1. Constructing the initial theory Realist Synthesis Panel Session Dr Gill Westhorp Dr Margaret Cargo Dr Geoff Wong

2. Overview How does one go about developing the initial theory to test and refine in a realist synthesis? Examples based on the work of panel members for different tasks, facing different dilemmas None of the review questions exactly in the form initially proposed for realist synthesis

3. The Technical Sequence Search to provide overview of programme theory (i.e. ‘theory elicitation’) Question selection to pinpoint key processes for investigation (i.e. ‘theory selection’) Search for studies best placed to test the chosen theory (i.e. ‘theoretical sampling’) Quality appraisal of primary studies, not against a hierarchy of evidence, by their ‘theory testing potential’ Data extraction, not to a standard matrix, but as ‘confrontation of theory with evidence’ Synthesis as ‘theory refinement’ Dissemination as production of abstract ‘middle-range theory’ (i.e. theory re-articulation) Courtesy Ray Pawson

4. The Examples Early Years Programs (Gill Westhorp) Aboriginal Children and Young People’s Wellbeing (Margaret Cargo, PI) Smoking in Cars (Geoff Wong & Ray Pawson)

5. Example 1: Early Years Programs Task: to explain a particular outcome pattern (programs that ‘work’ making child development outcomes worse for the most disadvantaged) Two broad kinds of programs: home visiting programs and centre based care. Multiple variants of programs; complicated and complex; various ToC The approach to theory elicitation: Build a typology from substantive theory; use the typology to propose realist ToC

6. Theory of Negative Impacts (1) Attachment Theory Attachment style influences views of self & others; close relationships; cognitive structuring Social Judgements Theory Views of self and others influence social judgements and therefore social relationships Social Capital Theory Relationships, trust & networks influence access to social, economic & political resources Social Inclusion / Exclusion Social inclusion/exclusion is both a product and a process in the relationship of individual/group to society

7. Theory Map 2 Social inclusion Social capital Relationship style View of others View of self SecureAvoidant/ dismissive Anxious/ ambivalent Disorganised

8. Theory Map 3 Level of theory Nature of interventionWorks for…Doesn’t work for… Social inclusion / exclusion Social & economic policy Creates contexts for communities, families and individuals Socially included individuals, families and communities Socially excluded individuals, families and communities Social CapitalCommunity Development Builds networks & relationships at community level – provides social support Secure attach’t; milder levels of insecure; positive social judgements Socially excluded; Severe insecure or disorganised; negative social judgements Social Judgements Individual change Build individual skills, self- esteem, behaviours - e.g. parenting / home management skills, assertiveness... Secure attach’t; milder levels of insecure; +’ve / neutral social judgements Socially excluded; Severe insecure or disorganised; negative social judgements AttachmentAttachment therapy Repairs relationships and fundamental perceptions of self and others Avoidant & insecure, some levels of disorganised Extreme disorg’d ; gen. distorted perceptions; ‘unavailable’ (D&A)

9. Families with multiple risk factors Families with significant attachment issues at parent & child levels  likelihood of social service involvements Increased risks of: * Poorer child development * -’ve social judgements * DV / CAN  parents’ negative attachment behaviours Withdraw from voluntary services Neg social judgements -> increased sense of threat from services Withdraw from social & community networks  isolation / decreased social capital  risk of statutory / justice involvement Theory Map 4 Worse cognitive & social development outcomes for children c c

10. Example 2: Aboriginal Children &Young People’s Social &Emotional Wellbeing Task: to explain mechanisms generating SEWB Multiple families of programs: Education; Cultural pride/ identity; Family strengthening; Community strengthening; Adverse mental health; Substance use; crime & violence. Complicated and complex programs, various ToC The approach to theory elicitation: CMOCs, stakeholder consultation, literature scan for ‘candidate theories’

11. Starting with CMOCs… Huge diversity in program activities, target groups, aims Poor quality of data for C, M and Os But: common themes in relation to early stages – ‘without engagement, nothing else follows’ Focus on CMOs for engagement Scoping study + stakeholder consultations to identify ‘candidate theories’

12. Candidate Theories Cultural respect framework (Australian Health Minister’s Advisory Council 2004-2009) – Trust and respect are important to relationships Social identity theory (Turner, 1991, 1999) – Shared history and culture between Aboriginal participants and program staff will facilitate development of trust and respect Aboriginal self-determination (stakeholder) – Aboriginal self-determination in the impetus for the program and all aspects of design and delivery facilitates engagement Ecological theory (Bronfenbrenner, Richard, stakeholder) – Programs need to implement strategies that modify the participant, their family environment and the broader environment  outcomes Informed by Scoping Review & Aboriginal Advisory Panel Courtesy Margaret Cargo

13. Initial program theory Aboriginal self-determination and partnerships Aboriginal capacity Engagement Trust Respect ↑Social & Emotional Wellbeing ↓ Mental Health Problems Aboriginal staff deliver program Competence Cultural identity Individual Strategies Group-based Strategies Involvement of the Family Environmental Strategies Courtesy Margaret Cargo

14. Example 3: Smoking in cars with children Task: to inform decision about whether to ban smoking in cars with children Relatively simple program theory – but no existing studies The approach to theory elicitation: ‘What would cause this theory to fail?’

15. Criminalisation Compensating (displaced) behaviour Lack of public support (individual freedoms) Low perceived threat of enforcement/punishment Lobby group opposition (infringement of rights) Problem misidentification Insufficient enforcement resources Obfuscating the new regulations Identification Compulsion Enforcement Threats to legislative effectiveness