Hi Amanda

There's no problem at all using a realist approach to investigate current practices. For realists, mechanisms exist at all levels (material, biological, social) all the time - _program_ mechanisms are just a particular variant of mechanisms. You could probably talk in terms of realist research rather than evaluation (given there's no program to evaluate) - but that's fine. Good luck with your study.

Gill

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

From:         Amanda King <[log in to unmask]>

Sender:       "Realist and Meta-narrative Evidence Synthesis: Evolving Standards" <[log in to unmask]>

Date:         Thu, 21 Apr 2016 20:38:53 

To: <[log in to unmask]>

Reply-To:     "Realist and Meta-narrative Evidence Synthesis: Evolving

              Standards" <[log in to unmask]>,

              Amanda King <[log in to unmask]>

Subject: Theorising about existing practice, not programmes



Hello all,

I am a PhD student at the University of Nottingham and from day one, I have been planning to use the realist approach as I was aiming to develop an outdoor activity and mobility complex intervention. However, this has changed somewhat and I am not sure if I am trying to hang onto the approach when it no longer fits the aim of my project. My query feels a bit daft, given that the approach is about understanding how and why programmes work (or not), but I am very stuck, so here goes. 



My project aim is to "identify practices and resources that increase outdoor activities and mobility in care homes". 

Whilst there are some health outcome evaluation studies,  I do not believe that there are any published interventions that look at working with care staff teams to increase garden access and use for residents with dementia. At this stage, I am interested in access and participation rather than health outcomes.  



I am on the brink of conducting a realist review to look at "which residents in dementia settings participate in outdoor activities and mobility in care home gardens, under what circumstances, to what extent and why?”. 



My intention was to look at who does and does not get outside and work backwards to identify institutional/staffing/resident characteristics and responses to existing resources. I will be doing observations in care homes using Dementia Care Mapping, plus focus groups with staff to refine and test my theories. 



My dilemma is that I have realised that I want to look at what is actually happening/current practice rather than responses to resources offered by a programme or potential programme - I am wondering if it is legitimate within the realist approach to talk about existing resources, rather than those provided by an intervention. And whether the term mechanism still applies if we are talking about responses to existing resources? 



Intuitively the approach seems right and eventually I may well develop a programme, but right now, is this a suitable approach for unpicking current practice? 



I hope this makes sense.



Kind regards,

Amanda