Background: Randomized controlled trials have been criticized for their inability to identify and differentiate the causal mechanisms that generate the outcomes they measure. One solution is the development of realist trials that combine the empirical precision of trials' outcome data with realism's theoretical capacity to identify the powers that generate outcomes. Main Body: We review arguments for and against this position and conclude that critical realist trials are viable. Using the example of an evaluation of the educational effectiveness of virtual (...) reality simulation, we explore whether Partial Least Squares Structural Equation Modelling can move statistical analysis beyond correlational analysis to support realist identification of the mechanisms that generate correlations. Conclusion: We tentatively conclude that PLS-SEM, with its ability to identify ‘points of action’, has the potential to provide direction for researchers and practitioners in terms of how, for whom, when, where and in what circumstances an intervention has worked. (shrink)

HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney diseaseThis paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite (...) efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. (shrink)