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Can “realist” randomised controlled trials be genuinely realist?

In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluatio...

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Autores principales: Van Belle, Sara, Wong, Geoff, Westhorp, Gill, Pearson, Mark, Emmel, Nick, Manzano, Ana, Marchal, Bruno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936237/
https://www.ncbi.nlm.nih.gov/pubmed/27387202
http://dx.doi.org/10.1186/s13063-016-1407-0
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author Van Belle, Sara
Wong, Geoff
Westhorp, Gill
Pearson, Mark
Emmel, Nick
Manzano, Ana
Marchal, Bruno
author_facet Van Belle, Sara
Wong, Geoff
Westhorp, Gill
Pearson, Mark
Emmel, Nick
Manzano, Ana
Marchal, Bruno
author_sort Van Belle, Sara
collection PubMed
description In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) with the randomised controlled trial (RCT) design. We identified three fundamental differences that are related to paradigmatic differences in the treatment of causation between post-positivist and realist logic: (1) the construct of mechanism, (2) the relation between mediators and moderators on one hand and mechanisms and contexts on the other hand, and (3) the variable-oriented approach to analysis of causation versus the configurational approach. We show how Jamal et al. consider mechanisms as observable, external treatments and how their approach reduces complex causal processes to variables. We argue that their proposed RCT design cannot provide a truly realist understanding. Not only does the proposed realist RCT design not deal with the RCT’s inherent inability to “unpack” complex interventions, it also does not enable the identification of the dynamic interplay among the intervention, actors, context, mechanisms and outcomes, which is at the core of realist research. As a result, the proposed realist RCT design is not, as we understand it, genuinely realist in nature.
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spelling pubmed-49362372016-07-07 Can “realist” randomised controlled trials be genuinely realist? Van Belle, Sara Wong, Geoff Westhorp, Gill Pearson, Mark Emmel, Nick Manzano, Ana Marchal, Bruno Trials Commentary In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) with the randomised controlled trial (RCT) design. We identified three fundamental differences that are related to paradigmatic differences in the treatment of causation between post-positivist and realist logic: (1) the construct of mechanism, (2) the relation between mediators and moderators on one hand and mechanisms and contexts on the other hand, and (3) the variable-oriented approach to analysis of causation versus the configurational approach. We show how Jamal et al. consider mechanisms as observable, external treatments and how their approach reduces complex causal processes to variables. We argue that their proposed RCT design cannot provide a truly realist understanding. Not only does the proposed realist RCT design not deal with the RCT’s inherent inability to “unpack” complex interventions, it also does not enable the identification of the dynamic interplay among the intervention, actors, context, mechanisms and outcomes, which is at the core of realist research. As a result, the proposed realist RCT design is not, as we understand it, genuinely realist in nature. BioMed Central 2016-07-07 /pmc/articles/PMC4936237/ /pubmed/27387202 http://dx.doi.org/10.1186/s13063-016-1407-0 Text en © Van Belle et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Commentary
Van Belle, Sara
Wong, Geoff
Westhorp, Gill
Pearson, Mark
Emmel, Nick
Manzano, Ana
Marchal, Bruno
Can “realist” randomised controlled trials be genuinely realist?
title Can “realist” randomised controlled trials be genuinely realist?
title_full Can “realist” randomised controlled trials be genuinely realist?
title_fullStr Can “realist” randomised controlled trials be genuinely realist?
title_full_unstemmed Can “realist” randomised controlled trials be genuinely realist?
title_short Can “realist” randomised controlled trials be genuinely realist?
title_sort can “realist” randomised controlled trials be genuinely realist?
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936237/
https://www.ncbi.nlm.nih.gov/pubmed/27387202
http://dx.doi.org/10.1186/s13063-016-1407-0
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