Critical Realist Approach Research Articles

Critical Teacher Education for Social Sustainability: Voices from Zambian Student Teachers and Tutors

ABSTRACT This study aims to reveal the contributions of teacher education to social sustainability in an African context. The study explored the gaps and connections between multiple layers of policy, global, regional, and national educational targets, and the voices of teacher education tutors and students from a local teacher education college in the Copperbelt region of Zambia. Semi-structured interviews were employed to gather participants’ views on their aspiration, knowledge transformation and professional capacity. Employing a critical realist approach, the study identifies four key ‘moments’ in teacher education (Robertson and Dale, 2015) and reveals dedicated teacher education practices that aim to support national economic development local demands for specialised subject knowledge, along with family and individual human needs within communities. The findings lead to a discussion mapping critical teacher education that promotes social sustainability within the Global South, emphasising the significant roles of teacher education in fostering a comprehensive understanding of societies and human well-being, encouraging reciprocal knowledge exchange within communities, and supporting the continued professional development of teachers.

Local Government and Natural Resource Management in Madhya Pradesh, India: A Critical Institutional Analysis

This paper investigates the factors that influence the involvement of local government in natural resource management in a decentralized institutional context. Institutions, regulating resource use patterns and practices are indicated to be decisive for the success or failure of resource management initiatives, and decentralization is considered a promising institutional arrangement in this regard. In this context, it is significant that India adopted decentralization through the 73rd Constitutional Amendment Act, devolving resource management functions to the local government. However, there is limited work on how local government engages with devolved functions and what factors influence its resource management interventions. Consequently, we investigate the factors that influence the involvement of local government in natural resource management across three village councils in India. Taking a critical realist approach, we find that although multiple factors exert their influence, institutional force and actors’ rational incentives serve as key causal factors explaining local government’s involvement with resource management.

Family caregivers' experiences of accessing information from healthcare professionals in heart failure.

With growing reliance on family caregivers to support people with advanced heart failure and to help them die at home, family caregivers need the relevant information to support this. However, evidence has shown that families continue to have deficits in their knowledge of heart failure and what to expect as the disease advances. This can lead to a high level of uncertainty and stress for family. To explore family caregivers experiences of accessing information from healthcare professionals when caring for someone with heart failure. A qualitative exploratory study design was adopted using a critical realist approach. The study was conducted in one large urban area of Aotearoa New Zealand. Participants were family caregivers of people who had died between April and November 2019. Data was collected using semi-structured telephone interviews. A total of 15 family caregivers participated. A thematic analysis identified three themes related to accessing information from healthcare professionals: 1) gaining access to healthcare professionals 2) developing, understanding and translating information and 3) receiving information in a timely manner. Findings highlight the difficulites that family carers of people with heart failure experience in accessing, receiving and understanding the information they require. Further research is needed on supporting healthcare professionals to develop skills in appearing accessible within an environment of 'busyness'. Furthermore, investigating strategies which will enable healthcare settings to be more responsive and flexible to the needs of family caregivers is needed.

Implementing a remote self-screening programme for atrial fibrillation using digital health technology among community-dwellers aged 75 years and older: a qualitative evaluation

ObjectiveTo examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system.DesignProcess evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875)...

Fostering health behaviour change in overweight male football fans through the European Fans in Training (EuroFIT) program: A Self-Determination Theory perspective

The European Fans in Training (EuroFIT) program integrated need-supportive motivational strategies from Self-Determination Theory (SDT) in the design of a healthy lifestyle program delivered to overweight or obese male football fans (n = 1113; mean age of 45.9 [SD = 9.0] years old and BMI of 33.2 kg/m2 [SD = 4.6]) in professional football club settings in the UK, Portugal, Norway and the Netherlands. With a critical realist approach, we developed a structured thematic framework analysis based on Self-Determination Theory (SDT) to investigate the process of change in men who participated in the EuroFIT randomized controlled trial (RCT). We examined whether men’s experiences of the social context of EuroFIT, and whether their engagement with the program’s motivational strategies supported or frustrated their basic psychological needs while attempting to change their lifestyle behaviours. We found that men in all countries perceived the social contexts of the EuroFIT program as mostly needs-supportive, and that they found engagement with most of the program components helpful in supporting their psychological needs when initiating health behaviour changes. However, some of the program elements in the EuroFIT program were perceived as needs-frustrating by some participants and need-supportive by others. Implications for the use of need-supportive motivational strategies in designing future lifestyle interventions in sport settings to promote health behaviour change among male football fans are discussed.

A critical realist approach to agent-based modeling: Unlocking prediction in non-positivist paradigms

Information systems (IS) scholarship and practice aim to predict phenomena and outcomes of IS use. These phenomena of IS use are typically set in multi-leveled, dynamic, and complex contexts that lend explanation to the non-positivist tradition in IS research. However, limited methodological options exist to make predictions. In this research, we propose stratified agent-based modeling, a step-by-step approach that enables prediction in non-positivist paradigms. Drawing upon the critical realist philosophy of science, which suggests ontological stratification and assumes open systems, we adopt a retroduction-based explanation formation and agent-based modeling to simulate different potential states of a complex system. The critical step in combining critical realism with agent-based modeling involves identifying and codifying the underlying generative mechanisms (i.e., causal powers) into various components of the agent-based model. We propose four steps toward prediction under the critical realist paradigm: (1) capturing the phenomenon, (2) identifying the generative mechanism, (3) building the agent-based model, and (4) simulating states of the system. We present an exemplar of our proposed approach that investigates the effectiveness of strategies to combat malicious content propagation in social networks.

Exploring users’ algorithmic knowledge and reflexivity in a music streaming context: A critical realist approach

Digital platforms such as Spotify have specific characteristics and properties that influence, to some extent, how the platform is used. However, users develop their own interpretations of these properties as well as unique ways to engage with the platform. This study applies a critical realist framework to explore how reflexivity modes are practiced in the context of Spotify as an example of algorithmic recommendation systems. From this perspective, reflexivity is a person’s capacity to reflect on their contexts, data, previous experiences, and knowledge, among other elements, before deciding how to act. Findings from interviews with Spotify users suggest that participants practice multiple reflexivity modes when interpreting Spotify’s recommendations and deciding what to listen to. These modes depend on each participant’s concerns and algorithmic knowledge.

Sensing physical properties for subjective meanings: Putting Emergent Consumer Perceived Value (ECPV) into the marketers’ toolbox

AbstractMarketers need to understand consumers in both theory and practice to create offerings that are valuable to them. Hence, the marketing discipline has conceptualized consumers’ subjectively perceived value in various ways, using multiple paradigms. Nevertheless, its constituents remain unclear. We argue that this is because the ontological and epistemological premises are both vague and narrow. Consequently, consumers’ value perceptions are still difficult to study or manage. With the aim of making a conceptual leap, our paper is the first to apply a critical realist (CR) approach to the phenomenon. CR’s stratified ontology and subjectivist/pluralist epistemology reconcile the positivist and interpretivist/constructionist paradigms, allowing the simultaneous existence of external socio-natural and internal subjective realities. Using these premises, we examine, from a marketer’s perspective, how consumers perceive value, which is a subjective, phenomenological, and socially constructed act embedded in the natural world. Our CR theorizing deploys Bhaskar’s (2010) RRREIC schema and includes a review of the extant subjective value conceptualizations (consumer perceived value, value-in-use, value-in-experience) and retroduction of the key mechanisms generating the phenomenon: meaning-making and sensory perception. Finally, we propose a novel conceptualization for Emergent Consumer Perceived Value formation (ECPV) as an open system. As its integral component, we introduce the concept of Sensory Value Affordance, explaining how consumers transform physical properties into subjective meanings. These conceptual tools cater especially to B2C managers and account for both the phenomenological and sociocultural as well as the corporeal and perceptual. Finally, we present broader implications for value research, the field of marketing, and society.

The ethics of enhancement among image and performance enhancing drug coaches

ABSTRACT This research examines image and performance-enhancing drug (IPED) use, specifically focusing on the emerging role of IPED coaches. Situating drug use within broader assemblage theory, we investigated how these coaches, often operating in an online context, function as enabling environments, influencing practices, and contributing to harm reduction in a broader social context within and for IPED communities. Ten IPED coaches were interviewed, with this work focusing on their legal, ethical, and moral considerations, risk assessment, and harm reduction strategies of their practices. We employed a critical realist approach, following flexible coding to identify and develop themes which were further framed an enabling environments framework. Coaches operated along an ethical tightrope, emphasising the conscious regulation of conduct within established norms and the nuanced assessment of risks aligned with individual goals and motivations. Power dynamics and responsibility concerns unfolded through the lens of collaborative decision-making, where trust emerged as an essential element of these relations within contextual risk assessments. IPED coaches play a role in harm reduction by fostering trust and informed decision-making, balancing clients’ goals with health considerations. These findings emphasise the potential for collaboration between IPED coaches and the health workforce to enhance health promotion and support within IPED communities.

Intersectionality of gender and age (‘gender*age’): a critical realist approach to explaining older women’s increased homelessness

ABSTRACT Older single women in Australia are increasingly experiencing homelessness. Age and gender seem inherently related to single older women’s housing crises, but no attempt has been made to account for the causes of their homelessness through an intersectional lens. This article develops a complex and contingent causal explanation of the structures and mechanisms implicated in growing homelessness for this group. We demonstrate an original use of critical realist-informed intersectional analysis which is characterized by stratified social ontology and emergence. We theoretically reframe existing literature to demonstrate how the intersectional causal powers of gender and age (‘gender*age’) discrimination and conventional life course experiences intersect to generate financial precarity for older women. Our causal model explains how economic insecurity, structural and individual contexts, and crisis events interact, challenging older women’s housing security and precipitating first-time homelessness later in life.

Exploring staff experiences of remote working in a new community rehabilitation team

Background/Aims Health services required significant adaptation during the COVID-19 pandemic. The remote community enhanced rehabilitation team was created during the pandemic in response to faster discharges. This service evaluation aimed to explore staff experiences of remote working when implementing this new community rehabilitation team. Methods Six members of the community enhanced rehabilitation team, including nursing and psychology staff, completed qualitative semi-structured interviews about staff experiences. The interviews explored experiences of delivering clinical care, providing and receiving team support and personal impacts of remote working. Data were analysed using thematic analysis via a critical-realist approach. Results Thematic analysis from the interview transcripts revealed five main themes: anxiety related to remote working practices during a global pandemic, work–life balance, developing relationships, limits to remote working and working towards a hybrid model. Conclusions Challenges and benefits of remote working were identified along with some mitigations. Moving forward, a hybrid working model would likely benefit both service users and staff.

Real Democracy: A Critical Realist Approach to Democracy and Democratic Theory

This article presents an alternative general model of democracy to traditional minimalist (electoral and liberal) and deliberative theories by drawing from critical realist philosophical thought. Realist or real democracy is proposed as a societal system where preconditions exist to fully empower all citizens to realize their individual capabilities. This includes empowerment opportunities at the ballot box - but also other preconditions such as health, educational and living standards. Real democracy also separates democratic preconditions from democratic outcomes. Democratic outcomes require the absence of inequalities in power as result from the contingent interaction preconditions and human agency. The new approach is argued to provide a more holistic and dynamic concept of democracy which is also more grounded in the everyday experience of the citizen compared to traditional approaches. It reconnects democracy with theories of human development and enables a new classification of political regimes and conception of democratic politics. An initial empirical mapping of patterns of global real democracy shows evidence of rising preconditions since 1990 – but stagnation since 2010 and some signs of decline. Democratic outcomes by socio-economic position saw the most notable decline.

Training as imagined? A critical realist analysis of Scotland’s internal medicine simulation programme

BackgroundEvaluating the impact of simulation-based education (SBE) has prioritised demonstrating a causal link to improved patient outcomes. Recent calls herald a move away from looking for causation to understanding ‘what else happened’. Inspired by Shorrock’s varieties of human work from patient safety literature, this study draws on the concept of work-as-done versus work-as-imagined. Applying this to SBE recognises that some training impacts will be unexpected, and the realities of training will never be quite as imagined. This study takes a critical realist stance to explore the experience and consequences, intended and unintended, of the internal medicine training (IMT) simulation programme in Scotland, to better understand ‘training-as-done’.MethodsCritical realism accepts that there is a reality to uncover but acknowledges that our knowledge of reality is inevitably our construction and cannot be truly objective. The IMT simulation programme involves three courses over a 3-year period: a 3-day boot camp, a skills day and a 2-day registrar-ready course. Following ethical approval, interviews were conducted with trainees who had completed all courses, as well as faculty and stakeholders both immersed in and distant from course delivery. Interviews were audio-recorded, transcribed verbatim and analysed using critical realist analysis, influenced by Shorrock’s proxies for work-as-done.ResultsBetween July and December 2023, 24 interviews were conducted with ten trainees, eight faculty members and six stakeholders. Data described proxies for training-as-done within three broad categories: design, experience and impact. Proxies for training design included training-as-prescribed, training-as-desired and training-as-prioritised which compete to produce training-as-standardised. Experience included training-as-anticipated with pre-simulation anxiety and training-as-unintended with the valued opportunity for social comparison as well as a sense of identity and social cohesion. The impact reached beyond the individual trainee with faculty development and inspiration for other training ventures.ConclusionOur findings highlight unintended consequences of SBE such as social comparison and feeling ‘valued as a trainee, valued as a person’. It sheds light on the fear of simulation, reinforcing the importance of psychological safety. A critical realist approach illuminated the ‘bigger picture’, revealing insights and underlying mechanisms that allow this study to present a new framework for conceptualising training evaluation.

It Takes Two to Tango: The Technocracy-populism Nexus in Italy and the EU from a Critical-realist Perspective

ABSTRACT The nexus between technocracy and populism in Italy can be better understood from a long-term perspective. Adopting a critical-realist approach to the explanation of political change, it is possible to identify the main contextual factors that favoured, from the early 1990s, the rise of these two alternative yet compatible logics of politics, which can be conceived as both causes and symptoms of the fatigue of representative democracy. This also allows (i) a better understanding of the entanglement of populism and technocracy after the global crisis of 2008, and (ii) the conceptualisation of the position of the European Union (EU) as a catalyst of these processes within a multi-level spatial nexus.

Reconciling Tensions in the Analysis of Bourgeois Revolutions: A Critical Realist Approach

When and how do agents consciously reproduce or unconsciously transform social structures? This inquiry is pivotal for advancing a theory of socio-historical development, particularly in addressing a key debate within International Historical Sociology (IHS) surrounding modern revolutions. This debate revolves around the tension between the “consequentialist” interpretation of bourgeois revolutions and the “revisionist” critiques, notably from the “historicist” wing of Political Marxism (PM). This article contends that the tension arises from an inadequate conceptualization of the agent-structure relationship. Drawing on Roy Bhaskar’s transformational model of social activity (TMSA) and critical realist philosophy of science, the article proposes a conceptual framework reconciling PM’s focus on class struggle to understand the historical specificity of capitalism with the role bourgeois revolutions historically and structurally played for the development of capitalism. Integrating Bhaskar’s framework with historical materialism-inspired debates on bourgeois revolutions, the paper suggests that agents’ unconscious actions can transform social structures amid social disintegration (“classic bourgeois revolutions”). Conversely, agents consciously seek to preserve and reproduce social structures, as seen in “passive revolutions”. This occurs when social structures, marked by inequality and hierarchies, are viewed as historical constructs rather than natural phenomena, particularly in the context of uneven and combined development of capitalism. This analysis contributes to ongoing IHS debates, enriches our comprehension of modern revolutions, and extends TMSA by empirically delineating circumstances wherein agents consciously uphold or unwittingly trigger the transformation of social structures.

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes.

To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.

'There's never really been an opportunity': perspectives of those with long-term conditions on advance care planning, a qualitative interview study in primary care.

Advance care planning (ACP), the process of discussing and documenting people's wishes for future care, is increasingly researched within health and social care. However, it is sometimes assumed that ACP is only for those experiencing advanced cancer or those reaching the end of life. Little is known about how those living with other major conditions perceive ACP. To explore attitudes towards ACP in this population. In-depth interview study in general practice. adults living with major conditions other than cancer (diabetes, heart disease, chronic respiratory disease, and kidney disease). Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Thematic analysis utilised a critical realist approach, underpinned by the COM-B Behaviour Change Model. NHS ethics approval (reference: 23/PR/0078). Eleven participants have been recruited (recruitment ongoing): aged 61-88 years, five males, and Rockwood Frailty Scores 1-5. Emergent COM-B themes relate to capability (wellbeing, organisational skills, and understanding); opportunity (setting, time, trust, involving others, and the 'right' moment); and motivation (motivating factors: helping loved ones, helping professionals, fearing undesirable outcomes, desiring a peaceful death, being organised, and valuing autonomy; and demotivating factors: trusting others with decisions, uncertainty regarding the future, distrusting health care, focusing on the present, and values-based objections). ACP is understood in three ways: as proactive planning, as anticipatory planning, and as acknowledgment of ill-health and mortality. Context influences understanding and understanding influences motivation. There is openness to discussing ACP as part of proactive care. Normalising ACP before ill-health may reduce distress. Public health campaigns and preventative healthcare consultations present opportunities for ACP signposting.

Establishing new medical schools in diverse contexts: A novel conceptual framework for success.

Establishing a new medical school is a significant venture involving many complex political, social, economic, educational, and organisational considerations. The published literature on the process of establishing a new medical school is, however, under-developed with minimal empirical research and no explicit reference to theory. This research sought to address these gaps and establish an empirical and theoretical evidence-base for the process of new medical school establishment in diverse contexts, particularly medically under-served areas. A Critical Realist Multiple Case Study was undertaken to examine the establishment of new medical schools across three continents. Data were collected between 2016 and 2018 through observational data gathered on site visits to three medical schools in medically under-served areas, relevant documents/audio-visual materials, and semi-structured interviews with key founding personnel. Data were analysed using the Critical Realist approach. Institutional Entrepreneurship theory was applied, adapted, and extended to explore and explain the phenomenon of new medical school establishment in diverse contexts. This study identifies eight critical success factors underpinning new medical school establishment. Framed as the Eight C's Framework (8CF), these factors include Context (field conditions), Catalysts (institutional entrepreneurs), Conducing (helping to bring about a particular situation or outcome), Collecting (resources), Connecting (relationships), Convincing (rationales), Challenges, and Consequences (outcomes). 8CF highlights that new medical schools are successfully established when Catalysts act within their Contexts to undertake the tasks of Conducing, Convincing, Collecting, and Connecting in order to produce desired Consequences and overcome Challenges. The Eight C's Framework is a theory-based, empirically supported framework that can be applied across different contexts to strategically guide the successful establishment of new medical schools. Founding leaders and stakeholders could use 8CF to ensure their establishment efforts are underpinned by theory and scholarship.

Expanding knowledge through sequential world views – a critical realist approach

ABSTRACT This paper addresses concerns that critical realism is a philosophy in search of a method, and that little guidance exists for the application of the philosophy to social research. It advances the idea that the absence of a philosophically embedded method gives critical realists the freedom to choose methods best suited to answering research questions under investigation. The paper utilizes a study into business advisor knowledge transmission, explicating how a sequential world views approach can be used to progressively expand knowledge about the topic. In this context, the research design further illustrates the symbiotic relationship of two different research methods: in-depth interviews & focus groups. The paper does not imply that any method is better than any other, rather adopts the position that methods must always suit the research aim and provide the best approach for answering the research question.

Spaycations: A Qualitative Study of Veterinarians’ Motivations And Perceived Impacts of Remote Volunteer Spay Neuter

Increasingly, veterinarians skilled in High Quality High Volume Spay Neuter (HQHVSN) are invited to volunteer their surgical services in distant low-resource communities on trips that have become casually known as “spaycations.” While these trips are numerous, there is little research on veterinarians’ motivations for participating and their perceptions of the impacts these clinics have on communities they visit. The current study was open to veterinarians who work in or are trained in HQHVSN whether or not they had been on a spaycation trip. For the purpose of this study, a spaycation is defined as an unpaid or minimally paid trip from a high resource area to a low or moderate resource country or area to provide spay neuter services that is organized by someone other than the individual surgeon. Forty-one veterinarians responded to an electronic questionnaire containing open-ended questions relating to their thoughts and experiences regarding spaycations and their impacts on the volunteer veterinarians as well as on the animals, clients, communities, veterinary practitioners, and animal populations in the areas visited. A reflexive thematic analysis was conducted in which the veterinarians’ responses were coded inductively for semantic themes using a critical realist approach. Respondents had participated in a variety of spaycations around the world over the past 20 years. Most responding veterinarians were motivated by a desire to make a difference and give back to communities in need as well as the desire to travel and to experience other cultures. Many enjoyed bonding with and learning from other vets and team members on the spaycation, and said that while the trips were exhausting they were also paradoxically energizing, and that they renewed their professional passion. Many veterinarians were concerned by the financial and time commitments associated with participating in spaycations, and these costs had prevented some veterinarians from participating. Further reasons for not participating in spaycations included concerns about stress and burnout and about the continual expectation for veterinarians to volunteer their time. Some veterinarians presented concerns about spaycations producing damaging interactions with the local communities including cultural misunderstandings, distrust, the creation of dependence, colonialism, and White Savior syndrome. Local involvement in the spay neuter event varied, with some events entirely planned and staffed locally and involving training and mentorship of local veterinary professionals and students, while other spaycations included little local involvement. Veterinarians varied in their estimation of the animal population impact of the spaycation and agreed that recurrent or ongoing interventions are necessary for appreciable and sustainable population impacts, but that health impacts on individual animals and their families were important and visible even after a single trip. Thematic analysis identified three main themes, HQHVSN is a special skill set, Colonialism and Cost and Value. Spaycations are a unique way for HQHVSN veterinarians to use their distinctive skills in communities of need. The compelling nature of these trips necessitates conscientious and culturally-sensitive leadership and planning to provide safe, sustainable, community-centered programs with a focus on long-term solutions.