BUILDING 'DOWN' FROM GRAND THEORY WHERE PROGRAMME THEORY IS LACKING Katie Shearn PhD Candidate Supervisors: Dr Hilary Piercy, Dr Peter Allmark, Professor Julia Hirst Sheffield Hallam University k.shearn@shu.ac.uk
Overview Outline of my project and problem Approaches to building initial rough theories Building 'down' from grand theory - Selecting useful theories - Mapping theories to intermediary outcomes - Layering statements to create programme theories Results Reflections
A need for theory and evidence to support the development of positive, comprehensive youth sexual health services Treating sexual illhealth Promoting sexual health and wellbeing Current model of delivery Aspirational model of delivery
Overall research approach
What should my theories consist of? C A D B Concepts A B C D B E Statements A B D C E Theories Adapted from Walker and Avant, (2005)
Directs Guides Theory, theory, theory Grand Theory Have abstract concepts and broad scope - gives perspective to goals and structure of practice Middle-Range Theory Are testable but sufficiently general to be scientifically interesting Substantive Theory Theory of action for a specific context Refines Programme Theory Comprise a desired goal and prescriptions for actions to achieve that goal Realist programme theory Attend to causal mechanisms and context Tests Adapted from Walker and Avant, (2005)
level of abstraction Spectrum across and within categories Grand theory Middle-range theory Programme theory
'Start' with programme theory Theory Program Specification Hypotheses "Theories must be framed in terms of propositions about how mechanisms are fired in contexts to produce outcomes. All else in the circumnavigation of inquiry follows from this." (Pawson and Tilley,1997 p.85) Observations The realist evaluation cycle, (Pawson and Tilley 1997)
'Start' with programme theory Theory Program Specification Observations Hypotheses The realist evaluation cycle, (Pawson and Tilley 1997) Develop an initial rough theory (IRT) Develop ideas about what the underlying causal forces are and how, and under what circumstances, they bring about change
Developing the IRT in realist studies Build from a theoretical framework Search for theories in the literature Elicit tacit theories held by 'experts' Programme already has an explicit theory e.g. on Hospital Patient Safety (Herepath et al, 2015) using a range of layered theory. 'Digging through the literature' (Pawson, 2006) BeHeMOTH template (Booth and Carroll, 2015) Realist review to identify 'explanatory accounts' (Pearson et al, 2015) Face to face or virtual brainstorming (e.g. Rycroft- Malone, 2012) including researcher 'creativity' (Wong et al 2013) e.g. on Managed Clinical Networks (Tolson et al, 2007)
Approaches to building IRTs based on examples in the literature Grand theory Top down When 'programmes' are not well established / defined Programme theory Inductive, abductive and retroductive inference based on data As the project develops likely to use all the strategies Data derived When there is some 'data' available for existing 'programmes' Bottom up When the 'programme' is well established / defined / discreet
My approach to initial theory building Grand theory Theories of behaviour, organisational and social change Inductive, abductive and retroductive inference based on data Secondary data from case studies which have adopted a positive approach Programme theory
Selecting existing theory M A C R O M E S O Theoretical Domains Framework, Cane et al Systems Theory, von Bertalaniffy M I C R O
Selecting existing theory M A C R O M E S O Theoretical Domains Framework Cane et al Systems Theory von Bertalaniffy M I C R O
Combine to provide a theoretical framework Cognitive Participation Structural, cultural conditioning Coherence Motivation Opportunity Collective Action Structural and cultural morphogenesis MICRO Capability MESO MACRO Reflexive Monitoring
Develop a broad model of intermediate outcomes Clarity / consistency of sex positive Evidence of efficacy Development of sex positive as an approach Outer Context Religious Social norms and prejudices Historical Political Competing demands Experience Interpersonal relationships Evidence Reasons to challenge dominant paradigm Adapt processes critical Exploration of alternatives Signal of intention Identification of sex positive as alternative approach Upskilling Trial adoption Evaluate Reinforce / maintenance Then prioritise / focus for in depth realist work...
Structural and cultural conditioning Map theoretical framework to intermediate outcome to create IRT (1/8: 'in/coherence') Signal of intention MACRO Coherence MESO Motivation MICRO Cognitive Participation Capability Reflexive Monitoring Opportunity Collective Action Structural and cultural morpho-genesis Incoherent national policy means different team members are motivated to pursue different aspects of the policy to safeguard their own positions (role and beliefs), thus inhibiting local buy-in to positive approaches and no clear signal of intention
Aspects of structure Layering statements to form theories Aspects of societal culture Infrastructural...in the context of incoherent policy what was it that galvanised the team... Institutional Interpersonal Aspects of structure/ culture and agency conditioning actions Signal of intention Adapt local processes Individual Time Service status quo Towards positive approach
Utility of existing theories in developing IRT They were a GUIDE to developing initial explanation Morphogenetic Approach Theoretical underlabouring - useful for considering interplay between structure, culture and agency Supports theorising about sustainability of change Normalisation Process Theory Supports working theory development and identification of likely key mechanisms at the level of the key actors (groups and individuals) COM-B Useful heuristic to consider individual's action
Challenges Selecting theories - there are so many to choose from Finding a balance - working at different levels within society demands lots of theories and lots of data. Zooming in and out Climbing up and down ladders Time travel Settling
Discussion Approaches to building IRT may depend on the 'programme under question' and its stage of evolution. Utilisation of existing and abstract theory as a guide to programme theory development provides structure and supports accumulation of knowledge Selecting theory in initial phases is challenging Layering theories supports complexity thinking
Any Questions?
BUILDING 'DOWN' FROM GRAND THEORY WHERE PROGRAMME THEORY IS LACKING Katie Shearn PhD Candidate Supervisors: Dr Hilary Piercy, Dr Peter Allmark, Professor Julia Hirst Sheffield Hallam University k.shearn@shu.ac.uk
References Archer, M. S. (1995). Realist social theory: The morphogenetic approach. Cambridge university press. Booth, A., & Carroll, C. (2015). Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?. Health Information & Libraries Journal, 32(3), 220-235. Herepath, A., Kitchener, M., & Waring, J. (2015). A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multi-site case study. May, C., & Finch, T. (2009). Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology, 43(3), 535-554. Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 1. Pawson, R., & Tilley, N. (1997). Realistic evaluation. Sage. Pawson, R. (2006). Evidence-based policy: a realist perspective. Sage publications. Pearson, M., Brand, S. L., Quinn, C., Shaw, J., Maguire, M., Michie, S.,... & Byng, R. (2015). Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health. Implementation Science, 10(1), 1. Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., DeCorby, K., Bucknall, T. K., Kent, B.,... & Wallin, L. (2012). Realist synthesis: illustrating the method for implementation research. Implementation Science, 7(1), 1. Tolson, D., McIntosh, J., Loftus, L., & Cormie, P. (2007). Developing a managed clinical network in palliative care: a realistic evaluation. International journal of nursing studies, 44(2), 183-195. Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing. Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11(1), 1.