Advertise on podcast: The Realist Lens - For Researchers Who Keep It Real

What can photographs, drawings, objects, music or stories reveal about why an intervention works for some people, but not for others? Alejandro is joined by Dr Seán Paul Teeling, Assistant Professor at University College, to explore the use of creative and artistic methods in stakeholder engagement forrealist evaluation and synthesis. Drawing on a background in nursing, healthcare improvement, Lean Six Sigma and person-centred practice, Seán Paul explains why his interest moved beyond whether improvement initiatives work to how they work, for whom, in what circumstances and why. He reflects on his early scepticism about creative activities and how visual materials, metaphors, artefacts and storytelling can open up reflection on less visible reasoning mechanisms. The conversation explores the practical ingredients that make this possible. Seán Paul discusses offering participants a choice of creative materials, using accessible vignettes rather than realist jargon, and inviting people to confirm, refine or reject emerging programme theories. He also reflects onpower differences between professional groups, the preparation and resources needed for workshops, and the importance of treating participants as co-interpreters rather than simply sources of data. Enjoyment matters, but creative activities must contribute explanatory insight: they supportmethodological rigour rather than replace it. Whether you are a realist evaluator, realist reviewer, healthcare improvement researcher, practitioner, patient or public involvement specialist, student, supervisor or PhD researcher, this episode offers a practical discussion of how creative, person-centred engagement can deepen theory development and refinement while respecting the experiences of those involved.

What happens when policymakers need theory-informed evidence not next year, but next month? Alejandro is joined by Sarah-Jane Fenton, Associate Professor of Mental Health Policy at the University of Birmingham, and Justin Aunger, a Research Fellow in Applied Health Sciences, to explore APRIL: the Accelerated, Parallelised, Realist, Informed Literature Review. Developed through commissioned work in adult community mental health, APRIL responds to a challenge familiar to researchers working close to policy and practice: decision makers may need robust, useful evidence on complex questions within timescales that conventional review processes cannot easily meet. Sarah-Jane and Justin explain how the approach works backwards from policymakerpriorities, brings extraction and analysis decisions forward and uses parallel workstreams to move from evidence to theory at speed. The conversation explores the practical ingredients that make this possible. But speed brings trade-offs. Sarah-Jane and Justin reflect on the limits of searching and interpretation under intense time pressure, the need to be selective about relevance and richness, the resources required to parallelisework and why APRIL should not be seen as a replacement for deeper, well-funded research. They also explain that its value is not limited to very short reviews: the approach can support broader policy questions that cut across several areas. Whether you are a realist evaluator, realist reviewer, policy researcher, health-services researcher, regulator, practitioner, student, supervisor or PhD researcher, this episode offers a practical discussion of how realist thinking can remain rigorous, transparent and useful when evidence is needed quickly.

What happens when nutrition research moves beyond asking whether an intervention works and starts examining why it works, for whom and under which conditions? Alejandro is joined by Saffron Whyton, a PhD researcher at the University of Surrey whose work sits at the intersection of nutrition and psychology, with a particular focus on plant-based diets, healthy ageing and care homes. Drawing on her realist synthesis, Saffron explores a challenge familiar across nutrition and public health research: conventional evidence reviews can tell us whether anintervention appears to work, but they often give less attention to the social context and underlying mechanisms that shape whether people can or will change what they eat. These questions become especially important in care homes, where settings and resident needs vary considerably. The conversation explores how realist approaches can support the design of plant-based meal interventions that are both evidence-informed and sensitive to context. Saffron discusses person-centred care, theoretical transferabilitywhen direct evidence is limited, the use of substantive theory and the value of combining qualitative and quantitative evidence to develop and refine initial programme theories. But applying realist approaches in nutrition also brings challenges. Alejandro and Saffron discuss sparse reporting of contexts and mechanisms, the technical language surrounding realist methods, the shift from a predominantly positivist background, and the importance of being transparent about limitations while treating programme theories as iterative and open to refinement. Whether you are a realist evaluator, realist reviewer, nutrition researcher, dietitian, public health researcher, care-home practitioner, student, supervisor, or PhD researcher, this episode offers an accessible exploration of how realistthinking can produce more useful explanations of dietary change and more practical recommendations for policy and practice

What happens when we bring behavioural science and realist research into the same conversation? And could the two approaches help address some of each other’s limitations? Alejandro is joined by Dr Justin Aunger, Research Fellow at the University of Birmingham, whose work spans behavioural science, patient safety, health services research, realist synthesis and realist evaluation. Drawing on his experience across both traditions, Justin explores a challenge familiar to many realist researchers: programme theories can be rich and context-sensitive, butthe language used to describe interventions and mechanisms can vary considerably from one study to another. Behavioural science, meanwhile, has developed increasingly structured ways of describing intervention components and the processes through which behaviour may change. The conversation explores what realist research might learn from concepts such as behaviour change techniques, mechanisms of action, and behavioural settings, and whether these could provide a more shared language for describing what interventions actually do, how people respond and why outcomes occur. Justin also introduces the idea of causal chain configurations, offering one possible way of connecting intervention resources, proximal and distal contexts, changes in reasoning and outcomes. But integration also brings trade-offs. Alejandro and Justin discuss the risks of adding further complexity to an already demanding approach, whether behavioural frameworks adequately capture social and organisational mechanisms and why greater standardisation should not come at the expense of the flexibility that makes realist approaches valuable. Whether you are a realist evaluator, realist reviewer, behavioural scientist, intervention researcher, healthcare researcher, student, supervisor, or PhD researcher, thisepisode offers an accessible exploration of what these traditions might learn from one another and how a more shared language could strengthen the accumulation and practical use of realist knowledge.

What does it mean to use artificial intelligence well in realist research? And where should we draw the red lines? In this timely and balanced conversation, Alejandro is joined by Professor Andrew Booth, Professor in Evidence Synthesis at the University of Sheffield, whose work spans systematic reviews, qualitative evidence synthesis, information retrieval, and realist synthesis. Andrew approaches AI not as a solution to every methodological challenge, nor as something researchers should simply reject, but as a potentially useful assistant. Drawing on his extensive experience in evidence synthesis and realist research, he considers where AI might genuinely enhance existing research practices and where its apparent convenience can become misleading. But the conversation also tackles the risks. Andrew discusses hallucinated references, the persuasive plausibility of AI-generated answers and the danger of producing neat, fully formed CMO configurations when the evidence itself may bepartial, ambiguous, or better represented through incomplete configurations that require human synthesis and discussion. Alejandro and Andrew also explore one of the deeper concerns surrounding AI: what happens to researchers’ intellectual development and academic voice when too much of the process begins with a blank page handed over to a machine? Andrew concludes with three practical principles for responsible AI use in realist research. Whether you are a realist evaluator, realist reviewer, evidence synthesis researcher, information specialist, student, supervisor, or PhD researcher, this episode offers a practical and refreshingly nuanced discussion of how we might engage with AI without allowing it to replace the distinctly human work of thinking, judging, interpreting and explaining.

What does it really take to conduct a realist review when you are new to realist research, and there is no simple methodological roadmap to follow? How can realist approaches help us understand why communication partner training works in some contexts but is difficult to sustain or embed in others? In this open and highly practical conversation, Alejandro is joined by Yvonne Fitzmaurice, an experienced speech and language therapist, educator and PhD researcher, currently working in clinical speech and language therapy education at the University of Galway. Drawing on more than 20 years of clinical experience, Yvonne explores her work on communication partner training (CPT) for people with communication impairments followingstroke. She explains why realist review felt particularly well suited to an intervention whose success depends not only on the training itself, but on the people delivering it, the settings in which it is introduced, the wider systems surrounding it and whether it can be sustained and embedded into healthcareeducation. Yvonne also reflects candidly on her transition from experienced clinician to novice realist researcher. She shares how developing a protocol, undertaking realist training working closely with supervisors and building acarefully selected advisory group helped provide structure and direction. The discussion explores what Yvonne’s realist review has revealed about the multiple, interacting and layered contexts surrounding CPT. Yvonne also describes the crucial contribution of realist advisors, educators, students, and public and patient contributors with lived experience of communication impairment in developing and refining programme theory. Whether you are a clinician, speech and language therapist, educator, researcher, student, PhD researcher, PPI contributor or someone beginning a realist review of a complex intervention, this episode offers an honest and encouraging account of learning to grow as a realist researcher.

What does it mean to conduct realist evaluation well when timelines are tight, budgets are limited, data access is imperfect, and commissioners want findings that areclear, useful, and actionable? How can evaluators remain faithful to realist principles without becoming trapped in theoretical complexity, or reducing context, mechanism, and outcome configurations to formulaic boxes? In this refreshingly practical conversation, Alejandro is joined by Associate Professor Brad Astbury, Associate Professor of Health Systems Evaluation at the University of Melbourne, whose work spans evaluation practice, public health,government-commissioned evaluation, programme theory, teaching, and realist approaches. Brad reflects on his journey from criminology and the corrections system to more than two decades of engagement with realist evaluation. Drawing on his extensive experience conducting evaluations for government, he explores some of the most common ways realist approaches are misunderstood, overcomplicated, underdeveloped, or applied in circumstances where another evaluation approachmight be more appropriate. The discussion explores the pressure commissioners and public servants face to produce straightforward answers to complex questions. Brad explains how evaluators canacknowledge legitimate accountability needs while also generating the more nuanced knowledge required to improve, adapt, target, transfer, and scale programmes. Throughout the episode, Brad emphasises the importance of accessible language, listening before prescribing a methodology, preparing to explain realist ideas todifferent audiences, and approaching evaluation as a form of disciplined curiosity that asks “why?” relentlessly. He concludes with four practical principles for commissioned work. Whether you are an evaluator, commissioner, researcher, public servant, policymaker, consultant, student, or PhD researcher, this episode offers practical wisdom for conducting realist evaluation with integrity under real-world conditions.

How can realist evaluation help us understand why exercise interventions work, for whom, in what circumstances, and why? And what happens when patients and interest group holders are not just consulted, but actively involved in shaping programme theories, intervention design, and implementation? In this reflective conversation, Alejandro is joined by Dr Deirdre McGrath, lecturer in nursing at Queen’s University Belfast, whose work brings together realist evaluation, co-design, patient and public involvement, oncology, palliative care, and cancer rehabilitation. Deirdre reflects on her journey from clinical practice in oncology and palliative care to realist research, focusing particularly on exercise interventions for women with ovarian cancer. Drawing on her PhD work, she explains why traditionalevaluations of exercise interventions often struggle to explain variation in participation, adherence, and outcomes, and how realist approaches can help us ask deeper questions about what works, for whom, in what circumstances, and why. The conversation explores how co-design can strengthen realist evaluation by bringing patients, carers, clinicians, academics, and other interest group holders into the research process in meaningful ways. Deirdre discusses how women with ovarian cancer helped reshape her assumptions about what an exercise intervention should look like, including the move from an initially imagined in-person intervention to a home-based programme shaped by lived experience, practical constraints, psychological safety, trust, relevance, and flexibility. Deirdre also reflects on the challenges of making realist terminology accessible, avoiding tokenistic involvement, managing different interest group holder perspectives, and creating safe spaces where people feel genuinely able to contribute. She highlights the importance of humility, listening, feedback loops, and recognising patients as experts in their own care. Whether you’re an evaluator, researcher, clinician, public health practitioner, student, PhD researcher, or someone interested in realist evaluation, co-production, cancer rehabilitation, patient involvement, or complex interventions, this episode offers valuable insights into how realist thinkingand co-design can work together to produce more grounded, useful, and meaningful research. Note: Although the terms “co-production” and “co-design” are sometimes used interchangeably in the conversation, this podcast episode specifically focuses on co-design.

What happens when realist approaches meet other research traditions, disciplines and ways of knowing? And how can researchers work across different assumptions about evidence, causation, truth, knowledge and equity without flattening, absorbing or privileging one tradition over another? In this thoughtful conversation, Alejandro is joined by Dr Kenneth Yakubu, whose work sits at the intersection of health systems, global health governance, implementation research, health equity, Indigenous methodologies and realist thinking. Yakubu reflects on his journey from family medicine in Nigeria to global health research, interdisciplinary work, and his current role across health systems implementation research and Indigenous health at the George Institute for Global Health in Sydney, Australia. He discusses how his clinical training helped him see people rather than diseases, and how this shaped his attention to context, complexity, culture, history and lived experience. The conversation explores Yakubu’s experience developing a realist protocol for evaluating the Healthy Homes and Neighbourhoods Project in Sydney, an integrated care initiative designed to support families facing complex healthand social challenges. The protocol brought together realist approaches, Indigenous research methodologies, implementation science, qualitative methods, quantitative analysis and health economics. Reaching shared agreement took nearly two years Yakubu reflects on the tensions that emerged around truth, voice, evidence, analysis and self-determination. He discusses why some team members found realist language or assumptions difficult, how Indigenous research traditions raised important questions about visibility, community voice and historical harms, and how the team worked through disagreement without forcing premature consensus. Whether you’re an evaluator, researcher, public health practitioner, implementation scientist, policymaker, student, or someone interested in realist approaches, Indigenous methodologies, global health, health equity or interdisciplinary research, this episode offers valuable insights into the messy but necessary work of building shared understanding across different ways of knowing.

How can realist evaluation help us understand health systems, inequality, and social change in marginalised and ecologically sensitive contexts? And what happens when realist thinking moves beyond academic projects and becomes part of long-term, participatory work with communities? In this insightful conversation, Alejandro is joined by Dr Prashanth N Srinivas, a public health researcher and health systems scholar at the Institute of Public Health Bengaluru. Prashanth reflects on his journey into realist evaluation, from his early work as a clinician in community health settings to using realist approaches in health systems research, government health management, and long-term work with Adivasi communities in Southern India. The conversation explores how realist inquiry can help move beyond surface-level explanations of health inequalities, such as remoteness, literacy, or cultural difference, to examine the deeper structures, mechanisms, relationships, and histories that shape health outcomes. Prashanth discusses the value of realist thinking for making sense of complexity, building explanations with communities, and creating research approaches that are less extractive and more participatory. Prashanth also reflects on middle-range theory, participatory workshops, learning sites, global health, donor dependence, resilience, and the importance of humility in research. He highlights how realist approaches can support more grounded, equity-oriented health systems research by helping researchers, practitioners, and communities ask not only what works, but why things are the way they are, for whom, and under what conditions. Whether you’re an evaluator, researcher, public health practitioner, policymaker, student, or someone interested in realist approaches, global health, Indigenous health, or participatory research, this episode offers valuable insights into using realist thinking as a way of building shared understanding, practical wisdom, and more equitable approaches to health systems research

How can realist synthesis help us understand digital forums, online communities, and living libraries? And what happens when lived experience, story sharing and peer support take place in dynamic online or hybrid spaces where safety, connection and meaning are constantly being negotiated? In this insightful and reflective conversation, Alejandro is joined by Dr Paul Marshall, Research Associate at the Spectrum Centre for Mental Health Research at Lancaster University. Paul shares his experience of working with realist approaches across projects on living libraries and online mental health forums, exploring how people share experiences, build connections and seek support in both face-to-face and digital environments. The conversation explores how realist evaluation and synthesis can help unpack what makes online forums meaningful, helpful or challenging for different people indifferent contexts. Paul reflects on the difficulty of conceptualising online forums as interventions, the difference between context and setting, and the importance of psychological safety that enables people to share experiences and ask questions. Paul also discusses the value of combining realist synthesis with realist interviewing, working with multiple stakeholders, and using mixed methods to understand what is happening beyond individual posts or interactions. He reflects on the roleof forum moderators, service leads, forum hosts and users in shaping the culture and functioning of online spaces. Whether you’re an evaluator, researcher, student, practitioner, digital health professional or someone interested in lived experience, online communities and participatory approaches, this episode offers valuable insights into using realist approaches to understand how digital and hybrid spaces work, for whom, and under what circumstances.

How can realist evaluation help make sense of government policy, complexity, and decision-making? And what happens when realist ideas move beyond academic journals and into fast-moving, politically shaped, resource-stretched environments where people need answers quickly? In this insightful and practical conversation, Alejandro is joined by Finlay Green, an evaluation and policy practitioner with experience across consultancy, government evaluation and policy advice. Finlay reflects on his journey into realist evaluation, from discovering Realistic Evaluation during recovery from an ACL injury to applying realist thinking in government settings. The conversation explores where realist evaluation fits within government, where it can clash with existing evidence expectations, and how realist ideas can be adapted without losing their integrity. Finlay discusses the importance ofdropping unnecessary jargon, making evaluation tangible and accessible, using quantitative and administrative data and focusing on explanations that are useful to policymakers. Finlay also reflects on the value of realist approaches for wicked problems, regulation, policy design, and ex ante evaluation. He highlights the need for realist evaluators to engage more directly with policy questions, collaborate across disciplines and understand the pressures and constraints faced by government teams. Whether you’re an evaluator, researcher, policymaker, student, or practitioner interested in applying realist approaches in policy contexts, this episode offers valuable insights into making realist evaluation feasible, credible, and genuinely useful where decisions happen and stakes are high.

How can realist approaches help us understand culturally safe, community-led healthcare? And how can storytelling, lived experience, and clinical practice come together to make research more responsive and relational? In this rich and reflective conversation, Alejandro is joined by Dr Katherine Zippel, a General Practitioner, DPhil student at the University of Oxford, and researcher working at the intersection of clinical care, cultural safety, social prescribing, Aboriginal health, and realist research. Katherine shares how realist approaches helped her move beyond asking “does it work?” to exploring what works, for whom, in what circumstances, and why. Drawing on herexperiences in remote Aboriginal communities in the Northern Territory, she reflects on how care is shaped by trust, cultural legitimacy, relational continuity, and community control. Katherine discusses powerful examples from her work, including HIV testing in Ghana, COVID-19 vaccine rollout in remote Aboriginal communities, and cancer survivorship. She highlights how realist thinking can reveal why interventions succeed in some settings but not others, especially when programmes are implemented in complex cultural and structural contexts. Drawing on narrative medicine, Katherine also explores how stories can surface mechanisms that might otherwise remain hidden. She reflects on the importance of listening deeply, honouring lived experience, and resisting one-size-fits-all models ofcare. Whether you’re a researcher, clinician, or interested in culturally safe and community-led approaches to healthcare, this episode offers rich insights into embracing complexity, valuing stories, and using realist thinking to supportmeaningful change.

What role can the arts play in recovery? And how can realist approaches help us understand the deeper processes behind healing, identity, and lived experience? In this creative and thought-provoking conversation, Alejandro is joined by Dr Louisa Peters, a researcher who brings together psychology, community arts, and realist thinking. Louisa’s work draws on her background in musicology, community arts practice, and her PhD research exploring recovery in serious mental illness. Louisa shares how realist approaches allowed her to movebeyond asking “does it work?” to exploring how and why arts-based interventions support recovery. She highlights how community arts create safe, trusting spaces that promote coping, acceptance, and positive emotional engagement, while also acknowledging the complexity and non-linear nature of recovery. Drawing on her research, Louisa discusses innovative methods such as arts elicitation interviews, poetry, and visual approaches, showing how creative expression can uncover mechanisms that are difficult to articulate. She also reflects on navigating complexity in realist research through mapping,causal loop diagrams, and embracing a flexible, adaptive approach. Whether you’re a researcher, clinician, or interested in theintersection of arts and health, this episode offers rich insights into embracing complexity, valuing lived experience, and using realist thinking to explore meaningful change.

What makes physiotherapy such a complex, context-dependent practice, and how can realist approaches help us better understand what works, for whom, and why? In this insightful and grounded conversation, Alejandro isjoined by Dr Leah Morris, a physiotherapist, senior lecturer, and realist researcher working at the University of the West of England. Leah’s work spans academia, teaching and supporting realist research across healthcare settings. Leah shares her journey into realist evaluation, reflectingon how it helped her make sense of complex roles such as first contact physiotherapy and why realist thinking aligns so naturally with physiotherapy’s core principles of individualised care and clinical reasoning. Drawing on projects like FREEHAB and her work in supporting colleagues, she highlights how realist approaches can uncover the mechanisms behind tailored interventions and explain variation in outcomes across contexts. From applying realist thinking in non-realist projects to navigating methodological challenges, limited guidance, and misconceptions about “realist light,” Leah offers practical insights grounded in both clinical and research experience. Whether you’re a clinician, researcher, or educator, thisepisode provides valuable lessons on embracing complexity and applying realist approaches to physiotherapy and beyond.