Realist inquiry

Public health interventions are complex interventions located within complex and open health and social systems. Both public health researchers and practitioners need to take into account this complexity, particularly the context in which interventions succeed or fail. Only then can context informed and appropriate recommendations be made for policy and practice. Experimental, positivist methodologies, which narrowly focus on the outcomes of interventions, are inadequate to deal with this complexity. Realist inquiry can help answer the question: “what is it about this program that works for whom in what circumstances”, in other words: which mechanisms cause which outcome under which circumstances. Realist inquiry can help unravel mechanisms of change in complex, open systems. It can help reveal how the interaction of an intervention with a specific context triggers reactions (mechanisms) which cause certain outcomes to occur. At the KIT Department of Development Policy and Practice our primary concern is with generating knowledge which is of practical relevance to policy and practice. We find the realist approach to be a particularly appropriate approach to achieve this end given our focus on the social sectors in international development. We have been using the realist approach in the advisory services that we provide, as part of the evaluations we conduct and the research we do. In further developing research and evaluation with a realist perspective, we work together with the Health Care Management Unit of the Department of Public Health, Institute of Tropical Medicine, Antwerp