Hi guys,

Thanks for all the support and direction. 
I have a lot to consider but will try and answer comprehensively. I paraphrase a bit, so please excuse if I misrepresent your ideas.

Regarding the format of review: 

Gill makes the point that Realist Synthesis can refer to the analytic paradigm used in analysing reviewed data, as much as the specific format of review used, as long as it does not claim to be something that it is not. Justin goes on to say that the RR format best suits the study of specific programme implementation or groups thereof. Therefore he suggests clarifying the exact resource being offered, thereby facilitating the realist approach. Further, Justin acknowledges the limitations and acceptances of RRRs as a valid option.

In response to this, I am now clearer (and I think somewhat more free) about the utilization of this approach to answer the questions I have, yet at the same time, it highlights the need to have clarity of purpose in designing the review. This presents an issue, in my instance, as I operate within a system in constant flux. I, along with the policy makers / service providers do not know what type of intervention will come out of the current process. The lack of clarity in “resources” as Justin puts it, or of a clear intervention (as I see it) complicate the planning of the Realist Review that will ultimately inform the very same intervention. 

A Chicken and Egg argument!

We are currently engaged in a formal process called an Oral Health Needs Assessment to try and measure needs among the population and capacity among services. Once completed, this will highlight the priority areas for policy makers and present the basic building blocks ( from the capacity assessment element ) for configuring a new model of dental care delivery.

Looking down the line, with a realist perspective, I ask how do commissioners / planners put these building blocks together ( in relation to the context and likely mechanisms) to come up with an intervention that will trigger the best outcomes… and in a format, Gill makes the point, that  aims to give policy makers a product that they will find useful for the specific tasks at hand. 

This touches on Justin’s point that participation of the decision makers (end users) is both essential and costly (in time), and could potentially weaken and strengthen the process and output. I agree completely with Simon’s points on engaging policy makers. I spend and have spent the greater part of my research time over the last two years managing the involvement of policy makers and service users with this in mind. A difficulty I have is that policy makers and service managers may look on me and my work as loosely connected with the “REAL” world of service delivery, change management etc. Indeed, what I see as integral planning for reliable outcomes – such as realist review of literature – they may see as “an academic exercise”.

As such, Simon, getting the policy makers, who are genuinely under a lot of pressure, to engage is difficult. For note – I do see the potential for the research process to change the mechanisms that underlie their responses, which may then change the context of their participation and improve the likelihood of deeper engagement. I apply my minor interventions with them in the hope that this mechanism will kick in.

Following the above points, I believe that RRR is valid option in my instance. I will need to pointedly define my criteria for defining the question, despite the circular argument that it relates to. To do this effectively, your comments reaffirm my need to foster contacts, partnerships and “create buy in”.

The joys of research.

Many thanks and I welcome further advice / comments

Kev