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Complexity Science & Critical Realism: Implications for Best Practices in Programming and Evaluation in a Settings Approach Blake Poland, University of.

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Presentation on theme: "Complexity Science & Critical Realism: Implications for Best Practices in Programming and Evaluation in a Settings Approach Blake Poland, University of."— Presentation transcript:


2 Complexity Science & Critical Realism: Implications for Best Practices in Programming and Evaluation in a Settings Approach Blake Poland, University of Toronto Mark Dooris, University of Central Lancashire IUHPE, Geneva, July 2010

3 Outline Rethinking business as usual Settings approach: taking context into account Deepening our understanding of context through critical realism & complexity science Implications for program planning & evaluation 2 examples i) framework for analyzing settings ii) 5 principles for settings-based work

4 Many Challenges Widespread exploitation and degradation of natural & human systems Failure to close the gap b/n rich & poor Growing interconnectedness & complexity Failure of mainstream responses = need to rethink dominant paradigm

5 Context Matters If the intervention / new practice doesnt fit & resonate, it wont take root values local history aims & ambitions of stakeholders Changes in context can undo an intervention Context-sensitive practice is typically more responsive, successful

6 Settings Approach: Taking Context into Account + much hp practice already organized this way + addressing setting itself as a determinant of health + a scale that matches how people experience the world Health is created & lived by people within the settings of their everyday life; where they learn, work, play & love (Ottawa Charter, 1986)

7 Critical Realism Makes distinctions between: empirical (what is observed) actual (events/experiences that may not be directly observed) real (underlying causal mechanisms) Mechanisms coincide under real world conditions to produce emergent properties contingent in time/space

8 According to CR, interventions are theories (hypotheses), which are resourced & inserted into existing social systems active (work through stakeholder reasoning/intentionality) long & thickly populated chains (of interaction) non-linear embedded in multiple social systems leaky & prone to being borrowed (copied, refined, reinvented, adapted) open systems that feed back on themselves (adapted from Pawson et al, 2004)

9 Redefining Context The (local) mix of conditions and events (social agents, objects and interactions) which characterize open systems... whose unique confluence in time and space selectively activates (triggers, blocks or modifies) causal powers (mechanisms) in a chain of reactions that may result in very different outcomes depending on the dynamic interplay of conditions and mechanisms over time and space (Poland, Frohlich & Cargo, 2009)

10 Complexity Science non-mechanistic understanding of change (discontinuous phase transitions) organisms & systems are self- organizing & self-actualizing order is emergent, not imposed predicated on interconnectedness (relationships, history) & feedback loops

11 SIMPLE Baking a cake COMPLICATED Rocket to the moon COMPLEX Raising a child Recipe essentialProtocols needed Rigid protocols often not very helpful Easily replicated (follow directions) Success with 1 increases likelihood of next Success with 1 is no guarantee for next No expertise required Considerable expertise required Expertise helps but responsiveness is key Good recipe a good guarantee Key elements required to succeed Every child unique, much uncertainty! SOURCE: Adapted from Westley, Zimmerman & Patton (2006)

12 Implications 4 Practice Both Critical Realism & Complexity Science: underscore the importance of context suggest slavish adherence to best practice runs rough-shod over local needs/capacities; risks under- achievement point to the promise of catalyzing & supporting communities of practice, rather than micro-managing frontline work

13 Beyond Recipes... From non-deviation (recipes) to adaptation (tweaking to fit context) to embedding (re-inventing in situ) It is not programmes that make things change, it is people, embedded in their context who, when exposed to the resources (ideas, funding, etc) that programmes make available, who choose to change what they are doing (Pawson & Tilley, 1997; Duguid & Pawson, 1998)

14 A Framework for Analyzing Settings for Health Promotion 3 key dimensions: 1) Understanding settings (25 questions) 2) Changing settings (16 questions) 3) Knowledge development/translation (3 q) (Poland, Krupa & McCall, 2009)

15 5 Principles 1) Start where people are (listen to & respect lived experience, diverse forms of knowledge) 2) Practice rooted in place 3) Deepen the social analysis (connect lived experience to that of others & to the practices/structures that create & sustain inequity) 4) Asset-based / appreciative inquiry approach 5) Build resilience (for change) instead of efficiency (for narrow set of operating conditions) (Poland, 2009; Poland & Dooris, in press)

16 Sources Cited Dooris, Poland, et al (2007) Healthy settings: Building evidence for the effectiveness of whole system health promotion - challenges & future directions in McQueen & Jones (Eds), Global Perspectives on Health Promotion Effectiveness, Vol.1. NY: Springer. Kontos & Poland (2009) Mapping new theoretical and methodological terrain for knowledge translation: Contributions from critical realism & the arts. Implementation Science. 4(1): 1-10 Pawson & Tilley (1997) Realistic Evaluation. Sage. Poland, Green, & Rootman (Eds) (2000) Settings for Health Promotion: Linking Theory and Practice. Sage. Poland, Lehoux, Holmes, Andrews (2005) How place matters: unpacking technology and power in health and social care Health and Social Care in the Community. 13(2): Poland, Frohlich & Cargo (2008) Context as a fundamental dimension of health promotion program evaluation in Potvin, McQueen & Hall, (eds.), Evaluating health promotion: Issues and perspectives from the Americas. NY: Springer. B Poland, G Krupa, D McCall (2009) Settings for health promotion: an analytic framework to guide intervention design and implementation. Health Promotion Practice. Westley, Zimmerman, Patton (2006) Getting To Maybe: How the World is Changed. Random House. Williams (2003). "Beyond meaning, discourse and the empirical world: critical realist reflections on health." Social Theory & Health 1:

17 My Coordinates a (416)

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