Alan, thanks for the question.

Participatory approaches to research aim to get different stakeholders involved on an equal basis. Getting a range of explanatory accounts can be challenging when practitioners and clients privilege research, assuming that it is more valid than their own experiences. Consulting research first, and bringing it back for comment, needs to be carefully facilitated to get critical views that are based on experiential knowledge. Reporting of how and why the intervention of peer support worked was thinly reported in some of the literature we looked at in the first instance. We saw two possible avenues: bring the research back to workers and clients, or ask them what they actually do when they provide/receive peer support.  We chose to listen to accounts of what they do, because this put researchers in the position of being learners, which went some way towards balancing the value of practitioner and experiential knowledge.  Repeated contact gave us the opportunity to form relationships, which also contributed to equitable exchange of knowledge.

After the first preliminary foray into the literature, the review and gleaning of participant accounts progressed in tandem, allowing us to bounce back and forth between pragmatic explanatory accounts and research-generated accounts. This turned out to be quite important, because the research had ignored what the workers and clients deemed to be the most important element of peer support.

This was a lesson for us, e.g. the framing of problems, designing of solutions and subsequent research is a social process. On an intellectual level, we already knew that. But when we critically reviewed the research with the question 'Who participated in framing the problem and identifying solutions?' a difference began to emerge between what Tones and Green call 'negotiated' health promotion and 'authoritarian' health promotion. There were indications that negotiation, which is a collective process of diagnosing, produces more relevant solutions. The relevance is reflected in more successful recruitment, less drop out, and higher levels of participation. 

People who practice community based participatory research (CBPR) and action research will say 'So what?' because they are quite familiar with the power of collective problem framing and sensemaking. Most of our health research, however,  doesn't draw upon this approach. Our experience on the last review and our current review is leading us to think that the process of diagnosing is an important consideration in realist evaluation and synthesis.

Best wishes
Janet



Janet Harris
NIHR Knowledge Mobilisation Research Fellow
Reader in Knowledge Mobilisation
University of Sheffield
School of Health and Related Research (ScHARR)
30 Regent Street
Sheffield  S1 4DA
England

+44 (0)114 222 2980

See our Masters programmes in Management and Leadership: MSc in International Health Management and Leadership by distance learning **New for September 2014**; and our MPH in Management and Leadership 
http://www.sheffield.ac.uk/scharr/prospective_students/masters/ihml



On 17 July 2017 at 19:09, Alan Boyd <[log in to unmask]> wrote:

Very interesting Janet

When you say “I think the order in which we consult research versus people influences our framing of the problem and the way we may go about 'diagnosing'”, what would you say about how the framing might be influenced if we consult research first, and how it is influenced if we consult people first (practitioners and clients rather than academic researchers?)?  I note that in your participatory you looked at the literature first, and then got explanations from practitioners …

 

Alan

 

 

 

Alan Boyd | Research Fellow in Healthcare and Public Sector Management

Alliance Manchester Business School | The University of Manchester | 6.29, Harold Hankins building | Oxford Road | Manchester M15 6PB | Skype  alanboyd1963 | Twitter @MBSHealthMgt

 

www.mbs.ac.uk/research/people/profiles/alan.boyd

https://research.mbs.ac.uk/health/Home.aspx

 

 

 

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Janet L Harris
Sent: 17 July 2017 17:56


To: [log in to unmask]
Subject: Re: 'realist diagnostic evaluation' of problems, not interventions- any examples?

 

Hi Mark

 

I'm looking at your first article and reflecting on explanatory accounts. There's an interesting synthesis conundrum in terms of whose explanations are represented (a sampling issue), whose explanations get valued and how the different sources get combined to produce the final proposition. We did something that I called a 'participatory review' in 2015 where we initially started with identifying accounts int he literature, then moved on before completing the search to get explanations from practitioners and clients. We did this because we wanted to use a CBPR approach. And also because some of us on the review team with experience in delivering the intervention began to suspect that some of the important ingredients were recognised as essential components in the research literature. We ended up with an approach that was iterative, looking like a multi-layered sandwich. In your review, did you involve the peer researchers concurrently? I ask because I think the order in which we consult research versus people influences our framing of the problem and the way we may go about 'diagnosing'.

 

The other thing that interests me is your Appendix listing sources (very helpful). I see the study groups listed in places, but would you say that in some instances they concurred with the research explanations (e.g. proposition concurrence across multiple sources). We found that they did in the peer support review, which gave weight to the explanatory accounts because they actually represented research knowledge alongside experiential and practitioner knowledge.

 

And finally - are you finding that this process produces more contextual validity? In our most recent realist evaluation, the multiple-source accounts are carrying much more weight with policymakers than the impact evaluation...

 

Thanks for keeping this strand going and best wishes to you

Janet


Janet Harris

NIHR Knowledge Mobilisation Research Fellow
Reader in Knowledge Mobilisation

University of Sheffield

School of Health and Related Research (ScHARR)

30 Regent Street

Sheffield  S1 4DA

England

+44 (0)114 222 2980

 

See our Masters programmes in Management and Leadership: MSc in International Health Management and Leadership by distance learning **New for September 2014**; and our MPH in Management and Leadership 
http://www.sheffield.ac.uk/scharr/prospective_students/masters/ihml

 

 

On 15 July 2017 at 09:25, Pearson, Mark <[log in to unmask]> wrote:

This is a great discussion for the way it opens up links between ‘realist diagnostics’ and other approaches, whether that be policy problem-framing, CBPR/AR, or problem structuring methods.

 

Linking back to what prompted Ray’s original response (the ‘problem rather than intervention’ focus of the Exeter ‘Care Under Pressure’ postdoc post), here are a couple of examples of using realist review in this way – although we make no mention of the ‘realist diagnostic’ terminology! Both ‘problematise’ with a view to informing intervention development (the first explicitly so as part of an NIHR Programme Grant) :

 

 

Pearson, M., Brand, S.L, Quinn, C., Shaw, J., Maguire, M., Michie, S., Briscoe, S., Lennox, C., Stirzaker, A., Kirkpatrick, T. & Byng, R. (2015) Using realist review to inform intervention development: Methodological illustration and conceptual platform for collaborative care in offender mental health Implementation Science 10:134

https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0321-2

 

Papoutsi, C., Mattick, K., Pearson, M., Brennan, N., Briscoe, S. & Wong, G. (2017) Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. Journal of Antimicrobial Chemotherapy

https://academic.oup.com/jac/article/doi/10.1093/jac/dkx194/3924243/Social-and-professional-influences-on  

 

Mark

 

Mark Pearson PhD

Senior Research Fellow in Implementation Science

NIHR CLAHRC South West Peninsula (PenCLAHRC)

University of Exeter Medical School

E: [log in to unmask]

T: 0044 (0) 1392 726079

My profile

Twitter

MSc Applied Health Services Research

 

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Alan Boyd
Sent: Thursday, July 6, 2017 9:04 AM


To: [log in to unmask]
Subject: Re: 'realist diagnostic evaluation' of problems, not interventions- any examples?

 

The literature is indeed widespread.  Much has been written about the development of problem structuring methods in the OR/Systems literature, including practical methods (see Rosenhead and Mingers, Rational Analysis for a Problematic World Revisited) and some underlying theory, (see E.g. Midgley, Systemic Intervention; and perhaps Mingers, Systems Thinking, Critical Realism and Philosophy for a realist take on this).

 

Alan Boyd

 

Alan Boyd | Research Fellow in Healthcare and Public Sector Management

Alliance Manchester Business School | The University of Manchester | 6.29, Harold Hankins building | Oxford Road | Manchester M15 6PB | Skype  alanboyd1963 | Twitter @MBSHealthMgt

 

www.mbs.ac.uk/research/people/profiles/alan.boyd

https://research.mbs.ac.uk/health/Home.aspx

 

 

 

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Janet L Harris
Sent: 06 July 2017 08:43
To: [log in to unmask]
Subject: Re: 'realist diagnostic evaluation' of problems, not interventions- any examples?

 

Hi Jo and Amanda

 

Good to hear from you! After the conference in October I had to go on sick leave - torn rotator cuffs, no typing allowed. There was a huge backlog of emails to get through so all the realist networking went on hold.

 

I don't know of any resources on Realist Diagnostic Evaluation but for a long time I've been fascinated by problem framing. I can understand why Ray feels he is banging on about it, I can't seem to get anyone interested and was starting to think I was the only one who thought it was really important. Anyway in my Fellowship I've had a chance to look at it further and I'm writing up one of my projects as a case study where the original problem formulation led to the development of an evaluation question/impact evaluation that weren't useful for informing programme development. 

 

There are papers written in the field of policy, many have cited Diane Stone's work on the relationship between how people see a problem and the agendas that get set. In strategic management, Marjorie Lyles (1988) seemed to trigger a strand of enquiry with her article on strategic problem formulation and decision making models. Markus Baer (2013) 'Microfoundations of strategic problem formulation' calls it 'collaborative structured enquiry'. Some people came at it from the perspective of eliciting views of problems from stakeholders (Bryson et al (2003) 'What to do when stakeholders matter' ). Another perspective is John Lavis et al who are using deliberative dialogue to look at whether policymakers' opinions about the problem align with the research evidence - this is aimed at knowledge translation.

 

So the literature is not in any one field. But I would love the opportunity to chat about it. Do you think we might be able to get together - maybe a very informal seminar to share what we know and are trying to do? You are very welcome in Sheffield or I could pop over to Nottingham.

 

Best wishes

Janet


Janet Harris

NIHR Knowledge Mobilisation Research Fellow
Reader in Knowledge Mobilisation

University of Sheffield

School of Health and Related Research (ScHARR)

30 Regent Street

Sheffield  S1 4DA

England

+44 (0)114 222 2980

 

See our Masters programmes in Management and Leadership: MSc in International Health Management and Leadership by distance learning **New for September 2014**; and our MPH in Management and Leadership 
http://www.sheffield.ac.uk/scharr/prospective_students/masters/ihml

 

 

On 5 July 2017 at 11:36, Joanne Howe <[log in to unmask]> wrote:

Hi all,

 

Here at the University of Nottingham we have a small but growing group of researchers (PhD and post doc) using realist methods.

 

There are two of us (myself and a colleague) who think our own RE projects may fit into Ray’s description of a “Realist Diagnostic Evaluation” as we are not evaluating an intervention - more looking at the problem that exists in practice. In essence we are conducting this RE to determine the nature of the problem, this may or may not result in the development of an intervention in time. Currently we are referring to our studies as “Pre Realist Evaluation projects” but we wonder if there is any more information out there on Realist Diagnostic Evaluations. 

 

Ray has mentioned that he has been banging on about this type of research for a while and we would both be grateful if anyone could point us in the direction of any resources on this topic so that we may explore the area further.

 

Thanks

 

Jo and Amanda 

 

From: "Realist and Meta-narrative Evidence Synthesis: Evolving Standards" <[log in to unmask]> on behalf of Janet L Harris <[log in to unmask]>
Reply-To: "Realist and Meta-narrative Evidence Synthesis: Evolving Standards" <[log in to unmask]>, Janet L Harris <[log in to unmask]>
Date: Tuesday, 4 July 2017 at 11:20
To: "[log in to unmask]" <[log in to unmask]>
Subject: Re: 'realist diagnostic evaluation' of problems, not interventions- any examples?

 

Hi Janet and John

 

I think there are some good examples in diabetes where research teams have started at the very beginning (before developing interventions) and asked 'what are the problems, who sees them as a problem, in these particular circumstances, and given the range of problems what are the possible solutions?' 

 

But the teams don't call this realist diagnostic evaluation. Teams using community based participatory research start by developing dialogue with local people to drill down into things that contribute to diabetes risk. The process identifies a problem, then the various dimensions of the problem. Taking physical activity as one example, local people describe environments that limit physical activity which include safety issues preventing activity, parental schedules and school schedules that limit opportunities for activity; increased availability of TV channel and computer games (sedentary activity). Moving on to food and nutrition, they list food deserts, issues with food labelling, cooking skills, etc. 

 

The aim of the process is to develop critical consciousness of how the surrounding context contributes to risk. The relationships between different sorts of risk are explored, and the understanding is used to make decisions about which problems can be addressed, and how they can be resolved.

 

We're just completing a review which looks at whether this sort of process helps to design more relevant and appropriate interventions. The protocol is here 

 

If you'd like some of the references showing how teams did this, feel free to get in touch -

 

Best wishes

Janet


Janet Harris

NIHR Knowledge Mobilisation Research Fellow
Reader in Knowledge Mobilisation

University of Sheffield

School of Health and Related Research (ScHARR)

30 Regent Street

Sheffield  S1 4DA

England

+44 (0)114 222 2980

 

See our Masters programmes in Management and Leadership: MSc in International Health Management and Leadership by distance learning **New for September 2014**; and our MPH in Management and Leadership 
http://www.sheffield.ac.uk/scharr/prospective_students/masters/ihml

 

 

On 3 July 2017 at 13:30, Janet Heaton <[log in to unmask]> wrote:

Dear all

I’d be interested to hear any more thoughts on the points John raises too.

I may have an opportunity to build this into a 5-year study which has two parts: the first to explore the problem of unscheduled care for diabetes in three settings and identify an intervention (or two) to reduce this by 10%; the second to then pilot and test the intervention(s) in the three settings (rural regions in three countries).

Regards to all,

Janet

 

Janet Heaton

Research Fellow, Rural Health and Wellbeing

University of the Highlands and Islands, Scotland

 

From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards <[log in to unmask]> on behalf of John Ling <0000113d68481414-dmarc-[log in to unmask]>
Sent: 03 July 2017 09:26
To: [log in to unmask]
Subject: 'realist diagnostic evaluation' of problems, not interventions- any examples?

 

Dear RAMESES subscribers,

In the recent thread (29/6) about the University of Exeter job, Ray Pawson mentioned the need for 'realist diagnostic evaluation', applying realist synthesis techniques to the evaluation of a 'problem', prior to evaluating interventions (or even perhaps developing them?).

I wondered if there any good examples of this that the RE community might be able to share.

I'm doing a masters level study examining children's experience of parental brain injury and how they might become resilient to that adversity. Hoping to develop this into a PhD proposal, perhaps using RS/RE principles.

The literature describing the problem is relatively sparse and published programmes / interventions even more so. There are pockets of good practice - but these could perhaps be described as being sunk into 'usual care' as opposed to being discrete programmes.

Interested to hear any thoughts about (a) using realist approaches to understand "the what, where, why and for whom" of complex problems; (b) how RS/RE approaches to 'diagnosing' problems might feed-forward into recommendations for programmes as yet un-commissioned.

many thanks in advance for your time...

John Ling
Clinical Nurse Specialist
King's College Hospital
London

 

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