The Realist Lens - For Researchers Who Keep It Real

What happens when we bring behavioural science and realist research into the same conversation? And could the two approaches help address some of each other’s limitations?Alejandro is joined by Dr Justin Aunger, Research Fellow at the University of Birmingham, whose work spans behavioural science, patient safety, health services research, realist synthesis and realist evaluation.Drawing on his experience across both traditions, Justin explores a challenge familiar to many realist researchers: programme theories can be rich and context-sensitive, butthe language used to describe interventions and mechanisms can vary considerably from one study to another. Behavioural science, meanwhile, has developed increasingly structured ways of describing intervention components and the processes through which behaviour may change.The conversation explores what realist research might learn from concepts such as behaviour change techniques, mechanisms of action, and behavioural settings, and whether these could provide a more shared language for describing what interventions actually do, how people respond and why outcomes occur. Justin also introduces the idea of causal chain configurations, offering one possible way of connecting intervention resources, proximal and distal contexts, changes in reasoning and outcomes.But integration also brings trade-offs. Alejandro and Justin discuss the risks of adding further complexity to an already demanding approach, whether behavioural frameworks adequately capture social and organisational mechanisms and why greater standardisation should not come at the expense of the flexibility that makes realist approaches valuable.Whether you are a realist evaluator, realist reviewer, behavioural scientist, intervention researcher, healthcare researcher, student, supervisor, or PhD researcher, thisepisode offers an accessible exploration of what these traditions might learn from one another and how a more shared language could strengthen the accumulation and practical use of realist knowledge.

What does it mean to use artificial intelligence well in realist research? And where should we draw the red lines?In this timely and balanced conversation, Alejandro is joined by Professor Andrew Booth, Professor in Evidence Synthesis at the University of Sheffield, whose work spans systematic reviews, qualitative evidence synthesis, information retrieval, and realist synthesis.Andrew approaches AI not as a solution to every methodological challenge, nor as something researchers should simply reject, but as a potentially useful assistant. Drawing on his extensive experience in evidence synthesis and realist research, he considers where AI might genuinely enhance existing research practices and where its apparent convenience can become misleading.But the conversation also tackles the risks. Andrew discusses hallucinated references, the persuasive plausibility of AI-generated answers and the danger of producing neat, fully formed CMO configurations when the evidence itself may bepartial, ambiguous, or better represented through incomplete configurations that require human synthesis and discussion.Alejandro and Andrew also explore one of the deeper concerns surrounding AI: what happens to researchers’ intellectual development and academic voice when too much of the process begins with a blank page handed over to a machine? Andrew concludes with three practical principles for responsible AI use in realist research.Whether you are a realist evaluator, realist reviewer, evidence synthesis researcher, information specialist, student, supervisor, or PhD researcher, this episode offers a practical and refreshingly nuanced discussion of how we might engage with AI without allowing it to replace the distinctly human work of thinking, judging, interpreting and explaining.

What does it really take to conduct a realist review when you are new to realist research, and there is no simple methodological roadmap to follow? How can realist approaches help us understand why communication partner training works in some contexts but is difficult to sustain or embed in others?In this open and highly practical conversation, Alejandro is joined by Yvonne Fitzmaurice, an experienced speech and language therapist, educator and PhD researcher, currently working in clinical speech and language therapy education at the University of Galway.Drawing on more than 20 years of clinical experience, Yvonne explores her work on communication partner training (CPT) for people with communication impairments followingstroke. She explains why realist review felt particularly well suited to an intervention whose success depends not only on the training itself, but on the people delivering it, the settings in which it is introduced, the wider systems surrounding it and whether it can be sustained and embedded into healthcareeducation. Yvonne also reflects candidly on her transition from experienced clinician to novice realist researcher. She shares how developing a protocol, undertaking realist training working closely with supervisors and building acarefully selected advisory group helped provide structure and direction.The discussion explores what Yvonne’s realist review has revealed about the multiple, interacting and layered contexts surrounding CPT. Yvonne also describes the crucial contribution of realist advisors, educators, students, and public and patient contributors with lived experience of communication impairment in developing and refining programme theory.Whether you are a clinician, speech and language therapist, educator, researcher, student, PhD researcher, PPI contributor or someone beginning a realist review of a complex intervention, this episode offers an honest and encouraging account of learning to grow as a realist researcher.

What does it mean to conduct realist evaluation well when timelines are tight, budgets are limited, data access is imperfect, and commissioners want findings that areclear, useful, and actionable? How can evaluators remain faithful to realist principles without becoming trapped in theoretical complexity, or reducing context, mechanism, and outcome configurations to formulaic boxes?In this refreshingly practical conversation, Alejandro is joined by Associate Professor Brad Astbury, Associate Professor of Health Systems Evaluation at the University of Melbourne, whose work spans evaluation practice, public health,government-commissioned evaluation, programme theory, teaching, and realist approaches. Brad reflects on his journey from criminology and the corrections system to more than two decades of engagement with realist evaluation. Drawing on his extensive experience conducting evaluations for government, he explores some of the most common ways realist approaches are misunderstood, overcomplicated, underdeveloped, or applied in circumstances where another evaluation approachmight be more appropriate. The discussion explores the pressure commissioners and public servants face to produce straightforward answers to complex questions. Brad explains how evaluators canacknowledge legitimate accountability needs while also generating the more nuanced knowledge required to improve, adapt, target, transfer, and scale programmes.Throughout the episode, Brad emphasises the importance of accessible language, listening before prescribing a methodology, preparing to explain realist ideas todifferent audiences, and approaching evaluation as a form of disciplined curiosity that asks “why?” relentlessly. He concludes with four practical principles for commissioned work.Whether you are an evaluator, commissioner, researcher, public servant, policymaker, consultant, student, or PhD researcher, this episode offers practical wisdom for conducting realist evaluation with integrity under real-world conditions.

How can realist evaluation help us understand why exercise interventions work, for whom, in what circumstances, and why? And what happens when patients and interest group holders are not just consulted, but actively involved in shaping programme theories, intervention design, and implementation?In this reflective conversation, Alejandro is joined by Dr Deirdre McGrath, lecturer in nursing at Queen’s University Belfast, whose work brings together realist evaluation, co-design, patient and public involvement, oncology, palliative care, and cancer rehabilitation.Deirdre reflects on her journey from clinical practice in oncology and palliative care to realist research, focusing particularly on exercise interventions for women with ovarian cancer. Drawing on her PhD work, she explains why traditionalevaluations of exercise interventions often struggle to explain variation in participation, adherence, and outcomes, and how realist approaches can help us ask deeper questions about what works, for whom, in what circumstances, and why.The conversation explores how co-design can strengthen realist evaluation by bringing patients, carers, clinicians, academics, and other interest group holders into the research process in meaningful ways. Deirdre discusses how women with ovarian cancer helped reshape her assumptions about what an exercise intervention should look like, including the move from an initially imagined in-person intervention to a home-based programme shaped by lived experience, practical constraints, psychological safety, trust, relevance, and flexibility.Deirdre also reflects on the challenges of making realist terminology accessible, avoiding tokenistic involvement, managing different interest group holder perspectives, and creating safe spaces where people feel genuinely able to contribute. She highlights the importance of humility, listening, feedback loops, and recognising patients as experts in their own care.Whether you’re an evaluator, researcher, clinician, public health practitioner, student, PhD researcher, or someone interested in realist evaluation, co-production, cancer rehabilitation, patient involvement, or complex interventions, this episode offers valuable insights into how realist thinkingand co-design can work together to produce more grounded, useful, and meaningful research.Note: Although the terms “co-production” and “co-design” are sometimes used interchangeably in the conversation, this podcast episode specifically focuses on co-design.