HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38 Understanding 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)

Critical realists offer a set of philosophical underpinnings for social research. Critical realists also engage constructively with social theory, but they are more than just theorists. In this chapter I list and describe various innovative methodological contributions made in recent years by realists. I point out ways in which research methods (i.e. techniques) fit with particular methodological assertions. There is a historical legacy of empiricism which critical realists often use as a foil to make their own position more clear. However, (...) among realists, a wide variety of methods are used, and the range of realist methodological assumptions is wider than one might expect because of their efforts to work with social theory.The introduction to the chapter covers ontology as it relates to research methods. The second section of the review introduces retroduction, a major methodological starting-point common to most realists. The third section reviews concretely the realist debate over statistics and some realist contributions to qualitative methodology, qualitative methods, and action research as used by realists. The fourth section takes up the challenge of realist claims about knowledge (debates usually known as epistemology). An important aim in this chapter is to argue that 'factual' statements usually embody layers of meaning, and thus are contestable; that enquiry using quantitative methods can coherently be done from a realist perspective; and that among realists qualitative enquiry is a broad and useful set of methods which have made genuine innovations in methodological knowledge. Meta-critique and pluralism are widely-used realist contributions to the methods tool-basket in social science, and the realist approach to social statistics is a much better guide to how statistics is, in practice, done than any currently available empiricist quantitative textbook (Ron, 2002). However 'quantitative' research always rests upon conceptual, theoretical and qualitatively derived frameworks and therefore is derived from qualitative work, whereas the converse is not true; qualitative research does not require any quantitative research. In the current scene, mixed methods also play a key role as a growing area of research methods. In this way, within sections one and two, the reader is given an overview of Volume 1 of this collection. Sections two and three of this chapter review Volumes 2 and 3 (realist methods, and empirical examples, respectively). Section four reviews the epistemological theme that is at the core of Volume 4. This introduction thus roughly parallels the contents of the rest of the volumes. (shrink)

Taking debates about the roles of structure and agency in health as a lens, this essay asks how Critical Realist and Feminist Intersectional approaches might inform health interventions research. Despite recognition of multiple determinants of health, health problems are often thought of as individual and interventions, in turn, target risky individual behaviours. Such approaches are rooted in a liberal model of personhood. This paper critiques enduring individualist assumptions linked to Western liberal underpinnings embedded in health interventions. It posits the need (...) to include a robust conception of the social world in which change depends on shifting power relations, and individual agency is shaped by power as well as individual will. We propose preliminary steps for undertaking critical realist intersectional interventions research. (shrink)