Getting to grips with context and complexity - the case for realist approaches.

There is cause for celebration in 2017 for some realist researchers and evaluators as it is the 20th anniversary of the publication of Realistic Evaluation by Pawson and Tilley.1 Whilst this may be the case, there is still a high chance that realistic evaluation (or realist evaluation as it is now more commonly referred to) will be unfamiliar to many public health practitioners and researchers. You are probably thinking ‘so what?’ and I would not blame you, as there are many research methods and approaches and realist research approaches are but one of many. But I would urge you to read on as why it would matter to you would depend on the type of problems you deal with and knowledge you need. I am happy to be challenged on this, but I suspect that you have noticed that researchers and evaluators keep mentioning that interventions in public health are ‘complex’ and that outcomes that occur in these interventions depends on ‘context’. Some would argue that most (if not all) public health problems are complex and that many researchers, rather than use methodologies that are able to deal with complexity and context dependent outcomes, prefer to ignore them or take a more reductionist approach. Knowing how to make sense of complex interventions with context dependent outcomes is not easy, but nor is it impossible. One possible option is to use realist approaches. Until I had learnt more about realist research approaches, I used to wonder how and why outcomes were influenced by context and also what to do about the issue of complexity. Whilst I am certain that there will be research approaches out there that have explanations of how context influences outcomes and/or how to undertake research or evaluation of complex interventions, to me, the appeal of realist research approaches are their explicit and coherent approaches to these issues. In addition, they have the added bonus of being approaches that focus on producing knowledge that is potentially transferable to other contexts. So, what are realist approaches to research or evaluation? In this editorial, at best I will only be able to provide a very brief overview and explanation of realist approaches. There are two realist research approaches that I will cover in this editorial –realist evaluation and realist review. Realist evaluation is a form of theory drive evaluation approach –that is it uses primary data (data you have to go out and collect) to confirm, refute and refine realist theory or theories about the phenomenon of interest.1 Realist evaluations often start with a programme theory –that is an explanation of how, why, for whom, in what contexts and to what extent an intervention is meant to ‘work’. At the start of an evalua-