Realist synthesis: What is it
and why might I want to use it?
Mark Pearson
PenSR – 6 December 2011
[email protected]
Overview
A very brief bit of ‘systematic review history’
What is Realist Synthesis?
Putting it into practice: NIHR SDO review of
‘intermediate care’
What is it good for? Why might it be ‘better’
than other methods?
We haven’t finished our review yet, so… some
interim reflections on the method
‘Back in the old days’ (1990s!)
Systematic
review, inc.
meta-analysis
Ye olde
literature
review
Objective
Comprehensive
Transparent
Biased?
Partial?
Opaque?
2011 – closer, but integrated?
‘Complexity’
‘Conventional’
systematic
review
Critical interpretive
synthesis
Narrative synthesis
Realist synthesis
Meta-narrative review
Meta-study
Meta-ethnography
and more…
2011 – closer, but integrated?
‘Complexity’
‘Conventional’
systematic
review
Critical interpretive
synthesis
Narrative synthesis
Realist synthesis
Meta-narrative review
Meta-study
Meta-ethnography
and more…
Realist Synthesis in 3 bullet
points & a slide
• ‘The nature of complex programmes’ (Pawson 2006)
1) Programmes are active, not passive (recipients have to choose to respond/participate)
2) Programmes have long implementation chains and multiple stakeholders
3) Programmes are embedded in complex social systems
4) Programmes are implemented against the background of other interventions/service changes
5) Programmes borrow and adapt from other programmes; they are rarely implemented exactly as
originally envisaged
6) Programmes have typically evolved from previous interventions
7) Programmes change the conditions that made them work in the first place
• Context-mechanism-outcome configurations
• Programme theory
Strengths of Realist Synthesis for
understanding complex social interventions
Remains usable where ‘interventions’ are weakly-defined,
porous, and ever-changing
‘Runs with’ complexity (rather than trying to control it)
Aims to explain differences, particularly in relation to
context
Responsive to (and integrative of) experiential knowledge
(enables ‘decision support’)
Systematic - a stated method that can be critiqued and
developed
Output: a broad ‘road map’
Issues with Realist Synthesis
The ‘swamp’ (and keeping track…)
Potential scale
Documenting decisions and the
development of ideas
Importance of dialogue between
reviewers
How appraise ‘relevance and rigour’?