What’s in a mechanism? Development of a key concept in realist evaluation

Implementation Science

Monique Lhussier³  Bill Cunningham¹  Diana Jones³  Joanne Greenhalgh²  Sonia Michelle Dalkin² 

[1] Hadrian Primary Care Alliance, Newcastle Upon Tyne, UK;University of Leeds, Leeds, UK;Northumbria University, Newcastle Upon Tyne, UK

关键词: Realist synthesis;    Realist evaluation;    Palliative care;    Methodology;    Realist;   

Others  :  1219043
DOI  :  10.1186/s13012-015-0237-x

 received in 2014-11-17, accepted in 2015-03-24,  发布年份 2015

【 摘 要 】

Background

The idea that underlying, generative mechanisms give rise to causal regularities has become a guiding principle across many social and natural science disciplines. A specific form of this enquiry, realist evaluation is gaining momentum in the evaluation of complex social interventions. It focuses on ‘what works, how, in which conditions and for whom’ using context, mechanism and outcome configurations as opposed to asking whether an intervention ‘works’. Realist evaluation can be difficult to codify and requires considerable researcher reflection and creativity. As such there is often confusion when operationalising the method in practice. This article aims to clarify and further develop the concept of mechanism in realist evaluation and in doing so aid the learning of those operationalising the methodology.

Discussion

Using a social science illustration, we argue that disaggregating the concept of mechanism into its constituent parts helps to understand the difference between the resources offered by the intervention and the ways in which this changes the reasoning of participants. This in turn helps to distinguish between a context and mechanism. The notion of mechanisms ‘firing’ in social science research is explored, with discussions surrounding how this may stifle researchers’ realist thinking. We underline the importance of conceptualising mechanisms as operating on a continuum, rather than as an ‘on/off’ switch.

Summary

The discussions in this article will hopefully progress and operationalise realist methods. This development is likely to occur due to the infancy of the methodology and its recent increased profile and use in social science research. The arguments we present have been tested and are explained throughout the article using a social science illustration, evidencing their usability and value.

【 授权许可】

   
2015 Dalkin et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Pawson R, Tilley N. Realistic evaluation. SAGE, London; 1997.
• [2]Pawson R. A measure for measures: a manifesto for empirical sociology. Routledge, London; 1989.
• [3]Hesse M. The structure of scientific inference. University of California Press, Oakland, CA; 1974.
• [4]Harré R. The philosophy of science: an introductory survey. Oxford University Press, London; 1972.
• [5]Pawson R. The science of evaluation: a realist manifesto. SAGE, London; 2013.
• [6]Sayer A. Realism and social science. Sage, London; 2000.
• [7]Sayer A. Method in social science: a realist approach. Hutchinson, London; 1984.
• [8]Bhaskar R. A realist theory of science. 2nd ed. Harvester Press, Brighton; 1978.
• [9]Boudon R. Social mechanisms without black boxes. Social mechanisms: an analytical approach to social theory. Hedström P, Swedberg R, editors. Cambridge University Press Cambridge, UK; 1998.
• [10]Stinchcombe A. The conditions of fruitfulness of theorizing about mechanisms in social science. Philos Soc Sci. 1991; 21(3):367-88.
• [11]Bhaskar R. The possibility of naturalism: a philosophical critique of the contemporary human sciences. Harvester Press, Brighton; 1979.
• [12]Archer M. Realist social theory: the morphogenic approach. Cambridge University Press, Cambridge; 1995.
• [13]Chen H, Rossi P. The theory-driven approach to validity. Eval Program Plann. 1987; 10:95-103.
• [14]Astbury B, Leeuw F. Unpacking black boxes: mechanisms and theory building in evaluation. Am J Eval. 2010; 31(3):363-81.
• [15]Chen H. Practical program evaluation. SAGE, Thousand Oaks, CA; 2005.
• [16]Weiss C. Theory-based evaluation: past, present, and future. New directions for evaluation. Jossey-Bass, San Francisco, CA; 1997.
• [17]Vassilev I, Rogers A, Kennedy A, Koetsenruijter J. The influence of social networks on self-management support: a metasynthesis. BMC Public Health. 2014; 14(719):1-12.
• [18]Hedstom P, Swedberg R. Social mechanisms: an analytical approach to social theory. Cambridge University Press, Cambridge; 1998.
• [19]Thoits P. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011; 52(2):145-61.
• [20]Greenhalgh T, Humphrey C, Hughes J, Macfarlane F, Butler C, Pawson R. How do you modernize a health service? A realist evaluation of whole-scale transformation in London. Milbank Q. 2009; 87(2):391-416.
• [21]George A, Bennett A. Case studies and theory development in the social sciences. MIT Press, Cambridge, MA; 2004.
• [22]Henry G, Julnes G, Mark M. Realist evaluation: an emerging theory in support of practice. New directions for program evaluation. Jossey-Bass, San Francisco, CA; 1998.
• [23]Jagosh J, Pluye P, Wong G, Cargo M, Salsberg J, Bush PL et al.. Critical reflections on realist review: insights from customizing the methodology to the needs of participatory research assessment. Res Synth Methods. 2013; 5(2):131-41.
• [24]Salter K, Kothari A. Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review. Implement Sci. 2014; 9(115):1-14.
• [25]Pawson R, Manzano-Santaella A. A realist diagnostic workshop. Evaluation. 2012; 18:176-91.
• [26]Berwick D. The science of improvement. JAMA. 2008; 299(10):1182-4.
• [27]Marchal B, van Belle S, van Olmen J, Hoerée T, Kegels G. Is realist evaluation keeping its promise? A literature review of methodological practice in health systems research. Evaluation. 2012; 18(192):192-212.
• [28]Murtagh F, Preston M, Higginson I. Patterns of dying: palliative care for non-malignant disease. Clin Med. 2004; 4:39-44.
• [29]Murray S, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. Br Med J. 2005; 330:1007-11.
• [30]Jagosh J, Macaulay A, Pluye P, Salsburg J, Bush PL, Henderson J et al.. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012; 90(2):311-46.
• [31]Wilson V, McCormack B. Critical realism as emancipatory action: the case for realistic evaluation in practice development. Nurs Philos. 2006; 7(1):45-57.
• [32]Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. BMC Med. 2013; 11(21):1-14.
• [33]Pawson R. Digging for nuggets: how ‘bad’ research can yield ‘good’ evidence. Int J Soc Res Methodol. 2006; 9(2):127-42.