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. It stands well on its own. As the construction of knowledge can never be infallible – sometimes we construct misconceptions or mistaken theories – our knowledge of the world is transitive. Theorizing approaches to parts, powers and the whole intervention. Actors can be described in terms of the social relations and institutional structures they belong to. 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. These power relationships are often related to structures and beliefs related to class, gender, age and ethnicity. Fiona Haigh. We cannot and should not assume that our views about these matters are shared by others. O'Cathain A, Murphy E, Nicholl J. Multidisciplinary, interdisciplinary, or dysfunctional? What are its preconditions? Thus, CR research has an inherent focus on ‘what to do’ to improve people’s human rights situation. London and New York: Routledge; 2016. Coleman JL, Himma KE. These invisible entities are not observable at the empirical level, but the effects of their activated powers/mechanisms may be observable (e.g. Danermark B. Interdisciplinary research and critical realism. 's words, critical realism: - "defends a strongly realist ontology that there is an existing, causally efficacious, world independent of our knowledge. 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. 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. London: Sage; 2000. Part of 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]. 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. In turn, those properties give the entity the power to activate or exercise mechanisms that can cause effects. 2016;16(1):291. Entities in health rights environments can take different forms such as physical, cultural, biological or social. While acknowledging the role of rights, few initiatives have explicitly attempted to incorporate rights into actions and priorities [4,5,6,7,8]. 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. beyond what can be observed, experienced and measured). 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. 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. It therefore functions at a level similar to that occupied by such philosophies as Positivism and Interpretivism. 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. The specifics of properties determine whether and what mechanisms can be activated. 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. However, as Huber and Morreale [42] observe about interdisciplinary encounters. 2019;19(1):88. 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. Sign into your Profile to find your Reading Lists and Saved Searches. 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. to claim rights through a right to health rights campaign). Again, the properties and associated mechanisms of specific entities (e.g. PubMed  Activation, which involves the exercise of particular mechanisms, is contingent on other entities and their mechanisms (context). The principles are derived directly from the ontological and epistemological assumptions of critical realism. Soc Sci Med. Chapman AR. to empower, to inform) activated when a group of people decided to exercise their power to ‘campaign for universal health care’. 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. In line with CRs emancipatory values, actions should target development of enabling and empowering relationships. Actors belong to, and are influenced by, multiple institutions and structural relations – but also have agency to influence and change those structures. 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). Those relationships, which are defined by the activation and effects of mechanisms, explain how the environment ‘works’ (e.g. While the differences between philosophical paradigms and the way … Google Scholar. This view, that Bhaskar calls the epistemic fallacy, reduces statements about the world (ontology) to statements about our knowledge of the world (epistemology) [21]. Because CR principles are usually used to underpin the developme… What is critical realism? Critical realism offers an ontology that can conceptualize reality, support theorizing, and guide empirical work in the natural and human sciences. Danermark points out that “A critical science often takes its starting point in notions that improvement of society is possible” [20]. This chapter introduces a critical realist approach to qualitative research. Keywords: epistemology, methodology, nursing, qualitative research, realism, rig-our, trustworthiness, validity Introduction In this paper I examine the issue of validity in qualitative research. Rasanathan K, Norenhag J, Valentine N. Realizing human rights-based approaches for action on the social determinants of health. The other is Pragmatism which is focused from the start on the practicalities of ‘what works’ (Scott and Briggs, 2009). MacNaughton G, Haigh F, Mcgill M, Koutsioumpas K, Sprague C. The impact of human rights on universalizing health Care in Vermont, USA. Journal of Human Rights. Critical realists recognize that the constancy of change and emergence means that a ‘settled’ theory concerning the relationships between phenomena cannot be formulated. Huber M, Morreale S. Disciplinary styles in the scholarship of teaching and learning: exploring common ground. Description of these entities, from both perspectives (cause and effect), involves structural analysis. That complexity is reflected in the array of relationships that potentially exist between the numerous entities involved. A theory is not intransitive, as reality is. This position can be seen in the work of Hammersley, Silverman, Creswell, Kirk and … 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’. Attention to human/health rights emphasizes the need to consider power-related relationships and associated accountabilities, in particular between states and communities. The latter involved a relationship between access to money and access to health services. In this context, the key human rights relational structure is that between rights holders and duty bearers. Article  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]. 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. In: Shapiro SJ, editor. They choose methods, therefore, based on their experience of what works best for answering their research questions. 2010;71(8):1520–6. avoids (typically inaccurate) generalizations and the unnecessary (and, for the most part, inaccurate) dichotomous positioning of qualitative research with respect to its quantitative coun - 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]. use the term “critical realism” in a broad sense to include a range of positions incorporat- ing this view, including Bhaskar’s. Although described by Alderson as different dimensions, these contrastive types of power could also be viewed as the extremes of one dimension (interpersonal relations). Scambler G, Scambler S. Theorizing health inequalities: the untapped potential of dialectical critical realism. Healthcare is paid for through a mix of private insurance and government funded health insurance schemes for particular population groups. The general case for attending to paradigm position when undertaking such research is also made. 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. An outcome-oriented definition such as that proposed by Nkwi et al. In an open system, such relationships are context dependent [31, 32]. The exercise of mechanisms was often contingent on the mechanisms of another entity being activated. Explaining society: critical realism and the social sciences. 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]. 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. 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. 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. Human rights and transnational corporations and other business enterprises resolution 2005/69 (20 April 2005) Para 1(d). 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. Emancipatory objectives form part of a critical realist research agenda. 2014;108:46–53. This manuscript draws on research carried out by FH during her doctoral studies. 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). 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. 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. 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)? In the following sections we briefly elaborate on the key features of the critical realist research paradigm. 1). 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. Alderson P. The politics of childhoods real and imagined volume 2: practical application of critical realism to childhood studies. Journal of Critical Realism. London and New York: Routledge; 2002. the activation of compliance mechanisms associated with the rules of accessing the Vermont Legislature). 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]. 2015;13(3–4):340–54. 2014;13(1):52–76. Forbes A, Wainwright SP. These various properties may be further differentiated and described. Polit Soc. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), 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. disadvantaged community, race, gender, sexuality, disability, and ethnicity) have similar properties and consequential powers. Critical realists contest the notion that what can be observed and measured is the thing itself [31]. 2005;20(4):479–93. This contrasts with a system in which law-like regularities can be identified (e.g. CAS  Lond Rev Educ. 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. Knowledge is transitive– our understanding of a phenomenon can change. If so, what else must be present? Some people had multiple roles (e.g. statement and 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. By using this website, you agree to our In London. 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? California Privacy Statement, Carter S, Little M. Justifying knowledge, justifying method, taking action: epistemologies, methodologies, and methods in qualitative research. As previously noted, different disciplines and subject matter fields have developed traditions in relation to these views. 2011. We see epistemic fallacy in some existing approaches to the right to health, that tend to focus on identifying changes to indicators. UN Doc. 2). The campaign adopted human rights principles to guide all its work. Critical realists seek to avoid being trapped within the silos of single disciplinary views. Can/could object A exist without B? Price L. Critical realist versus mainstream Interdisciplinarity. Are the findings from other research relevant given contrastive properties and powers? 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 … 2017;21(8):1098–113. 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. 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). Soc Sci Med. CR provides a coherent rationale for, and guidance on, the use of multiple data, methodologies and methods within SDOH and HR research. 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. Understanding the impact of area-based interventions on area safety in deprived areas: realist evaluation of a neighbour nuisance intervention in Arnhem, the Netherlands. It views reality as complex and recognizes the role of both... Looks like you do not have access to this content. 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. BMC Public Health 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. Bhaskar R. A realist theory of science. 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. Fourth generation evaluation. To demonstrate key points, we use a case study of the Vermont Right to Health Care Campaign [13]. 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. These effects may, in turn, involve changes to the properties of an entity and, therefore its potential mechanisms. At the same time, power relationships can trigger creative, emancipatory and transformative mechanisms that enable and empower agents [36]. In this sense, a social system is always open to and characterized by change. Method in social science: a realist approach (2nd Ed). With this in mind, CR axiology supports social critique as a dimension of the research process. 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). For example, the Vermont Workers Centre had its latent causal powers-mechanisms (e.g. 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. 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. Health and Human Rights Journal. Bhaskar R, Frank C, Hoyer KG, Naess P. In: Parker J, editor. If you encounter a problem downloading a file, please try again from a laptop or desktop. 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. Soc Sci Med. Critical realism is one of two philosophical underpinnings widely referenced in mixed method research (Creswell and Plano Clark, 2011). Ultimately the campaign contributed to a number of outcomes described in Fig. 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. And, the knowledge that we construct about these in-the-mind realities is influenced by the social relationships in which we are embedded. The levels identify people, the physical environment and social structures as key entities. Schrecker T, Chapman AR, Labonté R, De Vogli R. Advancing health equity in the global marketplace: how human rights can help. PubMed Google Scholar. see Fig. 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. Abstract. Article  Cite this article. someone reads and thinks about the norm). The authors declare that they have no competing interests. In 2008, the Vermont Workers’ Center (VWC) began a “Health Care is a Human Right” campaign. Vermont citizens gained knowledge of rights and corresponding state duties) and, in turn, power to exercise new mechanisms (e.g. Journal of Critical Realism. The example of disability research. 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. We demonstrate the utility of each of the principles through examples drawn from existing critical realist case studies. LINCOLN and GUBA reject any absolutist criteria for "judging either 'reality' or validity" (p.167). 2015;17(2):83–95. Then these textbooks could be introduced as part of 1, 2 or 3-week modules about critical realist research methods. It is open to challenge and change. However, sampling should also be focused on using key groups It represents a combination of views that contrast with those associated with traditional positivist and interpretivist positions [19,20,21]. The United States does not have a Universal Health Care (UHC) system. 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. 2007;85(3):212–7. 2013;93:185–93. In. 2001;53(6):801–16. If they already had some experience of Qualitative design I’d say go straight for this one. 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. 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. Health and Human Rights. Alderson P. International human rights, citizenship education, and critical realism. 2006;8(4):278–97. Manage cookies/Do not sell my data we use in the preference centre. The presentation is also intended to provide a transferable case study and model of critical realism ‘in action’. Team working in mixed-methods research. What cannot be removed without making the object cease to exist in its present form? CR in their foreword to a special issue of MISQ on critical realism and information systems research. 2009;(Supp 1):36–41. 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]. 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. E/CN.4/2003/58. The author applies critical realist ideas and approaches to the design and methods of qualitative research, and presents … What are human rights? Descriptions of complexity, as we have illustrated, necessarily go beyond the empirical domain of reality (i.e. 2017;16(5):451–67. 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. Scand J Disabil Res. Pawson R. The science of evaluation: a realist manifesto. This represents a form of ‘abductive reasoning’ which, along with retroduction, is a distinctive feature of a CR theorising methodology. Chapman A. Entities can take different forms such as physical, cultural, biological or social. Such contingent relationships are common in social environments. 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. ‘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). Abingdon: Routledge; 1992. Cookies policy. 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]. 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. That there is a relationship between human rights and health is well established and frequently discussed. health outcomes, access to health services, health service costs, measured inequalities). Springer Nature. 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. Does the explanatory theory provide a foundation for actions that can be demonstrated to be beneficial rather than harmful? Evaluating the health-related targets in the sustainable development goals from a human rights perspective. And, the exercise of some mechanisms was a manifestation of personal power to act (i.e. The same approaches could be drawn on when other significant relationships in health environments are investigated. London and New York: Routledge; 2013. 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. 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. The International Journal of Human Rights. For example, in New Zealand researchers give explicit consideration to Maori ontology and epistemology [18] and Maori specific research methodology (Kaupapa Maori). A framework summarizing the outcomes of these analysis and theorising processes is presented. https://doi.org/10.1186/s12889-019-7760-7, DOI: https://doi.org/10.1186/s12889-019-7760-7. Sayer A. 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). This perspective is also apparent in some conceptions of human rights as legal rules found within treaties [14]. Google Scholar. CR adopts ‘practical adequacy’ as one of the criteria for evaluating new theory. 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. The exercise of some mechanisms (e.g. Scott-Samuel A, O'Keefe E. Health impact assessment, human rights and global public policy: a critical appraisal. Research design should be ‘practically adequate’: that is,‘fit for purpose’ [30]. the Oxford handbook of jurisprudence and philosophy of law. The world is made up of entities that have properties that endow them with powers and liabilities. Differences in paradigm positioning might also be linked to different social groups or cultures. For examples norms may be universal/community specific, clear/unclear, accepted/contested, non/conflicting. human rights, discrimination, capitalism). 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. 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. California and London: Sage Publications; 1989. Qual Health Res. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Because of the stratified nature of reality, entities can be invisible or visible. They also lead to the emergence of new entities (e.g. 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. Price L. Wellbeing research and policy in the U.K.: questionable science likely to entrench inequality. American Association for Higher Education and The Carnegie Foundation for the Advancement of Teaching: Washington; 2002. 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. This calls into question the notion of determinants, as the term can imply a degree of stability that is not present. Piven FF, Cloward RA. Epistemologically, CR provides principles that can be applied by researchers developing theoretical explanations about phenomena in the world. When making a structural analysis of entities, it should not be assumed that entities that share the same name (e.g. Critical realism is a series of philosophical positions on a range of matters including ontology, causation, structure, persons, and forms of explanation. Bhaskar R. Dialectic: the pulse of freedom. 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). A CR approach also understands absence of entities as being causally efficacious. Each of these entities has a structure, a set of properties or attributes that differentiate it from other entities. Bull World Health Organ. The world as we know and understand it is constructed from our perspectives and experiences, through what is 'observable'. 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. new legislative proposals). These mechanisms are latent because their activation is contingent on the mechanisms of another entity being activated (e.g. Geneva: Office of the United Nations High Commissioner for Human Rights; 2005. 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. Its assumptions of open systems, generative logic, agency and structure-related factors, and its methodological eclecticism have been widely acknowledged and appreciated. 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]. Invernizzi-Accetti C. Reconciling legal positivism and human rights: Hans Kelsen's argument from relativism. the exercise of agency by a Vermonter to write a letter) or the power of social structures over personal action (e.g. While frameworks for research based on critical realism have been developed (Pawson and Tilley 1997; Danermark et al. As illustrated in Fig. Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works. 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”. Alderson P. Childhoods real and imagined: volume 1: an introduction to critical realism and childhood studies (ontological explorations). Haigh, F., Kemp, L., Bazeley, P. et al. From this perspective, “there exist multiple, socially constructed realities ungoverned by natural laws, causal or otherwise” [15]. 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. Danermark B, Ekstrom L, Jakobsen L, Karlsson JC. 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. Journal of Critical Realism. Soc Sci Med. The VWC developed a staged approach which first focussed on building power through activating Vermonters, then directly targeting the legislature. We applied a CR explanatory framework to explain how a human rights-based approach can work to influence access to health care. All authors were involved in conceptualising and revising the manuscript. Handbook of the philosophy of social sciences. Actors can be described in terms of the social relations and institutional structures they belong to. 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. BMC Public Health. Critical realism offers an ontology that can conceptualize reality, support theorizing, and guide empirical work in the natural and human sciences. Kramer D, Harting J, Kunst AE. The paper draws FH’s PhD thesis. 2018;17(2):215–28. On the methodological, theoretical and philosophical context of health inequalities research: a critique. Health and Human Rights. Explicit and indepth consideration of the relationship between human rights and the social determinants of health is critical to strengthening accountability and governance mechanisms. Qual Health Res. 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. New York: Routledge; 2008. The coherence rests on the ontological and epistemological perspectives of CR which leads to a pluralist, as well as pragmatic, stance on these considerations. Critical realism is a philosophical position that is attracting increasing interest in academic and professional fields. Rights UNCoH. “Scientific realism is the view that theories refer to real features of the world. London L, Schneider H. Globalisation and health inequalities: can a human rights paradigm create space for civil society action? While some researchers have an explicit awareness of their paradigm position and communicate it in research publications, others have an implicit position only. 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. 19 (4th December 1997) para 33. 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. 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. 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. Landscape Ecology. Correspondence to 2008;18(11):1574–85. 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). The social world is a layered, complex and open system. 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. Events happen when the powers of one or more entities are activated. Accordingly, if you have chosen realism as your research philosophy you are advised to assume the role of critical realist, rather than direct realist. The book outlines critical realism and considers its implications for how we conceptualize meaning and culture, causation, and diversity. 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. Specifically, CR emerged from the vision of realising an adequate realist philosophy of science, of social science,… doctor, campaigner, parent). social norms, policies, practices, economic arrangements, politics, education) and they may change over time and vary across social groups and contexts. Critical realism (CR) is a relatively new paradigm position. Some of the potential relationships and associated mechanisms are illustrated using the Vermont case study. 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. 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. Details of the case study are described in a separate publication [13]. 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]. Bhaskar R, Danermark B. Metatheory, interdisciplinarity and disability research: a critical realist perspective. BMC Public Health 19, 1571 (2019). events, effects). We would like to acknowledge the research team who contrinuted to the Vermont Case Study and the case study participants. qualitative research, including phenomenology/lived experience research. 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]. 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. (Februuary 13 2003) paras 82-85. These are presented in a summary framework. The social determinants of health, health equity, and human rights. 2016;14(3):3–12. signing human rights treaties invariably leads to decreases in human rights violations). Power repertoires and globalization. New York: Routledge; 2008. 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. 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. Critical Realist Human Rights and Social Determinants of Health Explanatory Framework. critical realism is a meta theory and does not offer a procedure for the conduct of social research. 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. 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. properties, and therefore mechanisms, changed) in order to ameliorate harmful effects or to enhance beneficial effects. 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]. a health policy, housing policy, an education programme) can be elaborated and delineated with much greater precision using CR ontological perspectives and analysis processes. ICESCT. People interact with entities and structures across these layers. 2002:5. What are social determinants of health? 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. Critical realists are pragmatic in their approach to methodology and methods. What are the components of complex interventions in healthcare? 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. 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. 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. 2000;28(3):413–30. 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." In the social world, entities are often invisible (e.g. 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. social reality and the other is the natural reality which is the pioneer of the structures which constructs the social reality. 2012;74(1):6–13. 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]. Critical realism is the concept which is being constructed by well known British philosopher Bhaskar Roy. 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. 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. For example, human rights may be observable at the empirical level through asking people about their beliefs and attitudes towards human rights. London and New York: Routledge; 2010. To what extent do they (e.g. 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. The transitive nature can be seen in how legal conceptualisations of the right to health have been broadened over the years. Terms and Conditions, Constructs and propositions may be transient. The strengths of critical realism is often described in contrast to the paradigms of positivism and interpretivism. The relationships that exist between entities within and across laminations can often be characterized in terms of the relative power that entities have. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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. Oxford: OUP Oxford; 2012. Abstract. Guba E, Lincoln Y. 2 including human rights principles being incorporated into Vermont legislation. affected communities) have common properties and therefore powers? The SAGE. Bhaskar describes two types of power relations linked to structure and agency [35]. Google Scholar. A coherent set of views in relation to these four considerations constitutes a paradigm position. Sayer A. Realism and social science. 2007;17(10):1316–28. BMC Public Health. We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. 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. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. 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]. Critical Realism (CR) is a branch of philosophy that distinguishes between the 'real' world and the 'observable' world. Key features of the framework are now identified and discussed. Critical realism (CR) has been known as a meta-theory that underpins research and practice. We can take account of dimensions of power when developing causal explanations and identifying what to do. 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). These studies were funded by an Australian National Health and Medical Research Council Postgraduate Scholarship. 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. He says that world poses two reality i.e. 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. Privacy informing mechanisms of conducting human rights assessments of new proposals) lead to changes in the properties of entities (e.g. Indicators are used as proxies for human rights (e.g. Tress G, Tress B, Fry G. Clarifying integrative research concepts in landscape ecology. The 'real' can not be observed and exists independent from human perceptions, theories, and constructions. 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. Critical realism provides a critique of ‘ontological monovalence’, which is the idea that only things that are present exist [21, 30]. Critical realism consistently points to the epistemological implications of implicit ontological commitments in sociological research. Hunt P. Missed opportunities: Human rights and the Commission on Social Determinants of Health. The Vermont Workers Centre case study received Internal Review Board approval number 2015020 from the University of Massachusetts Boston on February 26, 2015. Questions that can help identify the properties of entities include: What does the existence of this object/practice presuppose? 2015;15(1):725. 2010:12(2). 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. While we can acquire or construct knowledge about reality, that knowledge can be fallible, or mistaken. A further caveat concerns the attention that is given to what can be observed (the empirical domain). London: Sage; 2013. 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. 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. Soc Theory Health. Vermont Case Study: Towards a theory of how the campaign worked. Soc Sci Med. 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). In this instance, the mechanisms may include informing, guiding, persuading, preventing and enforcing. 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). 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. It was evident that causal power could shift between agency and structure. LK and PB were supervisors of the PhD and NH provided substantial input into the research planning and writing. Login or create a profile so that you can create alerts and save clips, playlists, and searches. evaluating critical realism-based explanatory case study research within the information systems field. In conjunction with this case study, we provide a reflective critique on our use of a CR-based theorizing methodology. Critical Realism (CR) is a philosophy of science that is based around a number of ontological principles. Conversely, those who read accounts of such attempts need to take into account the paradigm position of the researchers. It is difficult to know what to do when you do not understand how things work. In Mingers et al. 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, 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]. Harris P, Sainsbury P, Kemp L. The fit between health impact assessment and public policy: practice meets theory. Global Health Promotion. 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. Joseph Maxwell argues for critically applying a realist ontology to a number of important theoretical and methodological issues. This needs to be taken into account when the applicability of evidence from other research involving similar entities is considered. It represents a combination of views that contrast with those associated with traditional positivist and interpretivist positions [ 19 , 20 , 21 ]. All authors have read and approved the manuscript. © 2020 BioMed Central Ltd unless otherwise stated. 6—PART I A REALIST STANCE FOR QUALITATIVE RESEARCH Interdisciplinarity and climate change: transforming knowledge and practice for our global future. Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. Critical realism is a broad movement within philosophy and sociology. qualitative research involves collecting and/or working with text, images, or sounds. 2010;12(2):17–30. The case study used within the paper to illustrate key points was partially funded by the World Health Organization. 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.