Realist Ras of complex interventions - An oxymoron
Realist Ras of complex interventions - An oxymoron
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DOI：
10.1016/j.socscimed.2013.06.025
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发表时间：
2013-10-01
影响因子：
5.4
通讯作者：
Pawson, Ray
中科院分区：
文献类型：
--
作者：
Marchal, Bruno;Westhorp, Gill;Pawson, Ray
Bonell等人。讨论实施随机对照试验(RCT)以评估公共卫生中的复杂干预措施的挑战，并考虑现实主义评估在改进这一设计中的作用(Bonell、Fletcher、Morton、Lorenc和Moore，2012)。他们主张“现实主义评估与随机化评估之间的协同关系，而不是对立关系”，而且“在不放弃随机对照研究作为检验干预因果关系的最佳手段的情况下，也有可能从现实主义评估提供的见解中获益”。我们对他们对现实主义评估的分析和他们对现实主义RCT的建议提出了反驳。质疑是否以及如何改进(准)实验设计以更好地评估复杂的公共卫生干预措施是正确的。然而，这篇论文没有解释一个从根本上建立在实证主义本体论和认识论立场上的研究设计如何被有意义地调整，以便从现实主义范式中使用它。关于“现实主义区域协调机制”的建议没有充分考虑到对区域协调机制设计构成重大挑战的复杂因素。他们也忽视了现实主义评估方法的主要原则。我们建议，形容词‘现实主义者’应该继续用于基于现实主义哲学的研究，其分析方法遵循现实主义分析的既定原则。将Bonell和同事的理论提出的方法称为RCT更正确，这确实有助于增强RCT。(C)2013爱思唯尔有限公司。保留所有权利。
Bonell et al. discuss the challenges of carrying out randomised controlled trials (RCTs) to evaluate complex interventions in public health, and consider the role of realist evaluation in enhancing this design (Bonell, Fletcher, Morton, Lorenc, & Moore, 2012). They argue for a "synergistic, rather than oppositional relationship between realist and randomised evaluation" and that "it is possible to benefit from the insights provided by realist evaluation without relinquishing the RCT as the best means of examining intervention causality." We present counter-arguments to their analysis of realist evaluation and their recommendations for realist RCTs.Bonell et al. are right to question whether and how (quasi-)experimental designs can be improved to better evaluate complex public health interventions. However, the paper does not explain how a research design that is fundamentally built upon a positivist ontological and epistemological position can be meaningfully adapted to allow it to be used from within a realist paradigm. The recommendations for "realist RCTs" do not sufficiently take into account important elements of complexity that pose major challenges for the RCT design. They also ignore key tenets of the realist evaluation approach.We propose that the adjective 'realist' should continue to be used only for studies based on a realist philosophy and whose analytic approach follows the established principles of realist analysis. It seems more correct to call the approach proposed by Bonell and colleagues 'theory informed RCT, which indeed can help in enhancing RCTs. (C) 2013 Elsevier Ltd. All rights reserved.