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LICTR Seminar: From Chaos to Confidence Intervals

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Worsley Building, Level 9 Seminar Room

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From Chaos to Confidence Intervals: Combining Realist Evaluations with Trials of Complex Interventions

Steve Ariss

There has been much recent debate about the place of mixed-methods in trial design, particularly when considering complex interventions. In order to understand and account for complexities, recommendations and guidance have increasingly supported augmentations to trials. For instance since the earlier publication in 2000, MRC guidance for evaluating complex interventions has taken on board many aspects of complexity theory (e.g. non-linearity). This resulted in revised recommendations; notably to incorporate mixed methods and elements of process evaluation (Craig et al, 2006).

These recommendations emphasise the importance of theory-driven methods of enquiry, which have commonalities with Realist methodology; with a focus on understanding ‘causal mechanisms’, ‘active ingredients’ and ‘contextual factors’ associated with outcome variations (e.g. Moore et al, 2015). In parallel to an increased acceptance of the potential benefits of incorporating these approaches within trial designs, there have been developments within evaluation methodology to incorporate complexity theory (e.g. Pawson, 2013, Patton, 2011).

However, this apparent convergence in the development of Realist Evaluation methodology and trial design faces difficulties in establishing a widely accepted combined research approach. This talk will explain why complex interventions are becoming the norm in changes to health and social care delivery, and why as researchers we need to embrace complexity; to provide the type and quality of evidence that is required for service improvement. Using examples from an ongoing study, it will investigate the value of combining Realist methods with trial designs in complex settings, whilst exploring some of the associated theoretical and practical concerns.

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