Introducing Realist Evaluation and Synthesis

I recently attended an introduction to Realist Evaluation and Synthesis delivered by Justin Jagosh, Honorary Research Associate of Liverpool University. This was quite an intense introductory day and not-unreasonably, given the majority of Senior Public Health attendees, it was heavily focused on academic research themes and concepts and where the model fits, or doesn’t. The more epistemologically challenged of us stayed out of the weightier debates around knowledge, justifications and the rationality of beliefs versus hard data.

In a nutshell, realist evaluation asks the question ‘What works for whom, under what circumstances and how?’

Justin positioned Realism between more traditional Positivist - Deductive Reasoning and Constructivist - Inductive Reasoning. The conceptual model focuses on ‘Context, Mechanisms (intervention and response) and Outcomes’ (C-M-O) with a significant emphasis on the importance of context and theorising to better understand underlying causal factors in addition to the more obvious or visible factors. This was illustrated via the use of an iceberg model (above and below the water-line) and the point that realism attempts to bring the hidden into view. This can provide a fuller explanation of causation through a process called Retroduction. The model also theorises around the interactions between context and mechanism (intervention & actual response) elements.

Approaching the day from a systems thinker’s frame of reference, I was very interested in the increased emphasis on the importance of context or what I would term system conditions. Many will also be familiar with The Lean Leadership Iceberg Model of Peter Hines et al (2008) which takes a similar approach to understanding the wider system - as a precursor to quality improvement.

The Realist approach appears to sit in a space that will be familiar to soft systems thinkers, promoting the benefits of ‘explanatory insight’ and painting a rich picture that incorporates both the abstract and the real. Quality Improvement Practitioners may feel slightly more comfortable with this evolving research methodology than some purist research academics. Perhaps this approach is more suited to action research environments and I can see the potential value for clinical practitioners in the NHS. 

So final thoughts, the realist approach felt more towards the realms of qualitative, social science research. I think a day could only be an introduction given the density of the materials presented. Therefore my comments are just first impressions. I also think there may be some utility in adopting the realist approach into quality improvement interventions although this requires further investigation. As a parting shot Justin mentioned that the C-M-O Model was being adopted in clinical practice but that it is early days. I will watch for further developments with interest. Justin’s presentation style was very engaging and interactive. A very thought-provoking and useful event.

There are reading material/seminars on Justin Jagosh’s website for those who wish to learn more: https://realistmethodology-cares.org/