Challenges in doing a realist synthesis when theories are hard to find: Searching for theoretical explanations of how culturally adapted interventions influence learning and behaviour

We are conducting a realist synthesis of self-management interventions for disadvantaged populations. Our literature search and screening process suggest that the majority of the literature available to synthesize is on... [ view full abstract ]

We are conducting a realist synthesis of self-management interventions for disadvantaged populations. Our literature search and screening process suggest that the majority of the literature available to synthesize is on ethnic minority populations in the United States (African American and Hispanic populations). These studies largely involve self-management interventions that have been ‘adapted’ in various ways to better meet the needs of these cultural groups. These adaptations are implicitly understood by the authors to be important for the effectiveness of the interventions. Yet, theoretical discussions, when they exist, are most often related to social cognitive learning theories that do not specifically address the role these adaptations might play in learning and behaviour change processes.

In trying to understand the complex mechanisms operating between these cultural intervention modifications and participants’ responses, we have been searching for candidate mid-range theories. We have been looking for theoretical insights in health promotion, behavioural science, adult learning, culture and diversity and self-management literature and our search is continuing. Based on what we have been able to find to date, it seems that the assumption that culturally adapted interventions are essential for ethnic minority populations has evolved from practice, specifically cultural competency. From the vast literature on cultural adaptations by Resnicow et al. (2002), Cochran and Mays (1993), Barrera et al., (2012) we have also found that the question of whether existing behaviour change theories can be used as the foundation for explaining cultural adaptations of interventions is currently being debated.

This paper explores our journey to find theory that can help us understand how culturally adapted interventions work, that is, how they influence learning and behaviour change processes. We will discuss the implications of our theory search and findings on our realist synthesis process and highlight the challenges we are encountering when relevant candidate theories don’t seem to exist.