Abstract
BackgroundThe concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. Our large, interdisciplinary research team has also experienced challenges in making the concept useful in our study of the implementation of models of integrated community-based primary health care (ICBPHC) in three international jurisdictions (Ontario and Quebec in Canada, and in New Zealand).MethodsIn this paper we summarize definitions of mechanism found in realist methodological literature, and report an empirical example of a realist analysis of the implementation ICBPHC.ResultsWe use our empirical example to illustrate two points. First, the distinction between contexts and mechanisms might ultimately be arbitrary, with more distally located mechanisms becoming contexts as research teams focus their analytic attention more proximally to the outcome of interest. Second, the relationships between mechanisms, human reasoning, and human agency need to be considered in greater detail to inform realist-informed analysis; understanding these relationships is fundamental to understanding the ways in which mechanisms operate through individuals and groups to effect the outcomes of complex health interventions.ConclusionsWe conclude our paper with reflections on human agency and outline the implications of our analysis for realist research and realist evaluation.
Highlights
The concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research
This paper reports on our experience in relation to both empirical research and the theoretical literature, advancing dialogue on the conceptualization and operationalization of mechanisms in realist research and evaluation
We provide an example from our study of the implementation of integrated community-based primary health care (ICBPHC) to make these ideas more concrete, and suggest that further thought is required about the assumed ontological difference between context and mechanism in empirical realist analyses
Summary
The concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. The concept of “mechanism” has become a very popular analytic device in applied social science, and in health services and policy research. This concept is closely associated with the rise of realist evaluation [1], which seeks to articulate what works, for whom, under what circumstances [2]. This general approach has been used in a variety of settings to contribute to better. The concept has seemed to many investigators to promise a fruitful, stimulating direction of inquiry [3, 4, 7], yet the range of definitions and modes of usage still present in the literature may undermine the benefits of the concept
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