ArticleTrials2016
Can "realist" randomised controlled trials be genuinely realist?
Article in Trials, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Process evaluations of primary care interventions addressing chronic disease: a systematic review.BMJ open · 2019Pooled it
- A multidomain decision support tool to prevent falls in older people: the FinCH cluster RCT.Health technology assessment (Winchester, England) · 2022Trial
- A realist evaluation approach to explaining the role of context in the impact of a complex eHealth intervention for improving prevention of cardiovascular disease.BMC health services research · 2020Trial
- A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar.Implementation science : IS · 2018Trial
- Context, mechanisms and outcomes of a social enterprise model of residential rehabilitation for problem substance use: A realist-informed process evaluation.Addiction (Abingdon, England) · 2026Article
- Improving Palliative Care in Residential Aged Care Using Telehealth: Protocol for a Realist Process Evaluation Embedded in a Stepped-Wedge Cluster Randomized Controlled Trial.JMIR research protocols · 2025Article
- Assessing a Person-Centered and Culturally Sensitive Intervention for Arabic-, Turkish, or Urdu-Speaking Individuals With Type 2 Diabetes: Protocol for a Mixed Methods Realist Evaluation Study.JMIR research protocols · 2025Article
- Article
- Discussing methodological gaps in psychosocial intervention research for dementia: an opinion article from the INTERDEM Methodology Taskforce guided by the MRC framework.Frontiers in dementia · 2024Article
- A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being.Journal of urban health : bulletin of the New York Academy of Medicine · 2022Review
- Quantitative methods used to evaluate impact of health promotion interventions to prevent HIV infections: a methodological systematic review protocol.Systematic reviews · 2022Article
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- Article
- The reimagination of school-based physical activity research in the COVID-19 era.PLoS medicine · 2020Article
- Article
- Serious Gaming During Multidisciplinary Rehabilitation for Patients With Chronic Pain or Fatigue Symptoms: Mixed Methods Design of a Realist Process Evaluation.Journal of medical Internet research · 2020Article
- Article
- Which design to evaluate complex interventions? Toward a methodological framework through a systematic review.BMC medical research methodology · 2019Article
- Designing and evaluating provider results-based financing for tuberculosis care in Georgia: a realist evaluation protocol.BMJ open · 2019Article
- Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) with the randomised controlled trial (RCT) design.We identified three fundamental differences that are related to paradigmatic differences in the treatment of causation between post-positivist and realist logic: (1) the construct of mechanism, (2) the relation between mediators and moderators on one hand and mechanisms and contexts on the other hand, and (3) the variable-oriented approach to analysis of causation versus the configurational approach.We show how Jamal et al. consider mechanisms as observable, external treatments and how their approach reduces complex causal processes to variables. We argue that their proposed RCT design cannot provide a truly realist understanding. Not only does the proposed realist RCT design not deal with the RCT's inherent inability to "unpack" complex interventions, it also does not enable the identification of the dynamic interplay among the intervention, actors, context, mechanisms and outcomes, which is at the core of realist research. As a result, the proposed realist RCT design is not, as we understand it, genuinely realist in nature.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.