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Subject:

Rapid Realist Review and other thoughts

From:

"Jagosh, Justin" <[log in to unmask]>

Reply-To:

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

Date:

Sat, 25 Jan 2014 02:08:23 +0000

Content-Type:

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Hi Kev,

You're getting some good guidance I see. Here are some additional thoughts:. 

I like Gill's description of what would make a realist review 'rapid'. In realist methodology, we are committing ourselves to accept, and try to work with the great amount of complexity involved in programmes, service and policy operations. The product of a realist synthesis is still partial knowledge (to reference Ray), because even if we embrace complexity, we can't account for all of it - either because we do not have the time/resources in a given review, or even because we lack capacity in seeing/perceiving all of it (that's ok).  So a rapid realist review could be understood as the development of partial knowledge that has been shaped by some pre-authorized relevance - as opposed to a more exploratory, open-ended, realist design. 

The paradox though, is that sometimes involving decision-makers in a participatory research process is time-consuming, and coming to consensus on the research focus is not always simple. If this is your Ph.D  you probably want to find ways to make this a manageable experience so you'd need find balance in these competing factors. 

On a more practical note, you might want to change the word 'configurations' in 'configurations of managed care networks' to something else because if you mean 'what works for whom...etc' in the different ways in which managed care networks are put together, this is different from the usage of the word in the concept 'CMO configuration' and reader would be looking for your C-M-O configurations in the analysis. (But perhaps I've misunderstood what you mean here.)

In terms of the determination of fit between methodology and field of investigation, one can indeed tackle a research question with a variety of methodological approaches and do a really good job. And in some cases a realist approach may not be the best fit.  I think an easy way to question whether a realist approach would be a good fit for your project is to ask: Am I investigating the functioning of a specific set resources (e.g., policies, service delivery, programmes, or interventions)? If so, the realist approach works well because you set out to uncover the underlying logic and assumptions of the implementation of these resources and then how they play out in their contexts. In other words, the realist approach, (as has been developed to date), is easiest to do when you're studying the implementation of a very specific programme or set of related programmes. It becomes more challenging to apply the methodology to study the systemic injustices produced in the dental healthcare system as a whole for example. It's not impossible, but what becomes difficult is to pin down your middle-range theory and the underlying logic. Furthermore, the mechanism concept is really the mix of resources offered and reactions to that resource. So again, you need to ask: what is the resource being offered here?' then the definition of mechanism as set out in the realist methodology literature would be relevant to your CMO configuration analysis. You've probably advanced in your thinking about this anyway, but just to say that you may indeed be well poised to take the realist approach if you pin down and create parameters around the dental 'resource' that you would like to better understand. 

Justin


Justin Jagosh, Ph.D
Senior Researcher
Centre for Advancement in Realist Evaluation and Synthesis (CARES)
Liverpool Reviews and Implementation Group
University of Liverpool, United Kingdom

 Phone:
(in Canada)
001-604-822-3814 (w)
001-778-846-4589 (m)

________________________________________
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [[log in to unmask]] on behalf of Gill Westhorp [[log in to unmask]]
Sent: January 24, 2014 15:49
To: [log in to unmask]
Subject: Re: Rapid Realist Review - thoughts

Hi Kev - and all

I beg to differ (slightly) from my more erudite friends.  I agree (of course) that there are many methods of review and that each is best suited to particular tasks.

However, I believe that rapid realist reviews can be conducted on a variety of questions.  What makes them rapid is not the topic but the fact that a sufficiently refined and delimited question is asked, the boundaries that are put around the search process, and the safeguards that are put in place to keep the process both relevant (to the policy makers) and of sufficient quality (methodologically).  Keeping the claims made in keeping with the process used - i.e. don't claim a systematic review if you haven't done one - is of course also critical.  I assume you've seen Saul et al's article on RRR?

At essence, this refers back to 'what makes a review realist' - and in my view, that boils down to the nature of the analysis that is undertaken, not the breadth of the question or the comprehensiveness/systematic-ness of the search.

The selection of review method does of course relate to 'fitness for purpose' as Andrew and Trish discuss.  For me, there are two things to work through in order to make the choice of method.  The first is - what do the policy makers actually want to DO with the product?  Policy makers don't just 'make policy' - they make specific kinds of decisions at different levels of policy abstraction and they need different kinds of information to inform different kinds of decisions.  The second is - given this specific purpose, what is/are the review question(s)?  Once you know the purpose and the question(s), you can select the appropriate method.

Kev - your second question below is much more suitable for a realist review (rapid or otherwise) than earlier versions.  I'd still play with the structure a little: (I've put the outcome and the target group together) - "How do configurations of managed care networks in dental care and their underlying mechanisms influence  best outcomes for vulnerable groups?" - and I'd beware the assumption that 'it's something about the configurations' that changes the mechanisms that generate the outcomes - but that's something you could theorise and investigate.

Cheers
Gill

-----Original Message-----
From: Realist and Meta-narrative Evidence Synthesis: Evolving Standards [mailto:[log in to unmask]] On Behalf Of Caoimhin Mac Giolla Phadraig
Sent: Saturday, 25 January 2014 7:30 AM
To: [log in to unmask]
Subject: Re: Rapid Realist Review - thoughts

Thanks for the quick response Trish,

The research question I posted earlier is the overall question of the project as a whole and differs from the specfic question at hand which I hope to answer through realist review. The realist review section asks:

1.      How do we reorganize dental services to achieve changes that deliver best outcomes for vulnerable groups

or perhaps to make it more testable:

2.      How do configurations of managed care networks in dental care for vulnerable groups and their underlying mechanisms influence  best outcomes?

Andrew: your response is on the mark. I am only learning the utility of these tools and therefore the email. You suggest realist review to "shortlist" options for service development and then a Rapid RR to "fine tune" the selections.

The problem I face is simple: policy decisions will be made within a short timeframe. They can be informed by some sort of review of the available evidence or not. I will look into the other formats that you propose - as your response suggests they may add more "Tools" to my toolbox. The more steer you guys can offer the better.

Thanks for the response
Kev

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