On realist approaches

Posted by Monique Lhussier

Whilst I was originally educated as a scientist (an engineer in biological processes), many years later, I wrote a PhD thesis in… Nomadology.

This is not only about the kind of nomadism that describes the life of Bedouins in North Africa. It’s also about a flexibility of the mind, which allows us to accept that all research paradigms have a point, but rejects the fact that any single one of them could provide answers for everything at all times. The approach is postmodern and offers perspectives that most, at best, consider iconoclastic. It is as far from science as one can go, but I found it liberating. My PhD journey was one of discovery and intellectual indulgence that we rarely have the opportunity to engage in. This, for me, is what working in academia is all about. In fact, my ambition in life is to reach a stage where I am paid to think and do little else…that unlikely dream is what keeps me interested. 

The hampter wheel career stage

After my PhD, I went through a hamster-on-the-wheel stage. Work needed to be done to attract funding, deliver, attract more funding and deliver some more, with little time to build some kind of cumulative knowledge. 

Then, in the past few years I discovered realist approaches (evaluation, synthesis), which are about building theories of understanding. Understanding of how things work, for whom and in what circumstances. The kind of theory that isn’t a million miles away from the realities of life, but explains it in a way we might not have thought about before. It talks about the way in which contexts interact with underlying mechanisms to produce favourable outcomes. 

I recently attended a seminar on realist approaches, where the presenter illustrated this beautifully. Imagine a tennis ball in a hand. On earth, if the hand releases its grip, the ball falls. The action of the opening hand is only the visible part of what made the ball fall, though, as it is gravity that attracts the ball to the floor. Take that hand in outer space and, when it opens, the ball floats. The same visible thing happened (hand opening), but gravity has ceased to work. Take that hand under water and the ball goes upwards, towards the water surface. Gravity still applies, but is outweighed by buoyancy. Take the same action in three different contexts, and it leads to three different outcomes. 

How relevant is this in public health? Unless we can understand what really happens as a result of a public health intervention, we have no chance of replicating its successes and avoiding its pitfalls. I am currently undertaking a realist synthesis. Existing theories provide me with potential ‘menu’ of forces that may, in isolation or combination, explain published outcomes in any given circumstances. We constantly operate a toing and froing from theories to published data, until we feel we have developed a comprehensive enough explanatory framework. This process forces us to step out of our normal modus operandus of understanding (engaging in some kind of nomadism), to develop a new area of knowledge that can readily be translated. 

That knowledge is also beginning to instil conceptual sense in many other things I have done – whilst unfortunately not all I do, I at last am being paid to think my way out of the wheel.