Background:
As third year PhD students, we remain novices in realist evaluation (RE). However both have decades of clinical experience with open question interview style instilled into our beings. For we are not the person in front of us, who may be intimidated by our roles and be keen to please, giving the answer believed to be desired as opposed to actual. The concept of 'I'll show-you-my-theory-if-you'll-show-me-yours’ is thus a challenge particularly, based on our experience, when engaging with the vulnerable in society.
Our PhD research with vulnerable people:
The first realist inspired evaluation is on telecare for older people living in their own homes (MB). Some participants were frail and/or had cognitive impairment (CI) due to dementia. The second is on Salvation Army Corps based services for people with problematic alcohol use (PAU) and CI, including due to alcohol-related brain damage (JH). We argue that a realist interview approach of 'showing' your programme theory to the interviewees to ask for their opinion is not always appropriate. For as clinicians, we are also immersed in, 'first, do no harm' and programme theories presented may cause distress to participants. Nevertheless we recognise potential paternalistic influences in our stances in this matter.
Interviews and focus groups: what worked, for who, in what circumstances and why:
Both researchers opted for open question approaches based on topic guides, though JH found with certain participants, closed questions were sometimes useful for clarity and to encourage responses. Participants often had personal stories they wished to convey, not necessarily of relevance to the research. However the stories added to understanding of the complexity of the context. It also gave MB and JH opportunities to informally assess capacity for research participation: this could vary dependent upon influences on cognitive function including infection, alcohol and drugs. Key to interview success was a rapid establishment of trust enabling participants to feel relaxed and able to converse. With some, clear and relevant responses were provided to the interview topics, and with others, 'nuggets' were found within more participant led aspects of conversation. Sometimes conversations circled till clarity in a specific area was reached. For some of JH’s participants, the draw of alcohol limited the duration and thus interview content. However there was a 'drystane dyke' effect within the interviews, with different participants adding strength to understanding with recognition also that gaps remained. Both MS and JH adapted their interview style to that which met the cognitive ability, vocabulary, communication and behaviour style of each participant. This included encouragement of participant sharing of their own views as opposed to what they might think was expected. Personal reflections post each interview by MB and JH enabled refinement of subsequent approaches in accordance to individual participant need.
Conclusion:
In order to optimise researcher learning from vulnerable people including those with cognitive impairment, mental ill-health or problematic drug or alcohol use, sensitivity and readiness to adapt realist evaluation interviews to a style in keeping with participant cognitive ability, vocabulary, communication and behaviour style is recommended.
Please select one of the following:: Realist evaluation , Please select a maximum of two themes from the following list:: Theory in Realist Approach
