC PhD Candidate in Social Policy
Centre for Health Services Studies
University of Kent
George Allen Wing
Canterbury
Kent CT2 7NF
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Sonia Dalkin
Sent: 11 August 2015 10:48
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Defining mechanisms as processes? What Realist findings look like? PhD newbie questions
Hi Mandy and others,
Thank you for posting your questions Mandy and for all the responses so far, they are all so interesting and can only help us to question our own understanding of realist methods and learn more.
I would echo Trisha and Justin’s comments – picking an examiner with realist experience is essential if you’re using a realist framework and often methodological innovation is best left post PhD. A lot of PhD candidates can trip themselves up when trying to use hybrids as there can be clashes of philosophies and associated methodologies. This isn’t to say that this can’t be done though!
Q1 - I guess the question is why would you want to reinvent the wheel – Pawson & Tilley provide a definition of mechanism and if you’re using their methodology it’s probably best to stick to their definition, unless you have a rationale for changing it. In your PhD it’s always important to be able to justify any deviations from the traditional methodology. Why did you do it - how has it enhanced your research project? What would have been lacking had you not have done this?
Q2 – I think you’re using the term ‘mechanism statements’ as the equivalent of Context-Mechanism-Outcome configurations (CMOc) in Pawson & Tilley. Ana Manzano and Ray Pawson pick up on this further in their diagnostic workshop paper (attached). They state that C, M and O should not be listed (a common mistake) but should be in configurations – in this context, this mechanism is activated which leads to this outcome. A recent paper I wrote (attached) with colleagues from University of Leeds (Dr. Joanne Greenhalgh) and Northumbria University (Dr. Monique Lhussier, Dr. Anna Jones, Dr. Bill Cunningham) highlighted the need to outline resource and reasoning (another common mistake in RE) within CMOc and provided a rejig of the C+M=O formula to aid operationalisation. The paper still conforms to Pawson & Tilley’s original ideas but just provides an alternative way of configuring the formula. In this paper we provide examples of ‘mechanism statements’ or what are usually known as ‘CMOc’ with resource and reasoning. You may find this helpful to see whether your definition of mechanism statement is the same as CMOc.
I hope I’ve interpreted your questions correctly Mandy and hope this in some way helps!
Best of luck,
Sonia
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Dr Sonia Dalkin
Lecturer in Public Health, Department of Public Health, Faculty of Health & Life Sciences
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From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Trish Greenhalgh
Sent: 11 August 2015 07:33
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Subject: Re: Defining mechanisms as processes? What Realist findings look like? PhD newbie questions
I don’t like the way ‘motivation’ is creeping in here. Can we say ‘agency-dependent’? Motivation seems wrong paradigm.
Trisha Greenhalgh
Professor of Primary Care Health Sciences
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Nuffield Department of Primary Care Health Sciences, University of Oxford New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG
From:<Jagosh>, Justin <[log in to unmask]<mailto:[log in to unmask]>>
Reply-To: "Realist and Meta-narrative Evidence Synthesis: Evolving Standards" <[log in to unmask]<mailto:[log in to unmask]>>, "Jagosh, Justin" <[log in to unmask]<mailto:[log in to unmask]>>
Date: Tuesday, 11 August 2015 00:34
To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[log in to unmask]>>
Subject: Re: Defining mechanisms as processes? What Realist findings look like? PhD newbie questions
Dear Mandy,
Your rigorous questioning on the concept of mechanism is excellent!
I agree with Trish that it is vital to provide a definition of terms if you diverge from Pawson and Tilley. But Realist Evaluation is gaining recognition and credibility so if your reason to change the definition is because people in your field are not familiar with it, then as Trish says, you need to instead find the right supervisors/examiners and stick with it. Innovation is better done after you graduate :).
If, on the other hand, you want to diverge from the definition because you don’t feel it works for what you are studying, that’s a different story and it’s totally justified – but that would also need to be clearly explained. Is the definition of mechanism, as defined by P&T as reactions to resources offered – not adequate?
Are you examining youth employment interventions? If yes, do they create resources via implementation of the program theory? How do people respond to these resources, given who they are, their backgrounds, and their contextual constrainers and enablers?
If your research question is : what makes people ‘employable?’, and you are not studying a specific intervention (or class of interventions), then you do have to innovate P&T’s work, because they have built realist methodology pinned around the evaluation/synthesis of interventions, services, policies etc. The question: “what creates youth employability?” is a sociological question that, in and of itself needs to be unpacked.
So your definition of mechanism as:
‘a generalisable, context-dependent and motivation-dependent interaction process, through which outcomes of interest are partly generated (or strongly influenced?)’ to provide conceptual scaffolding for non-realist readers?
is a bit muddy to my mind. Are the concepts ‘generalizable’ and ‘context-dependent’ not antithetical when put together in this statement? Also ‘motivation-dependent interaction process’ is also a bit muddy. Is there such a thing as a motivation-independent interaction process when it comes to people interacting with each other and with policies? Also do people interact with policies? Or just react to them? We are all reacting to our environment all the time, and even when we think we’re not – (because it’s also happening subconsciously). Now if you want to say that mechanism has to do with how people react/respond within an interaction process - in a context - perhaps that might be clearer, I’m not sure.
You might have a look the figure in our paper, linking CMO configurations in a ripple effect - (attached). In that paper, we too looked at a process over time, and suggest that you can link CMOs to explain this kind of emergent causal chain – one in which reactions lead to outcomes, which impact on the context over time or across intervention phases. It’s still rather crude, but it has helped us create realist middle-range theory in our subject area that is more closely aligned with “what’s really going” …(which can be considered one of the possible overarching goals of RE)….
Please feel free to clarify if I haven’t grasped adequately your question! And hopefully others will stir the pot too… Justin
For example, my research question could ask:
What can be clarified about key processes that shape individual ‘employability’ and employment/unemployment outcomes; particularly for youth populations and with a focus on vocational and ‘at risk’ youth subgroup outcome patterns? How is the variation in youth outcomes, as subgroup patterns, explained by certain types of intervention and/or context conditions affecting those processes?
By the way - improvement in individual ‘employability status’ may be defined and studied as a harder to measure, long run outcome pattern of interest - for which improvements in an individual’s employment outcomes over time are treated as one of a few key employability status/outcome indicators. A Rough Theory section proposes that employment outcomes, and improvements in individual states of employability (based on theorised indicators), could simultaneously be evaluated as intertwined outcome objectives.
Question 2) When you describe mechanisms as research findings, don’t they need to comprise mechanism statements? I.e. they must explain a mechanism’s relevance to a set of outcomes - then also describe something about why, for which subgroup/s, or how at least one other context condition is relevant to understanding an outcome pattern that emerges from that mechanism (interaction process)?
So a mechanism could be summarised as say a 1-3 word label - whereas a mechanism finding must comprise a full sentence statement distinguishing something about context conditions affecting the outcome patterns emerging from that mechanism, and/or affecting an intervention's workability in turn.
Said another way - isn’t it true that a complete mechanism statement/finding must distinguish and relate at least one Context variable to how a Mechanism works, and to an Outcome pattern in turn? Whereas a mechanism on its own can be summarised as say a 1-3 word label (e.g. Recruitment and Selection Mechanisms as being relevant to employment).
I realise the above may be nit-picking but it helps to visualise what comprehensive Realist type ‘findings’ look like before trying to produce them.
Many thanks in advance for anyone who wants to add their two cents to any of the above screeds!
Regards
Mandy McGirr
PhD researcher
School of Government, Victoria University of Wellington New Zealand
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