By Marsha Orgill, Sara Van Belle, Woldekidan Amde, Aku Kwamie, Thubelihle Mathole, Gaëlle Vareilles, Emilie Robert, Valeria Campos da Silveira and Bruno Marchal
The authors, members of the SHAPES cluster group on ‘theory-driven inquiry’ attended the 1st International Conference on Realist Approaches to Evaluation and Synthesis in Liverpool, UK (27th – 30th October 2014). This was the first formal realist conference ever held, hosted by the new Centre for the Advancement of Realist evaluation and Synthesis of the University of Liverpool (CARES). Here are their notes (including the deep insights that emerged during a wonderful Italian dinner!).
This first conference was a quaint, well-organised get-together with approximately 180 people in attendance. The premises of the old New Royal Infirmary on the University’s campus provided a highly conducive context to meeting almost everyone there. A mix of researchers from a range of countries and disciplines made for lively cross-country and cross-disciplinary discussions. It is clear that realist evaluation and especially realist synthesis is currently making big waves in the UK, Canada and Australia, with smaller waves rippling through Ghana, Spain, France, Switzerland, Sweden and South Africa.
The conference had a clear methodological focus on realism and its application in realist synthesis and realist evaluation. The aims were indeed to provide a forum for networking and knowledge sharing among international researchers interested in advancing realist methodology in the health and social sciences, and to stimulate researchers and practitioners to present their realist research, discussing their successes and challenges. Opportunities for training on realist methodology were provided. The conference was also ‘philosophical’ in its approach, devoting time to considerations of realism (“how real is real”?), meanings of “what works” (what has worked, what can work, what will work?), and the easy conflation of contexts, mechanisms, moderators and mediators…
In addition to these theoretical and methodological leanings, presentations were also content-rich, dealing with realist research on a cross-section of social challenges, such as helping communities to use sport to promote learning in school children, organising effective management training programmes, synthesising knowledge for policy makers on reducing violence amongst young people, mental health services in correction sub-systems, and integration of care delivery platforms for the elderly. Despite the conference’s compact size, it was often difficult to choose between comparably exciting parallel sessions.
Well-known names in realist evaluation were in attendance, including Ray Pawson and Nick Tilley (authors of the seminal text ‘Realistic Evaluation’), Trisha Greenhalgh, and Gill Westhorp. Seasoned presenters as they are, they captured the imagination of the audience with insightful knowledge, creative presentations – and a good dose of humour. Nick Tilley talked about Policy Makers and Realist Evaluation and explained how he managed to find himself in a Department of Engineering at University College London. He was clearly fascinated by engineers’ ‘archetypal realism’, the fact that their systematic analysis of failure lead them to be innately theory-driven – perhaps this could be a lesson for policy-making (shifting from ‘evidence-based’ towards ‘tested-and-testing-theory-led’)? Trisha Greenhalgh dealt with challenging issues in realist research, such as how it relates to positivism and constructivism. She also challenged realist researchers to think whether they should join the campaign for real EBM. On a lighter note, Ray Pawson was the quiz master of the first ever realist evaluation quiz during the conference diner. As he attended the various sessions of the conference, it was quite insightful as well as a great learning opportunity having him in the audience. As he put it during Melanie Ehren’s presentation Wrangling with realist synthesis, “this is a direct on-spot supervision”!
There were also a number of plenary sessions that provided insights into how policymakers and research commissioners think about realist research. In his talk Research impact: can realist research make a difference, Kieran Walshe offered a view behind the scenes of the research commissioning processes of the health services and delivery research programme of the National Institute of Health Research. Similarly, Mike Kelley, Director of the Centre of Public Health at NICE (National Institute for Health and Care Excellence – UK) used Greek mythology (Dionysus being the god of disorder and complexity!) to talk about the bulk of behaviour change interventions to date being based on psychology, and the potential for integrating more sociological theory to help us understand how altering the structures of social practices are equally important mechanisms in changing behaviours.
The presence of many PhD students using the realist approach for their doctoral research is encouraging. It means that in a few years from now, more well-trained researchers will be able to use, train and reflect on the realist approach.
The Thematic Working group SHAPES, and its theme Theory-driven inquiry will contribute to building this capacity. Currently, action plans are being drawn, and we expect to be able to set up a number of exchange platforms, a buddy system and other processes to allow learning, developing and implementing realist and other theory-driven inquiry approaches in Health Policy and Systems Research. Let us know if you want to go with us on this fascinating journey!