Thanks, Justin. That’s an excellent example (toilet/drinking) to explain ontological depth and underlying mechanisms that I could have used in my viva last week! Similarly, Taubes’ analysis of the policy focus on individual responsibility is equally relevant to secondary prevention post-stroke (and other cardiovascular diseases) whereby if the individual would only do what they are told to do then their risk would be much reduced, irrespective of the complexity of managing a long-term condition and the socio-economic context.
Kind regards,
Vanessa.
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]
] On Behalf Of Jagosh, Justin
Sent: 28 January 2018 23:35
To: [log in to unmask]
Subject: Rival theories in biopsychosocial medicine
Steven, thank you for sending through the thought provoking article about the cause of obesity. It is an exemplar of ‘rival theories’ with relevance to biopsychosocial medicine and an important point about realism can be distilled from it. As I understand it, the article suggests that the ‘energy balance’ theory of obesity has won out over other endocrine-based theories. It’s the difference between ideas such as that people become obese because they eat too much vs. ideas such as people experience increased appetite due to overproduction of insulin which curtails the negative feedback loop on overeating. This exemplifies what Pawson means when he references the poem about ‘waving or drowning?’ (see Science of Evaluation, p. 29)– What appears to be at the empirical level appears that way because we are oriented (biologically and culturally) to perceive things in a certain way, even if there is more to the story or actual reality is something quite different. It is therefore necessary to move away from the scientific practice of sole reliance on observable evidence to make claims about underpinning causation, and find ways to theorize what is going on “below the surface”.
Taking another example in juvenile diabetes. When the condition is undiagnosed and untreated, the person experiences an increase in unassimilated sugar in the blood system. As a result, sugar ends up in the urine. Through osmosis, water is drawn into the bladder from the rest of the body to dilute the sugars in the bladder. Consequently the bladder fills up unusually fast and the person begins to urinate with great frequency. As a result of increased urination they experience increased dehydration and thirst. So they start urinating more, and drinking more. It appears as if the person is simply drinking too much. From observation, outsiders to the experience would be inclined to say ‘If only they would stop drinking so much, they wouldn’t need to go to the bathroom every 15 minutes!” – when in fact it’s the opposite that’s happening.
What is happening here is we are taking surface level observations to make claims about underpinning causation. It’s a ubiquitous problem across all sectors and everyday life. Developing hypotheses about underpinning causation that involves ontological depth is the solution Realism offers -- as “a powerful abstract language to resolve problems of explanation” Pawson &Tilley (1997) Realistic Evaluation. p. 55
In additional to important details about realist methodology application, I think this is the kind of discussion worth sustaining.
Justin
Justin Jagosh, Ph.D
Director, Centre for Advancement in Realist Evaluation and Synthesis (CARES)
www.realistmethodology-cares.
org &
Honorary Research Associate
Institute for Psychology, Health and Society
University of Liverpool, UK
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]
] On Behalf Of Steven Markham
Sent: January 26, 2018 1:45 AM
To: [log in to unmask]
Subject: Re: Realist evaluation
Hi Shatabdi,
I
cannot pretend that the attached article is 'Realist' but I do strongly believe that it could help you consider the context for the question you have posed.
With best wishes,
Steven Markham
On 25 Jan 2018 15:43, "Goon, Shatabdi" <[log in to unmask]> wrote:
Hello everyone,
I would like to do a realist evaluation of effectiveness of a nutrition and physical activity intervention program in improving children’s health. Would you mind suggesting me some articles written on "Realist evaluation of effectiveness of any health intervention program targeting children".
Thanks in advance
Shatabdi