1. A brief introduction to realist synthesis
Geoff Wong

2. Overview Objectives What is realist synthesis / review?
Why do we need ‘yet another’ approach?
What assumptions underpin realist synthesis?
Summary

3. Objectives
By the end of this presentation I hope you will have an understanding of:
what a realist synthesis is
what assumptions underpin realist synthesis
when you might use realist synthesis.

4. What is a realist synthesis?
Realist Synthesis - Theory driven systematic review (secondary research)
Goal is more explanation and understanding than judgment and summation
More a “logic of enquiry”- a way of analysing and making sense of data using a realist lens.

5. Why do we need ‘yet another’ research review method?
Because of ‘complex interventions’ – a realist perspective:
Volitions: Reliant on people to make choices
Implementation: Long implementation chains
Context: Outcomes change under differing contexts
Time: What has happened previously shapes what will happen next
Outcomes: multiple, planned and unplanned and even contested
Rivalry: Interventions ‘compete’ with one another in the real world
Emergence: interventions begets change which causes more change

6. A simplified diagram of a complex intervention!H J A B C D E G I K
Intervention M

7. Assumptions underpinning realist synthesis
Ontologically – how we believe the world to be constituted:
Developed from critical realism
A stratified and ‘filtered’ world
About identifying, understanding and explaining causation through generative mechanisms
All this may be explained by one or more (middle-range) theories
Context influences which mechanism(s) ‘fires’
Mechanism(s) B A

8. Assumptions underpinning realist synthesis
Epistemologically – what counts as knowledge and how can we come to know it:
Knowledge is built up gradually, is partial and conditional but corrigible
Knowledge should be judged by assessing the processes and assumptions by which it is produced
Theories are ‘right’ because they are (for example) coherent, plausible and repeatedly successful

9. Assumptions underpinning realist synthesis
Methodologically:
Uses a realist ‘lens’ to analyse and make sense of data
Theory-driven:
Realist programme theory
Middle-ranged theories to explain outcomes of interest
Requires focussing and prioritisation of what to study
Making and testing inferences from the data
Uses any data that can inform inferences
Iterative

10. Summary Realist research is based on a explicit philosophy of science.
Ontologically:
Stratification – the world has ‘depth’
Generative causation through mechanisms
Epistemologically:
Partial and corrigible knowledge, built up gradually and judged by assessing the processes and assumptions by which it is produced
Methodologically
Ontology and epistemology should inform methodology (and not the other way round)
You first have to acknowledge that the world can be constituted in different ways.
Ontological:
Realist assume that to make sense of any phenomenon we need to understand what is causing it to happen. The concept of a ‘mechanism’ used to explain causation. So if I do X, Y happens BECAUSE of mechanism Z.
In any complex intervention, context matters because it influences whether or not a mechanism fires. In addition, there may be mutiple competing, reinforcing or non active mechanism present that interact. Whether or not the outcome of interest occurs depends on the exact contextual milieu.
So ontologically, realism has a coherent model to explain causation, the place of context within this model its model of causation and a conceptualisation of ‘complexity’ might arise.
Epistemological:
Like all other methods realism has to contend with the problem of the underdetermination of theory – i.e. which competing theory is more right/likely.
In realism we are ‘proving theories’ – but there is the added complication that we are dealing with a ‘complex’ system – interacting mechanisms sensitive to contextual influences.
Inter-twining of method and epistemology here, but the above means that it is neither possible nor desirable to resort to controlled trials as the only means of determining if one theory is more likely. Controlled trials ‘petrify’ an important ontological element – context, thus limiting learning about the intervention. More importantly, it may not be possible to control all context uniformly.
Have to rely on other processes – such as coherence, plausibility and repeated success.
Methodological:
Any research method used should be based on explicit ontology and epistemology – BOTH and not just one or the other as all three and intertwined.

11. Realism is a way of looking at and making coherent sense of this ‘messy’ world we live in.

12. Thanks for your attention
Suggested readings:
Pawson R. Evidence-based Policy. A Realist Perpective. London: Sage, 2006.
Pawson, R., Greenhalgh, T., Harvey, G., and Walshe, K. Realist Synthesis: an introduction ESRC Research Methods Programme.
Wong G, Greenhalgh T, Westhorp G, Pawson R. Realist methods in medical education research: what are they and what can they contribute? Medical Education 2012, 46:1, 89–96
Wong G, Greenhalgh T, Pawson R. Internet-based medical education: a realist synthesis of what works, for whom and in what circumstances BMC Medical Education 2010, 10:12 (2 February 2010)
Wong, G., Pawson, R., Owen, L. Policy guidance on threats to legislative interventions in public health: a realist synthesis BMC Public Health 2011, 11, 222
Klee R. Introduction to the philosophy of science. Cutting nature at its seams. New York: Oxford University Press, 1997
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