Episode 39 – Creative Approaches to Stakeholder Engagement in Realist Research with Seán Paul Teeling

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.