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what is critical realism in qualitative research

what is critical realism in qualitative research

Interdisciplinarity and climate change: transforming knowledge and practice for our global future. Health and Human Rights. Critical realism is a philosophical position that is attracting increasing interest in academic and professional fields. This manuscript draws on research carried out by FH during her doctoral studies. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. In the social world, entities are often invisible (e.g. People interact with entities and structures across these layers. Critical realism accepts that there are New York: Routledge; 2008. The presentation is also intended to provide a transferable case study and model of critical realism ‘in action’. On the methodological, theoretical and philosophical context of health inequalities research: a critique. Tress G, Tress B, Fry G. Clarifying integrative research concepts in landscape ecology. Finally, we recommend some practical steps to facilitate greater consideration of the place of paradigms in research on human rights and social determinants of health. And, the knowledge that we construct about these in-the-mind realities is influenced by the social relationships in which we are embedded. This perspective is also apparent in some conceptions of human rights as legal rules found within treaties [14]. Critical realists are pragmatic in their approach to methodology and methods. Analysis of the relationship between human rights and health that doesn’t take account of the linkages between laminations may result in a focus on specific levels. The example of disability research. He says that world poses two reality i.e. Journal of Human Rights. in Vermont, information derived from a human rights analysis was presented to Vermonters to inform them about how policy changes impacted on human rights obligations). Harris P, Sainsbury P, Kemp L. The fit between health impact assessment and public policy: practice meets theory. Activation, which involves the exercise of particular mechanisms, is contingent on other entities and their mechanisms (context). Some people had multiple roles (e.g. Further, there are differing conceptualisations of the determinants of health used in human rights and public health that have important implications for how relationships between SDOH and health rights are understood [4, 7]. Soc Theory Health. The paper draws FH’s PhD thesis. One way would be to write short texts on various research methods from a critical realist perspective, similar to the series of short handbook on methods published by Sage. Part of Critical Realism (CR) is a branch of philosophy that distinguishes between the 'real' world and the 'observable' world. We understand a paradigm to constitute four categories of interrelated views that underpin our conceptions of knowledge and knowing: ontology – one’s understanding of the nature of reality and what can be known about that reality; epistemology – understanding of the nature of knowledge, the ‘getting to know’ process, the relationship between the person who seeks to know and the knowledge they construct, and the criteria for making claims about knowledge; methodology – approach to the construction of knowledge; and axiology – the influence of values on knowledge that is acquired and how it is acquired. 2017;21(8):1098–113. Global initiatives such as the WHO Commission on Social Determinants of Health, the 2011 Rio Declaration, and 2015 Sustainable Development Goals, identify human rights as key to addressing inequities in social determinants of health. What is it about this object, that enables it to do certain things (there may be several mechanisms at work and we need to seek ways to distinguish their respective efforts)? We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. causal mechanisms); the actual domain consists of events and their effects that have been caused by the activation of causal mechanisms; and the empirical domain represents actual events-effects that can be, or have been, observed or experienced. Method in social science: a realist approach (2nd Ed). Can/could object A exist without B? In turn, those properties give the entity the power to activate or exercise mechanisms that can cause effects. The framework can assist researchers to identify the mechanisms that may be in play and that should be subject to further in-depth investigation and development of explanatory theory. Attention to human/health rights emphasizes the need to consider power-related relationships and associated accountabilities, in particular between states and communities. 2013;93:185–93. London and New York: Routledge; 2010. The exercise of some mechanisms (e.g. the activation of compliance mechanisms associated with the rules of accessing the Vermont Legislature). ‘Reality’ here refers to whatever it is in the universe (i.e., forces, structures, and so on) that causes the phenomena we perceive with our senses” Thomas Schwandt, The SAGE Dictionary of Qualitative Research (1997, p. 133). Joseph Maxwell argues for critically applying a realist ontology to a number of important theoretical and methodological issues. London and New York: Routledge; 2016. Sayer A. Differentiating between actors and structures emphasises people and their capabilities as one unit of analysis and institutions and social relations associated with systems as another. Does the explanatory theory provide a foundation for actions that can be demonstrated to be beneficial rather than harmful? From a CR perspective, the way health rights are interpreted and discussed is also based on our understanding that may change over time – they are transitive understandings. In this sense, a social system is always open to and characterized by change. An increasing number of public health, and to a lesser extent human rights, scholars are adopting a CR position [e.g] [9, 22,23,24,25]. For example, human rights may be observable at the empirical level through asking people about their beliefs and attitudes towards human rights. Huber M, Morreale S. Disciplinary styles in the scholarship of teaching and learning: exploring common ground. PubMed Google Scholar. Epistemologically, CR provides principles that can be applied by researchers developing theoretical explanations about phenomena in the world. FH developed the draft manuscript. It stands well on its own. As each entity had properties that endowed it with mechanisms which could enable, constrain or block the mechanisms of other entities, the actual interactions between entities and their effects were extremely complex. 2015;15(1):725. use the term “critical realism” in a broad sense to include a range of positions incorporat- ing this view, including Bhaskar’s. Critical realism suggests that both quantitative and qualitative approaches are important to use in a single research project in order to fully explore and understand the structures and mechanisms of what can be observed and experienced. Article  Critical realism has been an important advance in social science methodology because it develops a qualitative theory of causality which avoids some of the pitfalls of empiricist theories of causality. Its assumptions of open systems, generative logic, agency and structure-related factors, and its methodological eclecticism have been widely acknowledged and appreciated. This calls into question the notion of determinants, as the term can imply a degree of stability that is not present. There is also now a large body work in the area of realist evaluation which is informed by a critical realist research paradigm [26], including examples in this journal [e.g] [27,28,29]. social reality and the other is the natural reality which is the pioneer of the structures which constructs the social reality. LINCOLN and GUBA reject any absolutist criteria for "judging either 'reality' or validity" (p.167). BMC Public Health. Price L. Wellbeing research and policy in the U.K.: questionable science likely to entrench inequality. Those relationships, which are defined by the activation and effects of mechanisms, explain how the environment ‘works’ (e.g. As London and Schneider observe, this can help ensure there is, “the space for civil society action to engage with the legislature to hold public officials accountable and confirms the importance of rights as enabling civil society mobilization, reinforcing community agency to advance health rights for poor communities” [37]. 2010:12(2). While the differences between philosophical paradigms and the way … BMC Public Health. Bhaskar R. Dialectic: the pulse of freedom. The strengths of critical realism is often described in contrast to the paradigms of positivism and interpretivism. As researchers when reporting on research on SDOH and HR, we can outline, as in this paper, the paradigm perspectives that influenced our research and related assumptions about the knowledge that we have constructed and evaluated. CR adopts ‘practical adequacy’ as one of the criteria for evaluating new theory. Questions that can help identify the properties of entities include: What does the existence of this object/practice presuppose? someone reads and thinks about the norm). In the following sections we briefly elaborate on the key features of the critical realist research paradigm. events, effects). In Vermont the laminated nature of the relationship between the human rights driven campaign and access to health care is illustrated using examples in Table 1. the Oxford handbook of jurisprudence and philosophy of law. Journal of Critical Realism. Rights UNCoH. The world as we know and understand it is constructed from our perspectives and experiences, through what is 'observable'. Oxford: OUP Oxford; 2012. The relationship between different fields and paradigm positions is more nuanced than presented here and within specific fields there exist a mix paradigm perspectives [16, 17] but for the purposes of this paper the main point is that differing ontological and epistemological positions have implications for the questions researchers seek to answer, the methodologies they employ, the data they gather - and the ways in which data are gathered, analysed and interpreted. 2002), it is often the task of researchers to develop methodological approaches that fit their situation by selecting and adapting methods that align the philosophical tenets of CR with the substantive focus of inquiry (Yeung 1997). Copy and paste the following HTML into your website, International Journal of Qualitative Methods, Political Science and International Relations, The SAGE Encyclopedia of Qualitative Research Methods,, Methodological Holism Versus Individualism, Association for Qualitative Research (AQR), Center for Interpretive and Qualitative Research, International Association of Qualitative Inquiry, International Institute for Qualitative Methodology, Membership Categorization Device Analysis (MCDA), Advances in Qualitative Methods Conference, Ethnographic and Qualitative Research Conference, Interdisciplinary Qualitative Studies Conference, International Congress of Qualitative Inquiry, International Human Science Research Conference, Thinking Qualitatively Workshop Conference, CCPA – Do Not Sell My Personal Information. This CR epistemological perspective means that we recognize that theory that we have developed about human rights and health may in time be extended, modified or rejected, notwithstanding our attempt to ensure its trustworthiness and practical adequacy. health outcomes, access to health services, health service costs, measured inequalities). Understanding the impact of area-based interventions on area safety in deprived areas: realist evaluation of a neighbour nuisance intervention in Arnhem, the Netherlands. What cannot be removed without making the object cease to exist in its present form? The case study used within the paper to illustrate key points was partially funded by the World Health Organization. Such contingent relationships are common in social environments. Qual Health Res. Health and Human Rights. And, the exercise of some mechanisms was a manifestation of personal power to act (i.e. California Privacy Statement, Hunt P. Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Report of the Special Rapporteur, Paul Hunt, submitted in accordance with commission resolution 2002/31. 2019;19(1):88. Landscape Ecology. 2001;53(6):801–16. It is particularly useful for understanding how and why things happen, as well as unpacking the influence of context on the outcomes of a program. to empower, to inform) activated when a group of people decided to exercise their power to ‘campaign for universal health care’. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. This framework emphasizes that these entities and relationships can be understood to exist within a stratified, laminated, emergent, open system that contains an assemblage of entities that have a relationship to human rights. Chapman AR. The United States does not have a Universal Health Care (UHC) system. When making a structural analysis of entities, it should not be assumed that entities that share the same name (e.g. Conversely, those who read accounts of such attempts need to take into account the paradigm position of the researchers. It is open to challenge and change. The latter involved a relationship between access to money and access to health services. Critical realism is not a research method per se but a set of philosophical tenets that can inform a wide variety of quantitative, qualitative or mixed-methods designs, which seek to understand different phenomena. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. An outcome-oriented definition such as that proposed by Nkwi et al. Soc Sci Med. statement and That there is a relationship between human rights and health is well established and frequently discussed. Human rights and transnational corporations and other business enterprises resolution 2005/69 (20 April 2005) Para 1(d). Pawson R. The science of evaluation: a realist manifesto. The International Journal of Human Rights. For example, while social constructionists are more likely than positivists to be interested in investigating qualitative differences in the meanings people give to experiences, positivists are more likely to be interested in identifying stable relationships between things and substantiating these relationships using generalisable quantitative data. Critical realists seek to avoid being trapped within the silos of single disciplinary views. (Februuary 13 2003) paras 82-85. From this perspective, “there exist multiple, socially constructed realities ungoverned by natural laws, causal or otherwise” [15]. This represents a form of ‘abductive reasoning’ which, along with retroduction, is a distinctive feature of a CR theorising methodology. Abingdon: Routledge; 1992. Soc Sci Med. Sign into your Profile to find your Reading Lists and Saved Searches. What are the components of complex interventions in healthcare? Within this system, multiple entities are present, the types of entities are wide ranging, each entity may subsume other entities or be subsumed within other entities, and a vast array of these entities’ mechanisms may be activated and in play moment by moment. Descriptions of complexity, as we have illustrated, necessarily go beyond the empirical domain of reality (i.e. For example, in New Zealand researchers give explicit consideration to Maori ontology and epistemology [18] and Maori specific research methodology (Kaupapa Maori). From this perspective, we believe that attempts to develop knowledge about particular phenomena require explicit attention by researchers to their ‘paradigm positioning’. Critical realists contest the notion that what can be observed and measured is the thing itself [31]. BMC Public Health Terms and Conditions, The key features of human rights and SDOH environments, identified as an our outcome of our theorising work, include the following: HR and SDOH environments are understood to be open, laminated, complex and adaptive systems. Scand J Disabil Res., DOI: While frameworks for research based on critical realism have been developed (Pawson and Tilley 1997; Danermark et al. However, sampling should also be focused on using key groups © 2020 BioMed Central Ltd unless otherwise stated. Healthcare is paid for through a mix of private insurance and government funded health insurance schemes for particular population groups. Health and Human Rights Journal. Journal of Critical Realism. 2018;17(2):215–28. “Scientific realism is the view that theories refer to real features of the world. These mechanisms were contingent on contextual factors such as Vermont’s history of being a progressive state and the Vermont Workers Centre being well established with an existing base and relationships. As illustrated in Fig. Emancipatory objectives form part of a critical realist research agenda. Bhaskar describes how “This is the arduous task of science: the production of the knowledge of those enduring and continually active mechanisms of nature that produce the phenomena of our world” (Bhaskar, 1975, p.47). Then these textbooks could be introduced as part of 1, 2 or 3-week modules about critical realist research methods. Vermont Case Study: Towards a theory of how the campaign worked. Reality is stratified into three domains: empirical, actual and real. 2002:5. Critical realism research paradigm – key features and relevance to human rights and social determinants of health Critical realism (CR) is a relatively new paradigm position. 2006;8(4):278–97. Critical realism has been an important advance in social science methodology because it develops a qualitative theory of causality which avoids some of the pitfalls of empiricist theories of causality. This view, that Bhaskar calls the epistemic fallacy, reduces statements about the world (ontology) to statements about our knowledge of the world (epistemology) [21]. The social world is a layered, complex and open system. Price L. Critical realist versus mainstream Interdisciplinarity. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). The SAGE. The exercise of mechanisms was often contingent on the mechanisms of another entity being activated. This allows space for the members of different disciplines to work together to understand a topic such as human rights and the social determinants of health. A CR approach also understands absence of entities as being causally efficacious. Manage cookies/Do not sell my data we use in the preference centre. London and New York: Routledge; 2002. human rights, discrimination, capitalism). These explanations focus on the mechanisms of entities that can generate events – as well as the properties of entities that empower them with such mechanisms. Scott-Samuel A, O'Keefe E. Health impact assessment, human rights and global public policy: a critical appraisal. Entities in health rights environments can take different forms such as physical, cultural, biological or social. Explaining society: critical realism and the social sciences. CR provides a coherent rationale for, and guidance on, the use of multiple data, methodologies and methods within SDOH and HR research. Abstract. We present a critical realist informed framework for describing the environment that incorporates human rights and social determinants of health-related entities – and defines their relationship (Fig. Critical Realist Human Rights and Social Determinants of Health Explanatory Framework. Critical Realism, Dialectics, and Qualitative Research Methods. Privacy This chapter introduces a critical realist approach to qualitative research. Research design should be ‘practically adequate’: that is,‘fit for purpose’ [30]. 2011. Correspondingly, there have also been calls from human rights monitoring bodies – including the United Nations (UN) Commission on Human Rights, the UN Committee on the Rights of the Child, the UN Committee on Economic, Social and Cultural Rights and the UN Special Rapporteur on the right to health [1,2,3] - for the development of health impact assessment tools and approaches that can provide insights into ways government actions affect the right to health. Because of the stratified nature of reality, entities can be invisible or visible. evaluating critical realism-based explanatory case study research within the information systems field. Critical realism (CR) is a useful philosophical framework for social science; however, little guidance is available on which precise methods – including methods of data collection, coding, and analysis – are best suited to applied CR research. However, the focus on such observable and measurable indicators ignores whether or how the indicators correspond to the ‘actual’ experience of human rights and the ‘real’ properties and mechanisms of human rights. Ultimately the campaign contributed to a number of outcomes described in Fig. In 2008, the Vermont Workers’ Center (VWC) began a “Health Care is a Human Right” campaign. Baum F, Delany-Crowe T, MacDougall C, van Eyk H, Lawless A, Williams C, Marmot M. To what extent can the activities of the south Australian health in all policies initiative be linked to population health outcomes using a program theory-based evaluation? affected communities) have common properties and therefore powers? Critical realism is a broad movement within philosophy and sociology. The authors declare that they have no competing interests. As practitioners, we can have conversations in our work with communities and other stakeholders about how we understand knowledge, the role of different types of evidence and ways of theorizing explanations and evaluating their practical adequacy. This type of research will enable the fields of public health and human rights to identify the fundamental causes of health and human rights inequities such as economic structures, class and racism, and to conceive ways of addressing them. Details of the case study are described in a separate publication [13]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. By using this website, you agree to our Bhaskar R, Danermark B. Metatheory, interdisciplinarity and disability research: a critical realist perspective. If they already had some experience of Qualitative design I’d say go straight for this one. Critical realism (CR) has been known as a meta-theory that underpins research and practice. Conceptual models used to understand and describe how the SDOH shape people’s lives are often limited to a narrow range of causal pathways that reflect particular disciplinary perspectives [9,10,11]. In contrast, social sciences often adopt a social constructivist paradigm which rests on the view that what is real is what our individual minds ‘make’ real to us; reality is a construction – by and of the mind. A theory is not intransitive, as reality is. It is difficult to know what to do when you do not understand how things work. Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works. The social determinants of health, health equity, and human rights. 2008;18(11):1574–85. These various properties may be further differentiated and described. Rasanathan K, Norenhag J, Valentine N. Realizing human rights-based approaches for action on the social determinants of health. Theorizing approaches to parts, powers and the whole intervention. 6—PART I A REALIST STANCE FOR QUALITATIVE RESEARCH Kramer D, Harting J, Kunst AE. CR in their foreword to a special issue of MISQ on critical realism and information systems research. E/CN.4/2003/58. Cite this article. critical realism is a meta theory and does not offer a procedure for the conduct of social research. Critical or Subtle Realist Paradigms have emerged recently and in the context of the debate about the validity of interpretive research methods and the need for appropriate criteria for evaluating qualitative research. Tendencies may include recurrent relationships between phenomena, variability in such relationships or the absence of a relationship – and complexity is likely to characterize the interactions between entities and their associated mechanisms. for analysing qualitative research data collected for public health nutrition and dietetic research ... 1997, 1999) and is theoretically rooted in critical realism (Bhaskar, 1978) and the social cognition paradigm (Fiske & Taylor, 1991). Critical realism consistently points to the epistemological implications of implicit ontological commitments in sociological research. These mechanisms related to learning about the right to health, community mobilisation, awareness raising in decision makers, framing of ideas, and responding to new developments. Hunt P. Missed opportunities: Human rights and the Commission on Social Determinants of Health. Events happen when the powers of one or more entities are activated. When we conceptualise the spaces where human rights play out as being laminated, we can begin to identify what entities and related mechanisms exist at different laminations and also to consider how the interplay of mechanisms and the specific context influences those mechanisms. Positivism's ontology is termed "naive realism"—reality is deemed both "real" and "apprehendable," while postpositivism's "critical realism" maintains that "'real' reality" is "probabilistically apprehendable." Critical realism is a series of philosophical positions on a range of matters including ontology, causation, structure, persons, and forms of explanation. Critical realism offers an ontology that can conceptualize reality, support theorizing, and guide empirical work in the natural and human sciences. 19 (4th December 1997) para 33. It was evident that causal power could shift between agency and structure. A framework summarizing the outcomes of these analysis and theorising processes is presented. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. Some researchers, especially those employing mixed methods, adopt a pragmatic paradigm position in which their view of reality is based on and tested through experience. Understanding and explaining the relationship between human rights and SDOH requires going beyond the observable to consider structures, powers, and mechanisms and requires transdisciplinary work. Bhaskar describes two types of power relations linked to structure and agency [35]. If you encounter a problem downloading a file, please try again from a laptop or desktop. This needs to be taken into account when the applicability of evidence from other research involving similar entities is considered. These invisible entities are not observable at the empirical level, but the effects of their activated powers/mechanisms may be observable (e.g. Springer Nature. Fourth generation evaluation. With respect to practical implications of our theorising work, we argue that successful implementation of global initiatives such as the Sustainable Development Goals requires more than the setting of targets and indicators. For example, medical sciences have tended to adopt a positivist or post-positivist paradigm, based on the view that what is real, and therefore knowable, is what can be observed ‘out there’ and measured. qualitative research involves collecting and/or working with text, images, or sounds. In. In Mingers et al. Constructs and propositions may be transient. Correspondence to This contrasts with a system in which law-like regularities can be identified (e.g. avoids (typically inaccurate) generalizations and the unnecessary (and, for the most part, inaccurate) dichotomous positioning of qualitative research with respect to its quantitative coun - While acknowledging the role of rights, few initiatives have explicitly attempted to incorporate rights into actions and priorities [4,5,6,7,8]. As such it can mean many things in practice and some of the most interesting theoretical work which seeks to bridge structure and agency has taken place without the help of critical realist theory or under the looser banner of post positivism. 2015;13(3–4):340–54. 2 including human rights principles being incorporated into Vermont legislation. Article  As Carter and Little [12] observe, it is impossible to create knowledge “without at least tacit assumptions about what knowledge is and how it is constructed”. Invernizzi-Accetti C. Reconciling legal positivism and human rights: Hans Kelsen's argument from relativism. qualitative research, including phenomenology/lived experience research. It therefore functions at a level similar to that occupied by such philosophies as Positivism and Interpretivism. 2). Again, the properties and associated mechanisms of specific entities (e.g. Are the findings from other research relevant given contrastive properties and powers? The VWC developed a staged approach which first focussed on building power through activating Vermonters, then directly targeting the legislature. Although described by Alderson as different dimensions, these contrastive types of power could also be viewed as the extremes of one dimension (interpersonal relations). While some researchers have an explicit awareness of their paradigm position and communicate it in research publications, others have an implicit position only. The campaign adopted human rights principles to guide all its work. What is critical realism? Haigh, F., Kemp, L., Bazeley, P. et al. We can take account of dimensions of power when developing causal explanations and identifying what to do. The specifics of properties determine whether and what mechanisms can be activated. It represents a combination of views that contrast with those associated with traditional positivist and interpretivist positions [ 19 , 20 , 21 ]. Journal of Critical Realism. LK and PB were supervisors of the PhD and NH provided substantial input into the research planning and writing. We see epistemic fallacy in some existing approaches to the right to health, that tend to focus on identifying changes to indicators. Team working in mixed-methods research. Alderson P. Childhoods real and imagined: volume 1: an introduction to critical realism and childhood studies (ontological explorations). doctor, campaigner, parent). beyond what can be observed, experienced and measured). The same approaches could be drawn on when other significant relationships in health environments are investigated. To confirm this stance, we have presented and account of, and commentary on, our application of the critical realist paradigm in a project focusing on the relationship between HR and SDOH. And, if we are to avoid conflating entities with our ideas about them, we need to recognise that rights as ‘real things’ are not the same as our local/personal/temporal interpretations of them. The principles are derived directly from the ontological and epistemological assumptions of critical realism. London and New York: Routledge; 2013. Actors belong to, and are influenced by, multiple institutions and structural relations – but also have agency to influence and change those structures. Critical realism provides a critique of ‘ontological monovalence’, which is the idea that only things that are present exist [21, 30]. Google Scholar. Some of the potential relationships and associated mechanisms are illustrated using the Vermont case study. However, as Huber and Morreale [42] observe about interdisciplinary encounters. the exercise of agency by a Vermonter to write a letter) or the power of social structures over personal action (e.g. This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. Such relationships were evident in the campaign in Vermont which involved civil society actions intended to minimize coercive repressive relationships that were associated with neoliberal health care policies. London: Sage; 2013. Please note that some file types are incompatible with some mobile and tablet devices. To what extent do they (e.g. The other is Pragmatism which is focused from the start on the practicalities of ‘what works’ (Scott and Briggs, 2009). We also propose that these apparent disciplinary differences may reflect, in turn, more fundamental differences and variations in points of view about reality, the nature of knowledge that we attempt to construct about what we construe to be real and how we should go about constructing and evaluating knowledge: different ‘paradigms’ may be in play. 2012;74(1):6–13. Soc Sci Med. O'Cathain A, Murphy E, Nicholl J. Multidisciplinary, interdisciplinary, or dysfunctional? Alderson P. The politics of childhoods real and imagined volume 2: practical application of critical realism to childhood studies. Danermark B. Interdisciplinary research and critical realism. disadvantaged community, race, gender, sexuality, disability, and ethnicity) have similar properties and consequential powers. Just as when lack of rain causes a drought, or in the case of Vermont, lack of access to health care causes unmet health needs or lack of respect for rights causes suffering, rights are often most causally powerful and important when they are absent. 2010;71(8):1520–6. An example of this is that people have the right to health even when they are not aware of it. Centre for Health Equity Training, Research & Evaluation (CHETRE), UNSW Sydney, Sydney, Australia, Translational Research and Social Innovation Unit (TReSI), Western Sydney University, Sydney, Australia, You can also search for this author in While we can acquire or construct knowledge about reality, that knowledge can be fallible, or mistaken. Accordingly, if you have chosen realism as your research philosophy you are advised to assume the role of critical realist, rather than direct realist. Bhaskar [33] identifies seven laminations and in the table below we identify examples of HR and SDOH entities and relationships across these laminations (see Table 1). London L, Schneider H. Globalisation and health inequalities: can a human rights paradigm create space for civil society action? Chapman describes how, reticence to recognize the shared agenda and potential contribution of the human rights paradigm is particularly surprising in view of the Commission secretariat’s recommendation that the CSDH adopt a rights-based approach as an appropriate conceptual framework to advance towards health equity through action on the social determinants of health [5]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Critical realists recognize that the constancy of change and emergence means that a ‘settled’ theory concerning the relationships between phenomena cannot be formulated. Vermont citizens gained knowledge of rights and corresponding state duties) and, in turn, power to exercise new mechanisms (e.g. Soc Sci Med. Different types of data and disciplinary perspectives may be required to describe the entities that make up different slices or laminations of reality and the interplay between them [11]. Critical Realism It is argued that critical realism can add to IS research by opening up a particular methodological space that lies between empiricism and interpretivism (Mingers 2004). While entities exist independent of our ability to perceive and conceive that they exist, we do use our minds to construct knowledge about them. The 'real' can not be observed and exists independent from human perceptions, theories, and constructions. Indicators are used as proxies for human rights (e.g.,,, The author applies critical realist ideas and approaches to the design and methods of qualitative research, and presents two in-depth case studies of projects he conducted, describing how realist (and other) perspectives informed the research, the methods, and the conclusions. For example, within the Vermont case study, entities that were attended to included organizations such as the Vermont Workers Centre, people such as political representatives, policies such as Health Care Policy, plans including those of the VWC campaign, goals such as improving access to health services, methods and tools such as letter writing and human rights assessment of proposals. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated. 2007;17(10):1316–28. A further caveat concerns the attention that is given to what can be observed (the empirical domain). After an introduction which suggests the purpose of CR research is to discover the operation of social mechanisms and for this reason researchers are eclectic when it comes to research techniques, it is argued that, nonetheless, a small number of research designs are favoured for CR research. Global Health Promotion. They choose methods, therefore, based on their experience of what works best for answering their research questions. The Vermont Workers Centre case study received Internal Review Board approval number 2015020 from the University of Massachusetts Boston on February 26, 2015. The actual level consists of what happens when people’s rights to the determinants of health such as education, housing, health care, freedom from discrimination are fulfilled or neglected. Understanding the role of entities within these different laminations may also require transdisciplinary work that goes beyond disciplines working in parallel or sequence, in order to utilise integrative approaches [38, 39]. We applied a CR explanatory framework to explain how a human rights-based approach can work to influence access to health care. They also lead to the emergence of new entities (e.g. This position can be seen in the work of Hammersley, Silverman, Creswell, Kirk and … These events-effects can only be explained with reference to the real level, where unseen causal powers associated with such entities as class, gender, and capitalism are triggered. There is a consensus among researchers that critical realist is more popular and appropriate than direct realist approach due to its ability to capture the fuller picture when studying a phenomenon. In London. All authors were involved in conceptualising and revising the manuscript. 2016;14(3):3–12. In order to develop explanatory theory, concerning the relationship between human rights and the social determinants of health, the entities themselves need to be described. We have argued that in order to advance our knowledge and understanding across a field that is characterised by multiple disciplinary perspectives and approaches, we need to think about the meaning of knowledge and knowing: we need to consider our research paradigm. With this in mind, CR axiology supports social critique as a dimension of the research process. These are presented in a summary framework. The matter with human beans is that they is absolutely refusing to believe in anything unless they is actually seeing it right in front of their own schnozzles The BFG. Key features of the framework are now identified and discussed. Abstract. Cookies policy. Human rights infringements are often the result of repressive power relationships that enable some agents to maintain destructive, coercive and oppressive advantages over others’ interests [36]. 2010;12(2):17–30. These power relationships are often related to structures and beliefs related to class, gender, age and ethnicity. BMC Public Health 19, 1571 (2019). These effects may, in turn, involve changes to the properties of an entity and, therefore its potential mechanisms. Jagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T, Wong G, Cargo M, Green LW, Herbert CP, Pluye P. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. The world is made up of entities that have properties that endow them with powers and liabilities. Critical realism (herein CR) is a movement which began in British philosophy and sociology following the founding work of Roy Bhaskar, Margaret Archer and others. It views reality as complex and recognizes the role of both... Looks like you do not have access to this content. A coherent set of views in relation to these four considerations constitutes a paradigm position. Critical realism is the concept which is being constructed by well known British philosopher Bhaskar Roy. American Association for Higher Education and The Carnegie Foundation for the Advancement of Teaching: Washington; 2002. As previously noted, different disciplines and subject matter fields have developed traditions in relation to these views. For examples norms may be universal/community specific, clear/unclear, accepted/contested, non/conflicting. In an open system, such relationships are context dependent [31, 32]. However, we think that this situation is not unsurprising as there is currently a lack of underpinning understanding of how human rights (HRs) and social determinants of health (SDOH) interact and affect each other: how the relationship can ‘work’. People themselves are also layered and “can be understood as a uniquely laminated layered structure, shaped by genetics, nurture and culture, so that each person has strong and partly predictable tendencies” [34]. Carter S, Little M. Justifying knowledge, justifying method, taking action: epistemologies, methodologies, and methods in qualitative research. Specifically, CR emerged from the vision of realising an adequate realist philosophy of science, of social science,… Danermark B, Ekstrom L, Jakobsen L, Karlsson JC. To clarify and illustrate the implications of this stance, we define the notion of a paradigm, outline the key tenets of our own paradigm position – critical realism, and then describe in detail how we applied these tenets to develop theory about the relationship between human rights and the social determinants of health. It offers the scholar or inquirer a lens for understanding human ontology (our ‘being-in-the-world’), epistemology (how knowledge is formed and apprehended) and ethics (how we ought to act as moral beings). Critical realism (CR) is a relatively new paradigm position. The relationships that exist between entities within and across laminations can often be characterized in terms of the relative power that entities have. Because of the layered nature of reality, multiple disciplines and methodological approaches may be needed to understand the multilevel relationships between human rights and social determinant of health. At the same time, power relationships can trigger creative, emancipatory and transformative mechanisms that enable and empower agents [36]. Schrecker T, Chapman AR, Labonté R, De Vogli R. Advancing health equity in the global marketplace: how human rights can help. These studies were funded by an Australian National Health and Medical Research Council Postgraduate Scholarship. In doing so, we focus on two processes; structural analysis of human rights and social determinants of health and identifying causal relationships between social determinants of health and human rights. There is intersectionality of actors whereby actors belong to, and are influenced by, multiple institutions and structural relations - and can also be simultaneously individual, primary and corporate actors. To facilitate understanding of complex health rights environments and decisions about evidence, researchers and practitioners are likely to need to make use of more varied conceptual frameworks that are grounded in different disciplines and their related methodologies [20]. Knowledge is transitive– our understanding of a phenomenon can change. ICESCT. For example, the Vermont Workers Centre had its latent causal powers-mechanisms (e.g. Bhaskar R. A realist theory of science. California and London: Sage Publications; 1989. Clark AM. In this context, the key human rights relational structure is that between rights holders and duty bearers. A Critical Realism Methodological Framework for Undertaking Conceptual and/or Empirical Research: The CER-model By Susanne Wiatr Borg*, Louise Young** and Kristin B. Munksgaard*** - Work in progress - Abstract: Over the years marketing scholars have repeatedly requested more conceptual work to the field of marketing. volume 19, Article number: 1571 (2019) to claim rights through a right to health rights campaign). social norms, policies, practices, economic arrangements, politics, education) and they may change over time and vary across social groups and contexts. a health policy, housing policy, an education programme) can be elaborated and delineated with much greater precision using CR ontological perspectives and analysis processes. Piven FF, Cloward RA. Geneva: Office of the United Nations High Commissioner for Human Rights; 2005. Actors can be described in terms of the social relations and institutional structures they belong to. 2, a wide range of mechanisms associated with the varied entities involved in the campaign were activated. Chapman A. The levels identify people, the physical environment and social structures as key entities. However, action specifically based in a human rights approach to identifying and addressing social determinants of health has been limited and these major global initiatives have been critiqued. Soc Sci Med. 2009;(Supp 1):36–41. growth in knowledge also comes at the borders of disciplinary imagination....It is in this borderland that scholars from different disciplinary cultures come to trade their wares – insights, ideas and findings – even though the meanings and methods behind them may vary considerably (p. 1). That complexity is reflected in the array of relationships that potentially exist between the numerous entities involved. Evaluating the health-related targets in the sustainable development goals from a human rights perspective. CAS  Human rights attributes include the following: rights are norms; rights exist within relationships between claim holders and duty bearers; rights have core principles that provide a framework for application; rights have substantive and procedural elements. We cannot and should not assume that our views about these matters are shared by others. It represents a combination of views that contrast with those associated with traditional positivist and interpretivist positions [19,20,21]. For example, the exercise of mechanisms associated with human rights norms can change the capacity of a community to hold duty bearers accountable for impacts on health and health rights. Power repertoires and globalization. The real domain consists of entities or structures which have properties that give them the power to activate mechanisms that can affect other structures (i.e. Critical Realism (CR) is a philosophy of science that is based around a number of ontological principles. Guba E, Lincoln Y. Emerging in the context of the post-positivist crises in the natural and social sciences in the 1970s and 1980s, critical realism represents a broad alliance of social theorists and researchers trying to develop a properly post-positivist social … Critical realism is one of two philosophical underpinnings widely referenced in mixed method research (Creswell and Plano Clark, 2011). Explicit and indepth consideration of the relationship between human rights and the social determinants of health is critical to strengthening accountability and governance mechanisms. 2014;108:46–53. Lond Rev Educ. In this instance, the mechanisms may include informing, guiding, persuading, preventing and enforcing. As the construction of knowledge can never be infallible – sometimes we construct misconceptions or mistaken theories – our knowledge of the world is transitive. Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. Current human rights interpretations of the right to the highest attainable standard of health and healthcare and health determinants contained in reports from human rights bodies may miss important causes due to human rights narrower conceptualisation of determinants of health. New York: Routledge; 2008. The general case for attending to paradigm position when undertaking such research is also made. Vermont is a small state in the northeast of the USA with a population of just over 600,000. Polit Soc. 2016;16(1):291. Sayer A. Realism and social science. see Fig. What are social determinants of health? In line with CRs emancipatory values, actions should target development of enabling and empowering relationships. In: Shapiro SJ, editor. Handbook of the philosophy of social sciences. Scambler G, Scambler S. Theorizing health inequalities: the untapped potential of dialectical critical realism. The transitive nature can be seen in how legal conceptualisations of the right to health have been broadened over the years. Differences in paradigm positioning might also be linked to different social groups or cultures. Because CR principles are usually used to underpin the developme… London: Sage; 2000. Danermark points out that “A critical science often takes its starting point in notions that improvement of society is possible” [20]. Description of these entities, from both perspectives (cause and effect), involves structural analysis. Google Scholar. We would like to acknowledge the research team who contrinuted to the Vermont Case Study and the case study participants. Bull World Health Organ. At the same time, some differentiation of entities (properties, mechanisms and relationships) that may be relatively stable is possible, as illustrated in the Vermont case study. Sampling in qualitative research informed by critical realism retains the same concerns as do other methods, including saturation, typicality of sample, and purposive case selection. Bhaskar R, Frank C, Hoyer KG, Naess P. In: Parker J, editor. To demonstrate key points, we use a case study of the Vermont Right to Health Care Campaign [13]. properties, and therefore mechanisms, changed) in order to ameliorate harmful effects or to enhance beneficial effects. The coherence rests on the ontological and epistemological perspectives of CR which leads to a pluralist, as well as pragmatic, stance on these considerations. Forbes A, Wainwright SP. What are human rights? 2017;16(5):451–67. Each of these entities has a structure, a set of properties or attributes that differentiate it from other entities. signing human rights treaties invariably leads to decreases in human rights violations). Without attention to the structural features of human rights and social determinants of health, it is difficult to theorize explanatory linkages between them and to develop recommendations that could result in changes to that relationship – and consequential health effects. UN Doc. The book outlines critical realism and considers its implications for how we conceptualize meaning and culture, causation, and diversity. If so, what else must be present? informing mechanisms of conducting human rights assessments of new proposals) lead to changes in the properties of entities (e.g.

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