Episode 32 – Co-Design in Realist Evaluation and Exercise Oncology with Deirdre McGrath

Episode 32 – Co-Design in Realist Evaluation and Exercise Oncology with Deirdre McGrath

How can realist evaluation help us understand why exercise interventions work, for whom, in what circumstances, and why? And what happens when patients and interest group holders are not just consulted, but actively involved in shaping programme theories, intervention design, and implementation? In this reflective conversation, Alejandro is joined by Dr Deirdre McGrath, lecturer in nursing at Queen’s University Belfast, whose work brings together realist evaluation, co-design, patient and public involvement, oncology, palliative care, and cancer rehabilitation. Deirdre reflects on her journey from clinical practice in oncology and palliative care to realist research, focusing particularly on exercise interventions for women with ovarian cancer. Drawing on her PhD work, she explains why traditionalevaluations of exercise interventions often struggle to explain variation in participation, adherence, and outcomes, and how realist approaches can help us ask deeper questions about what works, for whom, in what circumstances, and why. The conversation explores how co-design can strengthen realist evaluation by bringing patients, carers, clinicians, academics, and other interest group holders into the research process in meaningful ways. Deirdre discusses how women with ovarian cancer helped reshape her assumptions about what an exercise intervention should look like, including the move from an initially imagined in-person intervention to a home-based programme shaped by lived experience, practical constraints, psychological safety, trust, relevance, and flexibility. Deirdre also reflects on the challenges of making realist terminology accessible, avoiding tokenistic involvement, managing different interest group holder perspectives, and creating safe spaces where people feel genuinely able to contribute. She highlights the importance of humility, listening, feedback loops, and recognising patients as experts in their own care. Whether you’re an evaluator, researcher, clinician, public health practitioner, student, PhD researcher, or someone interested in realist evaluation, co-production, cancer rehabilitation, patient involvement, or complex interventions, this episode offers valuable insights into how realist thinkingand co-design can work together to produce more grounded, useful, and meaningful research. Note: Although the terms “co-production” and “co-design” are sometimes used interchangeably in the conversation, this podcast episode specifically focuses on co-design.

Episode 31 – Realist Research Across Ways of Knowing with Kenneth Yakubu

What happens when realist approaches meet other research traditions, disciplines and ways of knowing? And how can researchers work across different assumptions about evidence, causation, truth, knowledge and equity without flattening, absorbing or privileging one tradition over another? In this thoughtful conversation, Alejandro is joined by Dr Kenneth Yakubu, whose work sits at the intersection of health systems, global health governance, implementation research, health equity, Indigenous methodologies and realist thinking. Yakubu reflects on his journey from family medicine in Nigeria to global health research, interdisciplinary work, and his current role across health systems implementation research and Indigenous health at the George Institute for Global Health in Sydney, Australia. He discusses how his clinical training helped him see people rather than diseases, and how this shaped his attention to context, complexity, culture, history and lived experience. The conversation explores Yakubu’s experience developing a realist protocol for evaluating the Healthy Homes and Neighbourhoods Project in Sydney, an integrated care initiative designed to support families facing complex healthand social challenges. The protocol brought together realist approaches, Indigenous research methodologies, implementation science, qualitative methods, quantitative analysis and health economics. Reaching shared agreement took nearly two years Yakubu reflects on the tensions that emerged around truth, voice, evidence, analysis and self-determination. He discusses why some team members found realist language or assumptions difficult, how Indigenous research traditions raised important questions about visibility, community voice and historical harms, and how the team worked through disagreement without forcing premature consensus. Whether you’re an evaluator, researcher, public health practitioner, implementation scientist, policymaker, student, or someone interested in realist approaches, Indigenous methodologies, global health, health equity or interdisciplinary research, this episode offers valuable insights into the messy but necessary work of building shared understanding across different ways of knowing.

Episode 30 – Realist Evaluation and Health Systems with Prashanth Srinivas

How can realist evaluation help us understand health systems, inequality, and social change in marginalised and ecologically sensitive contexts? And what happens when realist thinking moves beyond academic projects and becomes part of long-term, participatory work with communities? In this insightful conversation, Alejandro is joined by Dr Prashanth N Srinivas, a public health researcher and health systems scholar at the Institute of Public Health Bengaluru. Prashanth reflects on his journey into realist evaluation, from his early work as a clinician in community health settings to using realist approaches in health systems research, government health management, and long-term work with Adivasi communities in Southern India. The conversation explores how realist inquiry can help move beyond surface-level explanations of health inequalities, such as remoteness, literacy, or cultural difference, to examine the deeper structures, mechanisms, relationships, and histories that shape health outcomes. Prashanth discusses the value of realist thinking for making sense of complexity, building explanations with communities, and creating research approaches that are less extractive and more participatory. Prashanth also reflects on middle-range theory, participatory workshops, learning sites, global health, donor dependence, resilience, and the importance of humility in research. He highlights how realist approaches can support more grounded, equity-oriented health systems research by helping researchers, practitioners, and communities ask not only what works, but why things are the way they are, for whom, and under what conditions. Whether you’re an evaluator, researcher, public health practitioner, policymaker, student, or someone interested in realist approaches, global health, Indigenous health, or participatory research, this episode offers valuable insights into using realist thinking as a way of building shared understanding, practical wisdom, and more equitable approaches to health systems research

Episode 29 – Realist Synthesis, Online Forums and Living Libraries with Paul Marshall

How can realist synthesis help us understand digital forums, online communities, and living libraries? And what happens when lived experience, story sharing and peer support take place in dynamic online or hybrid spaces where safety, connection and meaning are constantly being negotiated? In this insightful and reflective conversation, Alejandro is joined by Dr Paul Marshall, Research Associate at the Spectrum Centre for Mental Health Research at Lancaster University. Paul shares his experience of working with realist approaches across projects on living libraries and online mental health forums, exploring how people share experiences, build connections and seek support in both face-to-face and digital environments. The conversation explores how realist evaluation and synthesis can help unpack what makes online forums meaningful, helpful or challenging for different people indifferent contexts. Paul reflects on the difficulty of conceptualising online forums as interventions, the difference between context and setting, and the importance of psychological safety that enables people to share experiences and ask questions. Paul also discusses the value of combining realist synthesis with realist interviewing, working with multiple stakeholders, and using mixed methods to understand what is happening beyond individual posts or interactions. He reflects on the roleof forum moderators, service leads, forum hosts and users in shaping the culture and functioning of online spaces. Whether you’re an evaluator, researcher, student, practitioner, digital health professional or someone interested in lived experience, online communities and participatory approaches, this episode offers valuable insights into using realist approaches to understand how digital and hybrid spaces work, for whom, and under what circumstances.

Episode 28 – Realist Evaluation in Government and Policy with Finlay Green

How can realist evaluation help make sense of government policy, complexity, and decision-making? And what happens when realist ideas move beyond academic journals and into fast-moving, politically shaped, resource-stretched environments where people need answers quickly? In this insightful and practical conversation, Alejandro is joined by Finlay Green, an evaluation and policy practitioner with experience across consultancy, government evaluation and policy advice. Finlay reflects on his journey into realist evaluation, from discovering Realistic Evaluation during recovery from an ACL injury to applying realist thinking in government settings. The conversation explores where realist evaluation fits within government, where it can clash with existing evidence expectations, and how realist ideas can be adapted without losing their integrity. Finlay discusses the importance ofdropping unnecessary jargon, making evaluation tangible and accessible, using quantitative and administrative data and focusing on explanations that are useful to policymakers. Finlay also reflects on the value of realist approaches for wicked problems, regulation, policy design, and ex ante evaluation. He highlights the need for realist evaluators to engage more directly with policy questions, collaborate across disciplines and understand the pressures and constraints faced by government teams. Whether you’re an evaluator, researcher, policymaker, student, or practitioner interested in applying realist approaches in policy contexts, this episode offers valuable insights into making realist evaluation feasible, credible, and genuinely useful where decisions happen and stakes are high.