Evaluating complex public health interventions: theory, methods and scope of realist enquiry

By understanding the ontological and epistemological claims of critical realism, it is possible to transcend the methodological inadequacy of the standard model approach and take a coherent approach to evaluation of complex public health interventions.

Abstract

The standard models used in the study of complex public health interventions are inadequate. They adopt a simple empiricist theoretical foundation and attempt to graft onto an essentially open social system a contrived laboratory experimentation typically in the form of a randomized, controlled trial. By understanding the ontological and epistemological claims of critical realism, it is possible to transcend the methodological inadequacy of the standard model approach. Critical realism posits a substantive causal theory, an end to fact-value dualism, and a coherent and emancipatory model of social action; all of these features amount to a systematic and compelling account of public health practice and a coherent approach to evaluation of complex public health interventions.