HI there,
My name is Caroline Stretton and I am about to enter my final year of my PhD. I am a physiotherapist by background and wanting to develop a theoretically informed intervention to change walking habits after stroke using behaviour change techniques and social support. My project has been informed by the MRC guidelines for the development of complex interventions and fits in the development phase of these guidelines. The primary purpose is to develop an understanding of likely causal mechanisms of change behind increasing levels of real world walking behaviour for this population.
It is a mixed methods project and I have just finished a systematic review and a qualitative enquiry into perspectives of people with stroke. The third phase is to undertake a realist synthesis in order to understand the CMO configurations. I intend on using these findings to develop my treatment theory. I have chosen realist methodology over others because I think the focus on contextual conditions ( i.e. real world settings amongst others) and mechanisms is the best fit.
I have been following this list serve for over a year and working through the scoping phase of my proposed synthesis. Currently I am developing my protocol for PROSPERO. I have 12 months to go. My main outcomes of interests are sustained change in walking habits, and the identified mechanisms.
In order to focus the review ( and my project)- I have deliberately kept my emphasis on sustained change in walking behaviour. I have chosen this outcome for conceptual, measurement, pragmatic reasons and my stake holder engagement confirms this is a wise choice. My long term hope is that the treatment theory carefully developed with one outcome with in one clinical population could potentially serve as a model to other activities and clinical populations. I have two questions which would love your thoughts on:
1) What should I call this?
Given I am primarily focusing on a limited number of outcomes ( i.e.. sustained change in walking behaviour and any of the identified mechanisms) and using it to develop an intervention theory ( programme theory) should I call it a 'realist synthesis?' Gill Westhorp used the term 'modified' in her PhD thesis to describe the application of realist principles. I was wondering about using this phrase also. Or should I class it as a 'rapid realist synthesis' since time is a bit tight and my focus is more on developing an understanding of causal change mechanisms rather than being completely comprehensive. However it is not primarily stakeholder driven.
2) Realist review support:
I am from Auckland New Zealand. I have a wonderful supervisory team who are very supportive and experienced mixed methods researchers in rehabilitation and health psychology. However they are not experienced with realist review methodology ( and it is seldom used in my field). I noted with interest comments such as those by Emile Roberts on her slideshare from CARES about making sure your supervisory team understood issues around realist methodology. I can't make it to a northern hemisphere conference. Apart from appreciating this list serve, any other advice around methodological support?
Thanks in advance
Caroline
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