The Realist Lens - For Researchers Who Keep It Real
Published by Alejandro Arguelles Bullon
Education
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The Realist Lens is a podcast that makes realist evaluation and synthesis accessible and easy to follow. Through relaxed conversations with expert guests, students, and practitioners, we explore key realist concepts like mechanisms, context, and outcomes. Whether you're new to realist approaches or more experienced, this podcast offers practical insights, real-world examples, and thoughtful reflections to support your learning and curiosity—one conversation at a time.
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.
What makes medication management in older people with dementia such a complex challenge, and how can realist approaches help us make sense of it? Alejandro is joined by Professor Ian Maidment, whose career spans over two decades in pharmacy practice, mental health, and dementia care, alongside leading NIHR-funded realist research. Ian shares his journey from NHS pharmacist to realist researcher, explaining how he discovered realist evaluation and why it became essential for unpacking the complexity of medication safety in older populations. Drawing on flagship projects like MEMORABLE, he reflects on what realist synthesis and evaluation reveal about hidden burdens, particularly for family carers, and why understanding “what works, for whom, and why” is critical in this field. From the power of realist interviews and stakeholder engagement to navigating limited literature and co-producing meaningful findings, Ian offers practical insights grounded in both clinical experience and methodological expertise. Whether you’re a clinician, researcher, or policymaker, thisepisode provides valuable lessons on embracing complexity, translating findings into practice, and using realist approaches to improve care for vulnerable populations.
What makes realist evaluation so valuable in global health, and what does it take to apply it meaningfully? In this rich and reflective conversation, Alejandro is joined by Assistant Professor Brynne Gilmore, whose career has taken her from community health programmes in East Africa to leading realist research and mentoring PhD students at University College Dublin. Brynne shares how she first discovered realist approaches, why they’re so suited to the complexity of global health systems, and what it really means to work ethically, relationally, and with cultural awareness in contexts far from where the approach was born. From navigating power dynamics and co-producing knowledge to adapting interviews and focus groups so they resonate locally, Brynne offers practical insights grounded in years of fieldwork and methodological reflection. Whether you’re stepping into global health evaluation for the first time, refining your approach to stakeholder engagement, or looking for ways to close the capacity gap in realist research worldwide, this episode will give you both inspiration and practical tools.
In this episode of The Realist Lens, Alejandro is joined by Dr Robert Sandler, medical doctor and recent PhD graduate from the University of Sheffield, to explore how realist evaluation can help make sense of major changes in healthcare. Rob shares his doctoral research examining the impact of ETI for people with cystic fibrosis in the UK, a treatment that has rapidly transformed health outcomes and, in turn, reshaped clinical care, patient experiences, and treatment decision-making. The conversation explores what it means to conduct realist research in a fast-moving and uncertain context. Rob reflects on how the introduction of ETI, alongside the wider disruption of COVID-19 and the shift toward virtual care, created a dynamic environment that required continual theory development and adaptation. Rob discusses how he developed and refined programme theory using multiple methods, including multi-centre interviews with clinicians, targeted single-site interviews, a national patient survey, focus groups, and secondary quantitative analysis. He explains how realist logic guided the sequencing of these methods and how each contributed to theory refinement. The episode also explores keyfindings from the study, including tensions between clinicians and patients in how health and treatment decisions are understood, what Rob describes as “epistemological dissonance.” He reflects on the role of habit formation intreatment adherence, the challenges of maintaining intervention fidelity in changing contexts, and the importance of reflexivity as a clinician-researcher. Rob concludes by sharing practical advice for clinicians and researchers working with realist approaches, including the value of formal training, building supportive networks, and staying grounded in real-world complexity. This episode will be valuable for anyone conducting realist evaluation, working with mixed methods, researching complex interventions, or navigating research in rapidly changing healthcare environments.
In this episode of The Realist Lens, Alejandro is joined by Michele Wood, art psychotherapist in palliative care and part-time PhD researcher at Lancaster University, to explore what it really means to undertake a realist PhD alongside work, life, and personal commitments. Michele shares her journey into doctoral research after more than 30 years in clinical practice, where her interest in the role of technology in palliative care, particularly following the rapid changes during COVID-19, led her to investigate how and why new practices are adopted (or resisted) in complex healthcare settings. The conversation focuses on the realities of doing realist research part-time, including managing competing demands, navigating the iterative nature of realist thinking, and sustaining momentum over what Michele describes as a marathon rather than a sprint. She reflects candidly on the personal and professional contexts that shaped her journey, and how realist philosophy helped her make sense of complexity across different levels of experience. Michele also shares practical strategies that have supported her along the way, including reflective journaling, memoing, “deep work” practices, and what she calls leaving “pebbles through the forest” to stay connected to evolving ideas. This is an episode for anyone considering or undertaking a part-time PhD, working with realist approaches in practice-based settings, or trying to balance rigorous research with the realities of everyday life.
In this episode of The Realist Lens, Alejandro is joined by Dr Gareth Wiltshire, sociologist and critical realist scholar at Loughborough University, to unpack realist thematic analysis, a method designed to move qualitative analysis beyondsurface-level patterns and into causal explanation. Gareth shares his intellectual journey into critical realism and explains how realist thematic analysis emerged as a response to longstanding binaries in qualitative research, between positivist and interpretivist approaches, and between descriptive coding and explanatory theory-building. The conversation explores how experiential, inferential, and dispositional themes work together to support generative causal explanation, helping researchers move from what participants say, to what can be inferred, and ultimately to what must exist for those experiences to occur. Drawing on examples from sport, volunteering, and qualitative interviewing, Gareth explains how realist thematic analysis supports methodological coherence, interpretive rigour, and transparency while remaining flexible and usable for applied researchers. This episode is essential listening for anyone grappling with qualitative analysis in realist, critical realist, or complexity informed research particularly PhD students and early career researchers navigating how to analyse data without losing ontological depth.
In this episode of The Realist Lens, Alejandro is joined by Sebastian Lemire, evaluator and methodological pluralist, to explore one of the most contested questions in contemporary realist inquiry: Is the realist trial a methodological impossibility, or a rare but viable unicorn? Drawing on his extensive experience in theory-based evaluation and a review of published realist trials, Sebastian shares his pragmatic view on the long-standing debate between realist evaluation and randomised controlled trials (RCTs). Rather than taking sides in ontological disputes, Sebastian invites listeners to focus on what different forms of evidence can do and how they can be meaningfully integrated. The conversation traces Sebastian’s journey from theory driven evaluation into realist-informed work and unpacks how the debate around realist trials reflects deeper divides about causation, evidence, and credibility in evaluation. Together, Alejandro and Sebastian examine why the topic remains so divisive, what distinguishes the rare “unicorn” realist trials, and how integration can occur at the level of evidence and analysis rather than philosophical purity. This episode does not seek to close the debate. Instead, it keeps the conversation open, offering a thoughtful, empirically grounded perspective on how evaluators might navigate complexity, pragmatism, and explanation without becoming trapped by methodological dogma.
In this episode of The Realist Lens, Alejandro is joined by Dr Kerryn O’Rourke, public health researcher, realist evaluator, and Co-Lead of the Realist Research, Evaluation and Learning Initiative at Charles Darwin University, to explore what it really means to do realist work across cultures ethically, methodologically, and epistemologically. Kerryn shares her journey from nursing and frontline public health practice into realist research, shaped by a long-standing commitment to health equity and social justice. Drawing on her PhD and subsequent evaluation work, she reflects on how realist methodology offered a way to make sense of complex social programmes, particularly those involving vulnerability, power, language, and cultural difference. The conversation centres on cross-cultural realist interviewing: what happens when theory-testing conversations move across languages, worldviews, and livedrealities. Kerryn unpacks how bicultural collaboration became central to her work, not as a technical add-on, but as a core part of realist inquiry and knowledge co-creation. Kerryn also shares practical lessons from evaluating maternity and social support programmes with culturally diverse communities, as well as her current work with First Nations communities in Australia. This is an episode for anyone conducting realist evaluation or research in diverse, multilingual, or inequitable contexts, and for those grappling with how to remain philosophically coherent while working ethically across difference.
In this episode, Alejandro is joined by Dr Pragati Hebbar, dentist, public health researcher, realist evaluator, and Assistant Director at the Institute of Public Health, Bangalore to explore what it looks like to transition from clinical practice into policy, embrace complexity, and use realist approaches to make sense of real-world implementation. Pragati walks us through the journey that led her from treating precancer cases in dentistry to questioning the systemic forces shaping tobacco use in India — andeventually into realist research. She shares how realist evaluation helped her unpack why one national tobacco control programme produces vastly different outcomes across states, and how she combined quantitative proxies, qualitative interviews, and field observations to build and refine programme theories. We talk openly about unlearning linear clinical thinking, navigating contextual variation, realist interviewing, and the challenges of matching policymaker expectations with the nuanced findings that realism often provides. Pragati also highlights the importance of accessible training, communities of practice, and the growing momentum for realist work across India and the Global South.
In this episode, Alejandro is joined by Dr. Sara Dada, global health researcher, newly appointed Ad Astra Fellow at University College Dublin, and the mind behind a truly ambitious realist PhD. Sara walks us through what it means to build an entire doctoral thesis around realist principles: from developing initial programme theories, to conducting a realist review and realist evaluation in Zambia, to zooming out and constructing middle-range theories that speak to global health more broadly. She reflects candidly on the challenges and breakthroughs of realist work — including the messy, iterative nature of theory-building, the complexity of real-world contexts, and the importance of embracing imperfection as part of the learning journey.
In this episode, Alejandro sits down with Professor Joanne Greenhalgh, one of the core members behind the RAMESES standards — the evolving benchmarks that have shapedrealist evaluation and realist synthesis across the world. Joanne shares the story of how the standards came to life, their role in guiding quality and reporting in realist work, and why they were designed to evolve rather than prescribe. From anecdotes about working with Ray Pawson to reflections on teaching, mentoring, and community-building, Joanne offers candid insights on what makes realistresearch rigorous yet flexible. Whether you’re just starting your realist journey or refining your craft, this episode is packed with practical wisdom on doing realist work well.
Alejandro sits down with Dr Esther de Weger and Dr Natascha van Vooren to unpack the evolving world of realist configurations, from the classic CMO (Context–Mechanism–Outcome) to newer variations like SCMO, ICMO, and beyond. Following on from last week's episode on CMOs, in this lively, reflective conversation, Esther and Natascha draw on their PhD experiences and current research to explore how small shifts in configuration can transform the way we understand causality in realist studies. They discuss how to choose the right configuration for your question, what happens when you “add a letter,” and why thinking with configurations means embracing flexibility, reflexivity, and transparency. With practical insights for students, supervisors, and evaluators alike, this episode offers clarity on how to stay grounded in realist thinking while adapting tools for complex, real-world contexts.
Alejandro sits down with Andrew Harding, Lecturer in Health Inequalities at Lancaster University, to unpack one of realist research’s most defining ideas: Context–Mechanism–Outcome (CMO) configurations. In this lively and practical conversation, Andy reflects on his decade-long realist journey, from PhD student to supervisor, sharing how CMOs have evolved from textbook theoryto hands-on analytic tools. Together, they explore what it really means to “think with CMOs,” how to avoid common traps when building them, and why flexibility and creativity are vital in realist analysis. Drawing on real-world examples from his own work on housing and ageing, Andy illustrates how subtle shifts in reasoning and context can reshape outcomes. The discussionmoves beyond formulas, revealing CMO configuration as both method and mindset, a way of thinking that helps researchers make sense of complexity. Whether you’re new to realism or deep into your thesis, this episode offers clarity, confidence, and a few “light-bulb” moments for anyone trying to decode what makes interventions tick.
