Yeah, I know. Okay.
Good evening. Thank you so much. Over attending.
So with this this evening, we have and tribute to this.
I am not going to be able to pretend to be able to introduce Andrew, but he's definitely introduced himself.
And a great many of you are here. But it will be. And then the magic happens.
Can really synthesis really be systematic?
So, Andrew, the floor is yours. Thank you for attending.
It's great to be here. And so particularly appreciation.
You've had a heavy day and trying to not be too heavy, but I will try and be controversial.
So we'll see how that goes. And obviously the controversy is present there in the of the title.
What I would say is my background, just over 20 years ago, I joined the School of Health and related research for the University of Sheffield.
We do a wide range of systematic reviews for all sorts of funders.
Perhaps the one that I'm sort of most proud of at this particular moment was
doing the review of for the Department of Health on alcohol minimum pricing,
because although England resolutely refused to listen, partly because of how many votes they thought it would lose.
But Scotland has just of course reacted to that thought it would make a lovely impact story and I was the first reviewer on that particular piece.
But in later review life I saw the light and became a qualitative evidence synthesiser
and that sort of led me in a roundabout really to familiarity with reality synthesis.
I'm co-convenor, one of ten co-convenor of the Cochrane Qualitative and Implementation Methods Group.
So I'm coming from the stance of being systematic review of an introduction, if you like, sympathetic to the qualitative tradition,
very keen on the idea of the systematic review toolkit, in other words, that you need to be able to choose methods judiciously.
And so that's where I'm going to be coming from today. So this is what I said that I would talk through.
So I have to do this in some way.
I'm just going to very briefly rehearse the role of really synthesis within health services, research and evaluation.
Then looking at this sort of juxtaposition of another thing I should say is my my Ph.D. thesis,
fairly recently I did five publications was on the conflicting traditions of qualitative synthesis I'm sorry,
qualitative research, having systematic reviews as they came into conflict, if you like, about two tectonic plates rubbing together.
I could see an element of that here with with systematic reviews of realist synthesis
that they are like two tectonic plates struggling to to sort of occupy a role.
I'm going to be a little bit provocative.
This table is really synthesis, really a review method or is it so claiming time and resources away from from doing the real job?
And then I'm going to look at some of the challenges and issues and I've sort of given a little
bit of the story away at the end that won't be quite such an angry old man as I present myself.
So where are we coming from? Really, synthesis is fitting within a new feature in an evaluation world,
if you like research and evaluation world where we're increasingly interested in theory informed approaches.
And so really synthesis offers a mechanism by which we can engage with that theory.
Obviously we do that at two levels. We do it at the level of a programme theory, that's how it works type of theory.
But then we try and relate it to something a bit more generalisable, a bit more transferable, hence the interest in mechanism.
But it is only one route by which to pursue that sort of inquiry.
Complex interventions, a recognition that to understand not just the intervention itself but the the health system within which it's operating,
the population context, all of these other things, that that has become an increasing preoccupation.
Obviously the MRC guidance on use of complex interventions and increasingly we're recognising that context is important.
You can have the same intervention in different contexts, work or not, work or work with differential effectiveness.
And of course really synthesis is appropriate to this mantra and I wish I had a pound for every time I saw this about a grant proposal or an article.
What works for whom? Under what circumstances? The employer.
Here is the it's not the only methodology explore and deliver against know one of the it happens to be a particularly sexy one at the moment.
And by all means, let's take advantage of that. But let's not pretend it's the only one that looks at some variation.
And so, as many of you are already aware, that the effectiveness review has its limitations, it was designed for a particular purpose.
And when it gets beyond that purpose, it starts to feel deficient.
So, for example, a systematic review, you strip out all the context.
And then when you come to writing up your your discussion, you then try to reinsert the context with your recommendations.
This seems a little bit perverse for throwing all the facts information away and then reconstituting it.
It's a bit like a cartoon that I remember saying, which is someone who invented dehydrated water, and I'll just add water to get back to it again.
And there's an element to that with a systematic review. There's a recognition that there's more diverse data that we can actually bring to bear.
So we don't just think of the randomised controlled trial, we think of a company process evaluation.
Perhaps it comes from qualitative research we went through inside,
helped in the design of the intervention that all offers information that can help us to understand what's going on.
And importantly is there's a lot of the receptivity to either really state based approaches or the possible alternative logic model based approaches.
Essentially, they both have a logic. The terminology is different, and for many people,
the terminology of logic models is actually more accessible from another field of realist approaches.
But but increasingly, all funders are saying, where is your logic in your proposal?
You know, not just the outcome, but actually as part of the design, because this is a sort of cheap shot that I thought you'd find interesting.
This is the growth of realist reviews and sympathy, just calculated from a fairly simple third of public off.
Just earlier on in this week, we can see tremendous growth.
And of course, it's not just within the medical field that we see where this incomplete.
So this if be like is just just within the scope of my client.
I've just selected some of the funded realist work that has been received just through one funding organisation,
the nature of and the primary one in this country.
And you can see that the program that's most interested in, in the realist approaches is the health services and delivery research program.
That bears out my own experience as we come to the minute.
But we do see them already there with with health technology assessments and other projects through in process.
And the alternative here with this final one isn't a realist synthesis, but it's a logic model approach.
So if you're interested in, you know, sort of counter pose, no counterpoint in the two different approaches together,
that shows you another way of trying to explore the logic of what's going on.
And this is my my own experience of really simple things that are mounting up a bit.
So for the help that knows the assessment program, I'm looking at prevention of postnatal depression,
particularly looking at the contribution of group processes.
So groups have certain mechanisms that can be beneficial, so they can encourage you being part of a self-help group.
But on the other hand, they can be demoralising. You think so-and-so's getting better?
I'm not sure. Or I can sympathise with so-and-so, but she's been coming here for months and months and doesn't seem to be getting any better.
So is it likely that I'm not going to be getting any better? So.
So we do tend to think of groups as being a good thing,
but of course we realise that there are adverse effects of group treatment and so that was the sort of thing we were able to
explore in that particular really simple appointment to remind the system and looking at the logic behind people's attendance,
whether there are particular types of appointments that people are more likely to attend.
And one of the simple things we did was just look at the attendance rates across a variety of conditions,
and we found that things that were about attendance for something in the general population that like a blood donation,
had some very low participation, low attendance rates and things that were targeted at, for example, accompanying a sick child.
Perhaps an inherited metabolic disease clinic have very high attendance.
And so we could we can hypothesise things about people's feeling of the importance of the organs or indeed the symbolism of the appointment.
There are other ones in public health and the community engagement group clinics.
Some of you who are familiar with real surfaces might prefer that the idea of transferable or
reusable platforms where you can take some of the arising from one area and use it in another.
Well, course, because with the recurrence of groups in group clinics, I was able to use some of the thinking that had informed the group treatment,
post-natal depression in terms of thinking about both positive and negative consequences.
So work with a local research panel on dementia, dementia and how people,
people involved in improvement of services when they have that diminished capacity
and also that their life challenging while medically unexplained symptoms.
And that was challenging because every aspect of the the question was would say and then we use really synthesis which
is another layer of interpretation for the whole process and then one in a reorganisation context which is of care.
But then I'll go through all of these, but just to show that there are other ones taking place.
I will just highlight the avoidable admissions one that because this is part of
the half a million pound contract that we have to do on demand rapid reviews.
And we're actually doing a real synthesis to try and fix what happened with regard to avoidable admission.
That's an interesting one because the problem we've actually said we want to know barriers and
facilitators and we thought that's a very simplistic and probably not very helpful question to ask.
And because it was the HSBC all programme said, well, would you mind if we explore the theory of synthesis?
So, so we've up the expectations of behind that but we think would be more useful than just having a simple hope.
And barriers and facilitators postcode problem.
But I've already mentioned that some of the methods can contribute to all lines of inquiry.
This is supposed to be me writing to horses because I'm also involved in some of the thinking around use of logic models and systematic reviews.
And so it's just sort of fair to present factors.
I'm not sure if it's the control or the intervention really synthesis, but as a comparator.
And so I've been involved in producing guidance as part of an EU protocol on the use of logic models.
And this is where the interesting similarities and differences come from.
Erm there's no doubt that really synthesis can contribute something that is not present in most review methods.
And this is a very nice article, it's part of the theory from just it's written a very good piece to this own complexity, this a series.
But this is actually saying that that's one of the virtues of really synthesis
is it's a method for integrating quantitative and qualitative data together.
There are many methods to that. There are techniques for bringing together,
like putting things in matrices or using a model or framework to bring quantitative and qualitative data together.
But there are not very measured. So that to me could just we like to vote is the prediction.
And so that's certainly worth bearing in mind when we're trying to evaluate the role of
really thesis and the challenge of complexity is trying to unearth the sources of variation.
Well, that's very close, very far, really synthesis. Although it's interesting that the authors of this paper also say that.
So most of the models are a route by which to achieve that and we see a growing interest in review targets.
And so if you like, what we're doing is we're opening an increasing toolbox of different review types for different purposes.
And here are some examples. Rapid reviews.
I know the course has already mentioned the theories of by three or four different papers on review types.
So it's very appropriate to be thinking, well, what is the the role to be inhabited by realist reviews and really synthesis.
But the danger is the we could adopt this sort of uncritically is yet another method and as I indicated in.
I've been around a long time, and the first systematic reviews that we had to deal with were clinical effectiveness reviews.
That was that was the model pioneered by Cochrane.
Pretty early on, though, record of questions about clinical effectiveness in a health environment without asking the cost effectiveness question.
I was then involved in one of the earliest NIH, HDI reports that included qualitative research.
In a review. We were looking at a newborn screening, neonatal screening, and of course,
one of the things you have to do is take a blood sample from the heel of the of the newborn.
And we wanted to look at the qualitative evidence around that so that you have the question a bit larger.
We've got clinical effectiveness, cost effectiveness, acceptability.
And since then we had all of these parts of the decision in Portland, part of the decision question expanding the acceptability, feasibility,
meaningfulness, and so that we've now seen what work for whom under the circumstances, so that it's just getting longer and longer.
The patients are getting more and more expensive.
It makes a lot of work for the research community, but it makes it even more important to know that the money is being spent in a useful way,
just as a light hearted break here that there are so many review labels, we've estimated about 50 different review labels.
But the other week I went and did a presentation in Huddersfield Go to Oxford, but still an interesting experience.
I've developed a review label, Random Generator, and someone picked up on this on Twitter and said, Do you mind if I turn it into a tweet box?
And so what we have now, every hour a new review is generated hypothetical review with a topic area, but then the actual review cycle.
So there is a whole industry about review labels. So we've got a rapid make and narrative umbrella review.
We've got findings from a rapid quantitative framework overview, a rapid quantitative realistic review, and a rapid qualitative hermeneutics.
And so, yeah, I'm not sure you should follow the phone, but it's certainly if you want to get some really enthusiastic,
if you find one of these topics in their area, they're going to think it's a real review fact.
So you could be a bit mischievous and just read it and then it looks like we've done the same thing.
But this is a real one and this was the interrupt project.
And the reason for this is I want to show the complementarity of realist reviews within the whole, if you like, to a practice here.
So look at what we're looking at intervention effectiveness, cost effectiveness, qualitative synthesis.
That was a bit how I was involved and I'm going to rewrite since the first go round Crossing the load lead.
But perhaps the most memorable thing, apart from the findings, of course,
which were brilliant, but the most memorable thing was this scheme which actually,
once you get your head around, it starts to make you think of the different role of the different types of review.
So what we have found here are the different questions for decision making means to all of us.
And then what you have here, you have the processes of evidence selection, if you like,
and then you have different types of review that can help you answer these particular questions.
And you can see here that the real synthesis is making an important contribution in terms of workers plan what work for whom and what context,
what were the barriers. So it's important to think of really synthesis not as part of this industry,
but in terms of complementarity with other parts of review for from different types of practice.
This is from a recent paper from the theories on complex interventions authored by Michael Eagle.
Many of you know as a former public health director for Nice.
But what I wanted to show was that when you look at the problem of systematic reviews, of complex interventions,
when you try and invent the stages that you need to do in order to address that sort of review problem,
you end up with something that looks very much like the ingredients, not the structure, but the ingredients of a real synthesis.
Okay. And that leads me to this, which is, you know, I play all the right notes, but not necessarily in the right order.
So so have one of these people, right?
Is the systematic review, the complex interventions I just showed you, if that's the right way for you to really.
Emphasised the right way. So how can you judge which of these is appropriate?
Has one of them got all the right notes but not to my forward? So where do these two methods move?
And so I indicated that there are different views that you can take of some of the role between systematic reviews and real syntheses.
You can see them as as opposites, as enemies.
But certainly, as Jeff has said previously, that was very often the starting point between these two worlds rubbing against each other.
Perhaps we could see them one be additive to the other,
which is implied by the time I showed you earlier, or perhaps more helpfully, we could see a synergism.
The idea that these things become stronger than the sum of their parts by actually using them alongside each other.
So. So let's look at when systematic reviews meet real estate reviews here.
I think this was a very clever thing, a very cool thing to do, and this was to allow a real synthesis with systematic reviews.
You must have realised that there was a lot of, a lot of mileage,
a lot of funds in being a company with the idea of picking up the and and so this title is a need to put in place to do this reviews there.
But a lot of the other work doesn't show that same respect.
It's a bit like the kind of flight of convenience that many ships will have.
You know, it's not because they want to be allied with Panama, but because that is a place, a convenient place to locate your ship under.
And so I think this this was clever, very clever marketing that meant you could have your cake and eat it.
It doesn't mean you have to sell out, but you can, if you like.
The mixed analogy can ride the wave after wave.
That was that was there.
And when you see in that same paper something like this, when it clearly is at least imitating some of the systematic review process.
And the interesting thing is that if you look at them, right, both in the books and they don't show the same sort of more recipe type approach,
they're they're much more about this is the spirit of doing it.
If anyone's tried to do a review based on, for example, chapter four of a phrasebook,
you find it very challenging of a procedural manual for this particular audience the General Health Service, Research and Policy.
Catching the eyes of funders is very good marketing.
It's based on realist synthesis, how to really to be roughly under this sort of area.
But I'll just put this up as one example. When you start to put the two side by side, you can you can see some of the similarities and differences.
I think it's a little bit like the debate that we have with systematic review topics of record lumping versus splitting probably heard the fact.
So we couldn't decide that we're going to look at the similarity to real review with systematic reviews.
Or we could emphasise the difference depending on which suits suit psychological studies.
And so, you know, is it is it a real review method or is it a rogue claimant?
And this isn't just to publicise our book, which is still very well on Amazon value.
It is really to introduce one of my sort of constant pieces, if you like, which is that rather than saying every review has to be a systematic review,
which I have got colleagues in my own organisation who do believe that,
and we've had interesting debates when you try to get all master students to all do a systematic review.
So I'm sort of more and more in the middle.
I think that any literature review can be systematic and that you can add certain parts to the systematic process.
We came up with the acronym Southwest Search Appraisal, Synthesis and Analysis.
And if you think of a graphic equaliser where you have all of these things,
you can have a very systematic search, but not very much in the way of appraisal.
But you could have a very systematic approach to synthesis, or you could have something that is perhaps more narrative and less structured.
So all of these are negotiable points within so and so that's what the book's getting at.
The the this is the second edition. So more than one person bought the first edition and they asked us to do it now.
But I'm not quite sure about having a base there, I was told very early on.
Actually, if you just focus on parts of it, it looks like I'm allied with the National.
Her property that I was asking someone to admire the brand new book, just write for the post and they got it back.
So some tips you teach you humble but the book the first edition with a lot of
things like that which we told the publishers that wouldn't go down very well,
particularly in America. So we got that challenge.
But the point I'm making is that systematic reviews, systematic approaches to those sites are possible within a range of reviews.
So let's look at how a systematic review really review sort of, Maria, if you like,
using a systematic review with some sort of yardstick or benchmark in this context.
So you can have a structured question or a real synthesis.
You can construct this trend field and tenure in the field of management came up with this formulation called CMO,
which has intervention and mechanism, outcome and context.
So it's very close to the CMO. There are differences in the search strategy.
If you've ever tried mapping out the course of doing a a realist review in terms of the searching process.
Sorry, I get excited.
And then then you can see that it really challenges being documented in a formal XML sort of way and sampling in the matrimonial analytic context,
employing every appropriate or every included study.
And that's certainly not something we are encouraged to do in a realistic review of the role of quality assessment.
Well, the formula that that right articulates is that you're trying to trade off relevance and rigour.
And so as a consequence, the quality assessment process isn't privileged as much as it is within the systematic review process.
And unless the famous quote that you've got the encounter about finding nuggets, which means that even in a relatively poor quality paper,
you can find something that actually contributes an important part of your of your picture and synthesis.
It's not a problem. We propose mechanism for organising in some lovely presentations of synthesis of graphical and tabular form.
The analysis is obviously more interpretive rather than the process of systematic review.
In your classic systematic review. Use of theory is relatively uncommon, although in fairness in Cochrane reviews now they have a standard paragraph,
which is how this intervention is thought to work.
So there's some theorising going on there and that's been a major breakthrough.
And then reporting standards over to Jeff and colleagues that are well behind box initiative giving it is giving
it support and contributing a long way to getting the legitimacy of the review within the review community.
But actually we're on a lot stronger, if you like, if we don't use the quantitative systematic reviews, our benchmark.
But if we look to the field of qualitative synthesis, the areas that I'm concentrating on myself,
because essentially we see that that such things of purpose and theoretical sampling are regarded as being legitimate.
Within that context, we can see that in being interpretive such metrics is matter.
Ethnography is a legitimate thing to do with it.
It's not just about. I'm using that to reason that we can see a role for theory very prominently in qualitative research.
So we can see similarities in terms of the role of the reporting standards as a as a sort of more a guide rather than than a scaffold, if you like.
In fact, you know, if we look at it in that context, the only the only real differences is the the unique realist review of trading of relevance
and rigour where where quality assessments have an easy stance within quality of evidence.
But I think generally people accept that is something that you do need to do.
So we can see that things are much closer to each other than the sort of stereotype this antagonism brings.
So somewhat surprisingly, given my title, I do see realist review as occupying a place not just as another of these 50 labels,
but as a legitimate part of the toolkit.
And so when I produce guidance for the European project, looking at different methods of using qualitative evidence.
Really synthesis of here that together with an assessment of the different functions of the the different qualitative
methods of accepting that the synthesis is purely quality by the food and also looking at some of the roles.
So for example, in generating exploring the difference between the Trinity that that Goff and Thomas generating, exploring and testing.
And so if think really synthesis does all of those in the same package whereas other formats with methods the methods applied.
We already have allusion in the course downstairs to this particular diagram.
This was the inspiration for my title. If I can find inspiration for something like that.
But you know that you have all of the the sort of the new tie of mapping out these wonderful things.
And then a reporter enters the room and says, oh, what's going on here is this.
And magic happens. And you have a review for now.
And the next generation perhaps is not like nothing at all on the charts in this way.
But when we're measuring this against the standards for systematic reviews, we want to know,
well, what's going on there, what gets us from this side of the miracle to the other side.
And and so there is some of the areas that I personally think need more detailed report detailing
how you actually identify program theories that would take away some of the magic that's going on.
We need more detail on how people prioritise programs.
There is very clear, although not apparent to everyone, is that you can't support every program theory that you can generate the literature.
You have to have some method, method or mechanism for prioritising another one.
How do you select the evidence to support the program and how to then link the program?
Query and your explanation of what's going on to make range building?
Do you just have to resort and resort to having some right person who's multi-disciplinary, who's for all these theories going around in their head,
and who can suddenly make the link between program and mid-range and not component, and how do we make that link?
So there's lots of challenges there. That's the expression black box use before cuts work.
I think more detail is required.
I'm there's a couple of reasons for expressing these reservations that first, we've already said the realist review method is complexity.
And here we have from a forthcoming book, we have the sort of model of the conventional systematic review,
and then we have the model of the search for a realist review.
And you can see how how complex that process actually is.
And that provides a challenge every stage in terms of people having confidence in what you've done and how you report it.
And then we have challenges in terms of the interpretation.
So we have statements here. I have reference this.
We could probably track down who it is by putting it into phrase,
but essentially this is the magic trick I'm a little bit suspicious of that they suddenly
came up with these these four common mechanisms and they decided what they are.
And then in terms of how they selected them and decided they were important, they were in at least two of the three case examples.
So if they decide to exclude all of these things going on here.
And so the question that I had to grapple with very early on in the process is,
is it possible to search for theories, systematically compiled pilot program theory and reframe?
And this is where some of the conflict comes in. Ramsay is very friendly, can be real.
And so we're not talking about conflict. I don't mean that, like I've been emotionally scarred by the debate that we've had here.
But but certainly this was very interesting for me in the juxtaposition here.
So I posted on the round of these lists, but that I saw the Achilles heel of realist review being that.
So, you know, it really depends on the theoretical resources that you're helping to dispose of.
So, you know, how are you going to get back there if you've got an expert?
And that's great. I'm not an expert in the topic area, but an expert in all the theories that we can use to explain and ask the question,
is there any way to can make that more systematic? And as I said, we're just in danger of magic.
People clearly pulling flowers out of the box.
And then, of course, I left the person in fresh green have said, you're always asking for a technical way of eliciting program theories.
I say it can't be done. And of course, she's right in the sense that if can take it up to the server, that that's not the only way you can do it.
But certainly trying to be systematic can have a place in the process as I'm going to demonstrate and then reinforce.
And I mean, that's the brilliant thing about Rameses is that you had the very people who were thinking about these things all the time.
And so he says that the the mystery of theory generation is a little bit old and not that, again, coming in that first sentence.
But he says he likes a bit of magic can come. Bring them up.
But he suspects that we can't include hocus pocus in the Ramsay's declarations.
So he's realising that, in fact, you know, the fact of being able to sort of try to put into effect,
you know, so no hocus pocus in Ramsey's declarations, the two traditions they're contending with.
And he makes the point of the need to move between the programs through what he calls the stakeholder theories that and the abstract mid-range theory.
So he's appreciating it's an important process.
And then I tried to ask, what if he never did with that particular audience?
But I tried to have the last word I said. But, you know, even the analogy of magic is of an unfortunate one,
because if you look at people like the David Blaine or of the other magicians, they spend hours perfecting so that it all looks like magic.
But actually there's a lot of work going on beneath that.
I suspect there's an element of fact about really synthesis, but actually that the argumentation is very well constructed.
It has a very strong logic, but that still doesn't take away the need to explain how how the trick was done.
And then I just said, but the problem is that if we start to call, you turn out to be rather magic.
Then, although paused, Paulson said, We can think the nuggets.
Then we sort of really can't turn our thoughts into two nuggets.
So can we search for them? Well, this is a suggestion that we can actually search for particular types of theories using particular search methods.
There are a series of terms that we know are explicitly associated with program theory,
and these are primarily extracted from a very good article by James Thomas and colleagues, which is on and is on program logic from program theory.
Can we find bit range theory? Well, I'll show you. We can find mid range theory.
Obviously, the best part of the mid range theory in terms of its utility on the theory is why the contribution would be where the
people who have been grappling with the problem in the primary studies can make a connection to the mid range theory.
So there would be some of the spectrum for us. But it's not untypical to find that some literatures inhabit different worlds.
So there's one body of literature and perhaps one of retreat in the literature search and the example of the empirical stuff,
maybe another body of literature. So part of what I'm suggesting here is sort of joining those two literatures back home to help me find the range.
So if one was to combine a string of terms using Google Scholar,
not because it's superior to bibliographic databases, but because it has a full text facility.
So you're getting into the content of the article, not just the title.
That's right. But if we use a string of terms like logic model or theory of change or theory of action, etc.,
etc., and combine it with the topic that we're exploring, in my case, post-natal depression.
Then you find studies which articulate there is case.
They might not be the one that you choose to use, but they are candidate theory.
They might not be the ones that push greenhouse which used to generate,
but there are another pool that you can put alongside your expert generation, alongside the input from your study.
So she was right. You can't just do this. It's a single process, but it has some complementarity.
And by doing it systematically, you can report it and you can communicate the science of what you've done.
Of course, we do have some problems. Jeffress alluded to the fact that not the formal course of the program of change, the policy or theory of change.
So you will only get 12 if you like, the tip of the iceberg of theorising.
But it's a good way in which they may not relate to your specific focus.
And so just because it happens to be on the topic might not be the part of the clinical part,
but has to be part of the chain of the theory of change may be in a separate document.
And what I've come up with is a method called cluster theory,
which is where you try and track down from a source article or other related reports to that particular study.
And so the theory of change might might be identified with one of those other accounts.
So essentially, you're using the the study you have found as the gatekeepers of the study, you have found the problem because again,
reportable and systematic and come up with a procedure for handling theory recorded became an acronym and give you the reference.
So the this is one quote for my kids.
These two are looking at realist theory for how local government uses nice guidance,
but so the behaviour is actually to provide guidance to the health context,
the public health and local government, the the exclusions, the sorts of models or theories.
We're not interested in a thing called economic models, statistical models, and then we have the terms associated with multiple multiplicity.
And I'm not going to go into the details of the procedure, but just to say that this is starting to make look more systematic but reproducible.
It's transparent, it's explicit. And we mustn't pretend that that's when it comes to mid range theory, but it's completely open season.
There were a number of pro of mid-range theories which are very common in phenomena in literature, and that's how they become mid-range theories.
So there are certain ones we could actually be looking at in our literature.
So if you've got a reference management database you could be searching.
I wonder if any of the abstracts have any of these laboratories in American what's made the.
But again it's not the. Speaker to lead you all the way that you can be a star.
And in fact, there's an even better list of competitive competition because you can see behaviour
change changes where you actually almost like choosing a pipe for your bedroom,
you can go through and decide which of these might well be ones that help to explain what's going on.
So here's just a couple of strategies here. So two strategies, diffusion of innovation for now is guidance.
Okay. So I picked something that I think is a potential theory and I've done a search to see has anyone
cross reference or used in the same document the diffusion of innovation theory and nice guidance.
And sure enough, at the top here we have someone making that particular point.
So again, it's being systematic in its relation.
Well, what I'm trying to do is get more if you think of your detective programs on telly, you have the power of something.
That's sort of the magic connected to that. But you also have folks who go through the grass looking for the murder weapon.
And so I'm a plus. This is this is pretty well a systematic way, not for the whole process.
We determine the plot rows, but actually giving you some of the evidence.
And then this is the other approach once you have a citation for a theory.
So this is the citation of diffusion of innovations you can use in Google Scholar search within citing articles.
And so there anyone who cited the diffusion of innovation theories have they reference national of the nice guidance.
So to approach is to systematically start making connections between midbrain theory and public with all the others.
But there are some problems with biases here.
Certain disciplines that cooler theories. Theories.
There's a lot of theories in the sociology and causal theory, the things that we work in like public health like most and they used to.
There is another issue is actually you might find some theory that explains some parts of the pathway, but not the pathway you're interested in.
And we've had problems with that before in selected models and theories of the right phenomenon.
But the right path which is. To be aware of the temple and try to be customers and serve as well as the behemoth thing.
If that wasn't enough, then we listened to clusters, which essentially were looking for two types of evidence.
We're looking for sibling studies.
These are studies that actually issued from the same study, sibling papers from the same study, or kinship papers, papers that are linked in some way.
So there might be antecedent projects to your project.
So that's cited in your paper and that's where some of the initial theorising and I'm aware of time,
so I would just preference to add quickly here, I'm not going to spend much time on this.
The purpose of really synthesis is making a link with ground theory.
What we want, some practical, we want to stick with mid range theory.
But just to say that some of these things are not typically people because they're
typically labelled to solve with social inequality to try and place to pick them up.
So this is just very briefly a worked example of and we use the existing logic model and tested against collective model.
We tried to make a link between various initiatives of postnatal depression and the theory.
So this is where we start to move from the the program theory behind each of these and make a link to a wider field.
So this relies on the if the originators of the initiative action identifying that there is a new branch behind it.
And so this is where we link our program series.
We give them labels. Some people won't like that, but it's just a sort of shorthand for referring to them later.
So we have a program theory, developing trust program theory.
Post-natal depression will be prevented if women develop meaningful relationships with other women's in the group,
women in the group and with health care providers. Some references there, a link to mid-range theory and then some sort of component.
So after starting off in a fairly antagonistic view, I'm coming towards the end to suggesting some sort of rapprochement.
We can see similarities between qualitative synthesis and really synthesis.
We can recognise that the world is big enough for horses, for courses, approach to going deep into the toolkit,
either for a particular review method for a particular problem, or to place them alongside each other in order to yield some sort of complementary.
So from the searching that I've hopefully demonstrated, it is possible to be more systematic than we are at the moment with realists.
And I think we do that, that with more knowledge as a genuine, bona fide method of doing review.
But at the moment, this is not I hope we've demonstrated through examples and they weren't manufactured examples,
those of standard search strings using the very crude search strategies, as you can see for much of their compression with the right results with the.
And so there is a role for another sort of type of search assistance specifically looking for.
But what we don't want to do is move to search whether we fly.
And this is where we come back to screen analysis point.
If we only draw on the theories that people have already identified, we're losing some of the value.
And so we really need to make sure that this is just a line of inquiry, a line of exploration.
It's not the answer. It's part of the journey, part of the plane.
I'm not trying to turn us all into let's try to churn out ideas by just having a to search term.
So the reconciliation and reconciliation is possible and these are two of the possible routes.
We can certainly demonstrate that realist review.
Really, synthesis is more systematic than it currently does.
Just on the other side,
we can actually look at the contribution of some of the things that really synthesis brings to the mix and how that impacts on other review methods.
So we have, if you like, we're benefiting both parts by strengthening both parts by the synergy between them.
And so in the forthcoming book, it's overtaken by the two back in leads and just contribute to the to contribute the chapter.
We've tried to put the real research into a more systematic basis.
Sorry about that. I'm happy to say that some of these things like around afterwards.
But the other thing that will increase the acknowledgement, the acceptance,
the greater synthesis is recognition of the importance of the theory to our understanding of interventions.
And this is where where real synthesis can benefit from the work we're doing in qualitative synthesis.
This is a seminal initiative, not the paper,
but the initiative for a really important Cochrane funded qualitative methods group to actually demonstrate,
along with members of the quantitative community, the importance of all social theories for that systematic review.
And so we start to move into other types of quality assessments.
How we judge papers for purposes of theories.
Are we moving away from judging fitness of research designs, which is the systematic reviews to fit lots of theories?
Do we start evaluating theories? So we want to move away from the current sexiness of really synthesis as the answer to everything.
If we were to leave certain funding programmes, that's the idea.
To the man with a hammer, everything is a nail to open up this really rich new toolbox,
selecting appropriate methods for each of the problems that we face.
And on that note of the wide field.