events, effects). While we can acquire or construct knowledge about reality, that knowledge can be fallible, or mistaken. London L, Schneider H. Globalisation and health inequalities: can a human rights paradigm create space for civil society action? “Scientific realism is the view that theories refer to real features of the world. The specifics of properties determine whether and what mechanisms can be activated. Danermark B. Interdisciplinary research and critical realism. 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. 2012;74(1):6–13. the Oxford handbook of jurisprudence and philosophy of law. 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. Handbook of the philosophy of social sciences. use the term “critical realism” in a broad sense to include a range of positions incorporat- ing this view, including Bhaskar’s. 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). qualitative research involves collecting and/or working with text, images, or sounds. 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]. 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. 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]. Vermont Case Study: Towards a theory of how the campaign worked. 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. evaluating critical realism-based explanatory case study research within the information systems field. 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. The coherence rests on the ontological and epistemological perspectives of CR which leads to a pluralist, as well as pragmatic, stance on these considerations. It is open to challenge and change. However, the capacity of rights holders to claim rights may also be contingent on the exercise of the mechanisms of education programs that are intended to facilitate learning about rights and ways of claiming rights (e.g. Because CR principles are usually used to underpin the developme… If so, what else must be present? Key features of the framework are now identified and discussed. 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. 1). 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”. We demonstrate the utility of each of the principles through examples drawn from existing critical realist case studies. 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. Explicit and indepth consideration of the relationship between human rights and the social determinants of health is critical to strengthening accountability and governance mechanisms. 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. 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. The social determinants of health, health equity, and human rights. 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? Events happen when the powers of one or more entities are activated. Reality is stratified into three domains: empirical, actual and real. Please note that some file types are incompatible with some mobile and tablet devices. That complexity is reflected in the array of relationships that potentially exist between the numerous entities involved. Manage cookies/Do not sell my data we use in the preference centre. 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. Constructs and propositions may be transient. Alderson P. Childhoods real and imagined: volume 1: an introduction to critical realism and childhood studies (ontological explorations). 19 (4th December 1997) para 33. Invernizzi-Accetti C. Reconciling legal positivism and human rights: Hans Kelsen's argument from relativism. The principles are derived directly from the ontological and epistemological assumptions of critical realism. The implication of this emancipatory worldview is that when phenomena are under investigation it may be possible to identify how these features may be influenced (e.g. These power relationships are often related to structures and beliefs related to class, gender, age and ethnicity. 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. Are the findings from other research relevant given contrastive properties and powers? These mechanisms are latent because their activation is contingent on the mechanisms of another entity being activated (e.g. California Privacy Statement, Joseph Maxwell argues for critically applying a realist ontology to a number of important theoretical and methodological issues. While acknowledging the role of rights, few initiatives have explicitly attempted to incorporate rights into actions and priorities [4,5,6,7,8]. 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. PubMed  It views reality as complex and recognizes the role of both... Looks like you do not have access to this content. properties, and therefore mechanisms, changed) in order to ameliorate harmful effects or to enhance beneficial effects. A theory is not intransitive, as reality is. Research design should be ‘practically adequate’: that is,‘fit for purpose’ [30]. A framework summarizing the outcomes of these analysis and theorising processes is presented. For example, the Vermont Workers Centre had its latent causal powers-mechanisms (e.g. Indicators are used as proxies for human rights (e.g. Polit Soc. What are the components of complex interventions in healthcare? These invisible entities are not observable at the empirical level, but the effects of their activated powers/mechanisms may be observable (e.g. The United States does not have a Universal Health Care (UHC) system. This represents a form of ‘abductive reasoning’ which, along with retroduction, is a distinctive feature of a CR theorising methodology. Those relationships, which are defined by the activation and effects of mechanisms, explain how the environment ‘works’ (e.g. the exercise of agency by a Vermonter to write a letter) or the power of social structures over personal action (e.g. The transitive nature can be seen in how legal conceptualisations of the right to health have been broadened over the years. Qual Health Res. Alderson P. International human rights, citizenship education, and critical realism. Rasanathan K, Norenhag J, Valentine N. Realizing human rights-based approaches for action on the social determinants of health. Critical realists are pragmatic in their approach to methodology and methods. 2007;85(3):212–7. He says that world poses two reality i.e. In London. Critical realism is a philosophical position that is attracting increasing interest in academic and professional fields. 2001;53(6):801–16. 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. 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. Structural analysis and development of explanatory theory is necessary if we are to understand what things are, how they work – and how they might work better. 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). The author applies critical realist ideas and approaches to the design and methods of qualitative research, and presents … A CR approach also understands absence of entities as being causally efficacious. Description of these entities, from both perspectives (cause and effect), involves structural analysis. 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. 2002:5. Critical realism consistently points to the epistemological implications of implicit ontological commitments in sociological research. 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. O'Cathain A, Murphy E, Nicholl J. Multidisciplinary, interdisciplinary, or dysfunctional? What are social determinants of health? 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. The relationships that exist between entities within and across laminations can often be characterized in terms of the relative power that entities have. 2013;93:185–93. Interdisciplinarity and climate change: transforming knowledge and practice for our global future. The world as we know and understand it is constructed from our perspectives and experiences, through what is 'observable'. 2005;20(4):479–93. 2015;13(3–4):340–54. It therefore functions at a level similar to that occupied by such philosophies as Positivism and Interpretivism. Health and Human Rights. FH developed the draft manuscript. 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 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. To what extent do they (e.g. The example of disability research. 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. Human rights and transnational corporations and other business enterprises resolution 2005/69 (20 April 2005) Para 1(d). While some researchers have an explicit awareness of their paradigm position and communicate it in research publications, others have an implicit position only. If they already had some experience of Qualitative design I’d say go straight for this one. 2010;71(8):1520–6. Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. The case study used within the paper to illustrate key points was partially funded by the World Health Organization. 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. qualitative research, including phenomenology/lived experience research. Kramer D, Harting J, Kunst AE. In 2008, the Vermont Workers’ Center (VWC) began a “Health Care is a Human Right” campaign. For example, in New Zealand researchers give explicit consideration to Maori ontology and epistemology [18] and Maori specific research methodology (Kaupapa Maori). On the methodological, theoretical and philosophical context of health inequalities research: a critique. Vermont citizens gained knowledge of rights and corresponding state duties) and, in turn, power to exercise new mechanisms (e.g. 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Some of the potential relationships and associated mechanisms are illustrated using the Vermont case study. American Association for Higher Education and The Carnegie Foundation for the Advancement of Teaching: Washington; 2002. Chapman AR. Given this agenda, we have highlighted the following aspects of the CR paradigm: Critical realist ontology acknowledges the complexity inherent in social phenomena and provides a conceptual framework for describing this complexity. Soc Sci Med. Differences in paradigm positioning might also be linked to different social groups or cultures. Bhaskar R. Dialectic: the pulse of freedom. Health and Human Rights. 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. affected communities) have common properties and therefore powers? Global Health Promotion. 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. A further caveat concerns the attention that is given to what can be observed (the empirical domain). 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. Springer Nature. The presentation is also intended to provide a transferable case study and model of critical realism ‘in action’. Although described by Alderson as different dimensions, these contrastive types of power could also be viewed as the extremes of one dimension (interpersonal relations). What cannot be removed without making the object cease to exist in its present form? 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. The latter involved a relationship between access to money and access to health services. All authors were involved in conceptualising and revising the manuscript. 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. Māori health models – Te Whare Tapa Whā [http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha]. People interact with entities and structures across these layers. BMC Public Health 19, 1571 (2019). social reality and the other is the natural reality which is the pioneer of the structures which constructs the social reality. The International Journal of Human Rights. Activation, which involves the exercise of particular mechanisms, is contingent on other entities and their mechanisms (context). 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). Actors can be described in terms of the social relations and institutional structures they belong to. The authors declare that they have no competing interests. doctor, campaigner, parent). London and New York: Routledge; 2002. 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. 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 (CR) is a branch of philosophy that distinguishes between the 'real' world and the 'observable' world. 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]. By using this website, you agree to our 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). Oxford: OUP Oxford; 2012. Critical realism accepts that there are 2008;18(11):1574–85. https://doi.org/10.1186/s12889-019-7760-7, DOI: https://doi.org/10.1186/s12889-019-7760-7. In the following sections we briefly elaborate on the key features of the critical realist research paradigm. human rights, discrimination, capitalism). Scand J Disabil Res. These studies were funded by an Australian National Health and Medical Research Council Postgraduate Scholarship. Some people had multiple roles (e.g. Critical realists recognize that the constancy of change and emergence means that a ‘settled’ theory concerning the relationships between phenomena cannot be formulated. Terms and Conditions, Soc Sci Med. As illustrated in Fig. At the same time, power relationships can trigger creative, emancipatory and transformative mechanisms that enable and empower agents [36]. And, the knowledge that we construct about these in-the-mind realities is influenced by the social relationships in which we are embedded. 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. ICESCT. 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. From this perspective, we believe that attempts to develop knowledge about particular phenomena require explicit attention by researchers to their ‘paradigm positioning’. In an open system, such relationships are context dependent [31, 32]. PubMed Google Scholar. 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. 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. Critical realism provides a critique of ‘ontological monovalence’, which is the idea that only things that are present exist [21, 30]. 2011. 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. avoids (typically inaccurate) generalizations and the unnecessary (and, for the most part, inaccurate) dichotomous positioning of qualitative research with respect to its quantitative coun - Again, the properties and associated mechanisms of specific entities (e.g. (Februuary 13 2003) paras 82-85. 2 including human rights principles being incorporated into Vermont legislation. 2014;13(1):52–76. 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)? Critical realism is a series of philosophical positions on a range of matters including ontology, causation, structure, persons, and forms of explanation. 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). Rights UNCoH. 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. Specifically, CR emerged from the vision of realising an adequate realist philosophy of science, of social science,… This contrasts with a system in which law-like regularities can be identified (e.g. If you encounter a problem downloading a file, please try again from a laptop or desktop. Knowledge is transitive– our understanding of a phenomenon can change. Health and Human Rights Journal. 2). New York: Routledge; 2008. a health policy, housing policy, an education programme) can be elaborated and delineated with much greater precision using CR ontological perspectives and analysis processes. 2015;17(2):83–95. 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. Thus, CR research has an inherent focus on ‘what to do’ to improve people’s human rights situation. From a CR perspective, the primary purpose of research, and therefore of the application of a methodology, is the theorizing of explanations for ‘tendencies’ in phenomena that have been observed or experienced (e.g. 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. These various properties may be further differentiated and described. 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. We would like to acknowledge the research team who contrinuted to the Vermont Case Study and the case study participants. Critical realism is a broad movement within philosophy and sociology. 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. Landscape Ecology. 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. Danermark B, Ekstrom L, Jakobsen L, Karlsson JC. Explaining society: critical realism and the social sciences. Price L. Wellbeing research and policy in the U.K.: questionable science likely to entrench inequality. In the following sections, we describe how we drew on critical realist perspectives to develop theory about the relationship between human rights and social determinants of health. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Attention to human/health rights emphasizes the need to consider power-related relationships and associated accountabilities, in particular between states and communities. to claim rights through a right to health rights campaign). A coherent set of views in relation to these four considerations constitutes a paradigm position. While this paradigm now underpins the research of an increasing number of researchers involved in health and rights related research, for many it is unfamiliar, challenging or even troublesome newcomer. We see epistemic fallacy in some existing approaches to the right to health, that tend to focus on identifying changes to indicators. Critical realists take a pluralist and pragmatic stance with respect to methodologies and methods that might be drawn on to theorising this complexity - and to the associated use of perspectives and approaches that may be multi-disciplinary, interdisciplinary and transdisciplinary. Bull World Health Organ. 2009;(Supp 1):36–41. Part of BMC Public Health BMC Public Health. disadvantaged community, race, gender, sexuality, disability, and ethnicity) have similar properties and consequential powers. 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. Accordingly, if you have chosen realism as your research philosophy you are advised to assume the role of critical realist, rather than direct realist. Correspondence to Critical Realism (CR) is a philosophy of science that is based around a number of ontological principles. 2007;17(10):1316–28. 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. LINCOLN and GUBA reject any absolutist criteria for "judging either 'reality' or validity" (p.167). It stands well on its own. The book outlines critical realism and considers its implications for how we conceptualize meaning and culture, causation, and diversity. As the construction of knowledge can never be infallible – sometimes we construct misconceptions or mistaken theories – our knowledge of the world is transitive. Critical realism (CR) is a relatively new paradigm position. 2015;15(1):725. 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]. Power repertoires and globalization. to empower, to inform) activated when a group of people decided to exercise their power to ‘campaign for universal health care’. Actors belong to, and are influenced by, multiple institutions and structural relations – but also have agency to influence and change those structures. Healthcare is paid for through a mix of private insurance and government funded health insurance schemes for particular population groups. Sign into your Profile to find your Reading Lists and Saved Searches. Scott-Samuel A, O'Keefe E. Health impact assessment, human rights and global public policy: a critical appraisal. Critical realism (CR) has been known as a meta-theory that underpins research and practice. Theorizing approaches to parts, powers and the whole intervention. someone reads and thinks about the norm). This manuscript draws on research carried out by FH during her doctoral studies. Fiona Haigh. Google Scholar. The SAGE. What are human rights? Abingdon: Routledge; 1992. Team working in mixed-methods research. 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]. Login or create a profile so that you can create alerts and save clips, playlists, and searches. 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). E/CN.4/2003/58. informing mechanisms of conducting human rights assessments of new proposals) lead to changes in the properties of entities (e.g. Bhaskar R, Frank C, Hoyer KG, Naess P. In: Parker J, editor. All authors have read and approved the manuscript. 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. Article  In turn, those properties give the entity the power to activate or exercise mechanisms that can cause effects. The framework can be subject to substantial elaboration, as below, which emphasizes the complexity of this environment. 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. This view, that Bhaskar calls the epistemic fallacy, reduces statements about the world (ontology) to statements about our knowledge of the world (epistemology) [21]. Cookies policy. In Mingers et al. Epistemologically, CR provides principles that can be applied by researchers developing theoretical explanations about phenomena in the world. 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). Does the explanatory theory provide a foundation for actions that can be demonstrated to be beneficial rather than harmful? 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. 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]. the activation of compliance mechanisms associated with the rules of accessing the Vermont Legislature). Such contingent relationships are common in social environments. CAS  Journal of Critical Realism. beyond what can be observed, experienced and measured). 6—PART I A REALIST STANCE FOR QUALITATIVE RESEARCH CR provides a coherent rationale for, and guidance on, the use of multiple data, methodologies and methods within SDOH and HR research. In this sense, a social system is always open to and characterized by change. The focus on critical realism was a useful adjunct for my own research and I would have no hesitation in recommending this to students also interested in taking a critical realism approach to qualitative research projects. In: Shapiro SJ, editor. 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. Concluding Observations on the United Kingdom, UN Doc E/C.12/1/Add. For example, human rights may be observable at the empirical level through asking people about their beliefs and attitudes towards human rights. 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]. 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]. Forbes A, Wainwright SP. The general case for attending to paradigm position when undertaking such research is also made. Guba E, Lincoln Y. Critical realism is one of two philosophical underpinnings widely referenced in mixed method research (Creswell and Plano Clark, 2011). 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]. Then these textbooks could be introduced as part of 1, 2 or 3-week modules about critical realist research methods. Carter S, Little M. Justifying knowledge, justifying method, taking action: epistemologies, methodologies, and methods in qualitative research. In this context, the key human rights relational structure is that between rights holders and duty bearers. This position can be seen in the work of Hammersley, Silverman, Creswell, Kirk and … Article  The same approaches could be drawn on when other significant relationships in health environments are investigated. While frameworks for research based on critical realism have been developed (Pawson and Tilley 1997; Danermark et al. 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. Chapman A. 2014;108:46–53. 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. 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. It is difficult to know what to do when you do not understand how things work. Ultimately the campaign contributed to a number of outcomes described in Fig. Understanding the impact of area-based interventions on area safety in deprived areas: realist evaluation of a neighbour nuisance intervention in Arnhem, the Netherlands. Geneva: Office of the United Nations High Commissioner for Human Rights; 2005. 2017;16(5):451–67. Conversely, those who read accounts of such attempts need to take into account the paradigm position of the researchers. The campaign adopted human rights principles to guide all its work. In this instance, the mechanisms may include informing, guiding, persuading, preventing and enforcing. Emancipatory objectives form part of a critical realist research agenda. Danermark points out that “A critical science often takes its starting point in notions that improvement of society is possible” [20]. Price L. Critical realist versus mainstream Interdisciplinarity. Entities can take different forms such as physical, cultural, biological or social. Bhaskar R. A realist theory of science. Tress G, Tress B, Fry G. Clarifying integrative research concepts in landscape ecology. MacNaughton G, Haigh F, Mcgill M, Koutsioumpas K, Sprague C. The impact of human rights on universalizing health Care in Vermont, USA. For example, individual lifestyle factors (such as excessive alcohol use) may be attended to without a concurrent focus on possible more distal causes (for example, the colonisation history and racism within the country) that emanate from other laminations [9, 32]. 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. Abstract. 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. 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. Critical realism offers an ontology that can conceptualize reality, support theorizing, and guide empirical work in the natural and human sciences. 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. Can/could object A exist without B? Schrecker T, Chapman AR, Labonté R, De Vogli R. Advancing health equity in the global marketplace: how human rights can help. 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, https://dx.doi.org/10.4135/9781412963909.n87, 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. Bhaskar describes two types of power relations linked to structure and agency [35]. Questions that can help identify the properties of entities include: What does the existence of this object/practice presuppose? 's words, critical realism: - "defends a strongly realist ontology that there is an existing, causally efficacious, world independent of our knowledge. Vermont is a small state in the northeast of the USA with a population of just over 600,000. 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). 2016;16(1):291. When theories that are founded in different paradigm positions and across different disciplines are drawn on, they are re-interpreted through a critical realist ontological lens. 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 For example, human rights conceptualisations of social determinants of health often fail to take into account how determinants interact with each other and also to consider the structural determinants of health [5]. The Vermont Workers Centre case study received Internal Review Board approval number 2015020 from the University of Massachusetts Boston on February 26, 2015. 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. Critical realists contest the notion that what can be observed and measured is the thing itself [31]. 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. 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. The levels identify people, the physical environment and social structures as key entities. The 'real' can not be observed and exists independent from human perceptions, theories, and constructions. According to CR, there is a reality that exists independent of our thoughts about it, and while observing may make us more confident about what exists, existence itself is not dependent on observation [19]. 2017;21(8):1098–113. 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. Soc Sci Med. 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]. We applied a CR explanatory framework to explain how a human rights-based approach can work to influence access to health care. The world is made up of entities that have properties that endow them with powers and liabilities. Actors can be described in terms of the social relations and institutional structures they belong to. Huber M, Morreale S. Disciplinary styles in the scholarship of teaching and learning: exploring common ground. Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works. 2006;8(4):278–97. http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12889-019-7760-7. Journal of Human Rights. Critical realism offers an ontology that can conceptualize reality, support theorizing, and guide empirical work in the natural and human sciences. LK and PB were supervisors of the PhD and NH provided substantial input into the research planning and writing. When making a structural analysis of entities, it should not be assumed that entities that share the same name (e.g. London and New York: Routledge; 2013. Google Scholar. They also lead to the emergence of new entities (e.g. volume 19, Article number: 1571 (2019) new legislative proposals). Coleman JL, Himma KE. 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. This calls into question the notion of determinants, as the term can imply a degree of stability that is not present. 2000;28(3):413–30. From this perspective, “there exist multiple, socially constructed realities ungoverned by natural laws, causal or otherwise” [15]. However, sampling should also be focused on using key groups Method in social science: a realist approach (2nd Ed). Clark AM. 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. 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. The VWC developed a staged approach which first focussed on building power through activating Vermonters, then directly targeting the legislature. 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. Social determinants of health are entities that can cause health-related effects on individuals and communities and that have the following general properties: they exist within the social environment, they result from decisions about how societies should be organised and ‘work’ (e.g. health outcomes, access to health services, health service costs, measured inequalities). Abstract. An example of this is that people have the right to health even when they are not aware of it. Critical realists seek to avoid being trapped within the silos of single disciplinary views. 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. Sayer A. 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. Pawson R. The science of evaluation: a realist manifesto. 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 was evident that causal power could shift between agency and structure. 2018;17(2):215–28. Journal of Critical Realism. Scambler G, Scambler S. Theorizing health inequalities: the untapped potential of dialectical critical realism. Because of the stratified nature of reality, entities can be invisible or visible. ratification of human rights conventions, overall finance commitments for respecting human rights, number of employees and community members that have access to complaints, disputes, and grievance processes, access to health insurance). The exercise of mechanisms was often contingent on the mechanisms of another entity being activated. London: Sage; 2000. 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. The other is Pragmatism which is focused from the start on the practicalities of ‘what works’ (Scott and Briggs, 2009). BMC Public Health. UN Doc. Soc Sci Med. Critical realism is the concept which is being constructed by well known British philosopher Bhaskar Roy. These effects may, in turn, involve changes to the properties of an entity and, therefore its potential mechanisms. We can take account of dimensions of power when developing causal explanations and identifying what to do. It represents a combination of views that contrast with those associated with traditional positivist and interpretivist positions [ 19 , 20 , 21 ]. Sayer A. Realism and social science. 2, a wide range of mechanisms associated with the varied entities involved in the campaign were activated. The paper draws FH’s PhD thesis. These are presented in a summary framework. California and London: Sage Publications; 1989. © 2020 BioMed Central Ltd unless otherwise stated. Hunt P. Missed opportunities: Human rights and the Commission on Social Determinants of Health. While entities exist independent of our ability to perceive and conceive that they exist, we do use our minds to construct knowledge about them. This means they can include non-physical things such as ideas, theories, concepts or institutions, as well as physical entities such as cigarettes or guns. Descriptions of complexity, as we have illustrated, necessarily go beyond the empirical domain of reality (i.e. statement and We cannot and should not assume that our views about these matters are shared by others. Soc Theory Health. They choose methods, therefore, based on their experience of what works best for answering their research questions. Each of these entities has a structure, a set of properties or attributes that differentiate it from other entities. Fourth generation evaluation. New York: Routledge; 2008. CR in their foreword to a special issue of MISQ on critical realism and information systems research. critical realism is a meta theory and does not offer a procedure for the conduct of social research. Critical Realist Human Rights and Social Determinants of Health Explanatory Framework. 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. BMC Public Health. CR adopts ‘practical adequacy’ as one of the criteria for evaluating new theory. Qual Health Res. 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. This needs to be taken into account when the applicability of evidence from other research involving similar entities is considered. That there is a relationship between human rights and health is well established and frequently discussed. As previously noted, different disciplines and subject matter fields have developed traditions in relation to these views. What is critical realism? And, the exercise of some mechanisms was a manifestation of personal power to act (i.e. To demonstrate key points, we use a case study of the Vermont Right to Health Care Campaign [13]. social norms, policies, practices, economic arrangements, politics, education) and they may change over time and vary across social groups and contexts. ‘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). Details of the case study are described in a separate publication [13]. 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. Evaluating the health-related targets in the sustainable development goals from a human rights perspective. Journal of Critical Realism. In the social world, entities are often invisible (e.g. Keywords: epistemology, methodology, nursing, qualitative research, realism, rig-our, trustworthiness, validity Introduction In this paper I examine the issue of validity in qualitative research. 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. This chapter introduces a critical realist approach to qualitative research. Bhaskar R, Danermark B. Metatheory, interdisciplinarity and disability research: a critical realist perspective. Soc Sci Med. see Fig. We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship.
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