Methodological innovations across realist methods and behavioural science.

Realist methods generate context-sensitive programme theories that explain how, why and for whom complex health interventions work — but these theories often lack structured operationalisation to inform comparison or intervention design. Behavioural science systematically identifies and modifies behaviour change mechanisms using theory-driven frameworks, but has been criticised for insufficiently considering context. My work brings the two together: using behaviour change techniques and mechanisms of action to clarify mechanisms, and behavioural settings to explicate context, I have proposed a five-step framework for integration that gives programme theories a common language — making them more structured, testable and transferable, and better able to support intervention design and policy translation.

I have also applied this behavioural lens empirically, systematically coding 44 interventions to reduce unprofessional behaviour between healthcare staff against the 284-technique Behaviour Change Technique Ontology — demonstrating that the ontology is broadly applicable to organisational behaviour change in healthcare, and showing that complex interventions rely on consequence-based and goal-oriented techniques.

A second strand tackles speed. Policymakers and regulators often need rigorous evidence within timeframes academics consider unworkable. The Accelerated Parallelised Realist-Informed Literature review (APRIL) is a nine-step method I developed for delivering a realist review in under one month, originally for the Care Quality Commission. It achieves its rapidity through parallelised review processes, highly purposive but still systematic searching, and theory-informed data extraction. Its first application — a four-week review of adult community mental health services in England spanning 81 sources — produced an initial programme theory of how a system under stress can generate conditions that undermine good practice, increasing risk and ultimately harm. What that review found about community mental health services, and the second application of APRIL to policy support for military families, are covered on the other research areas page.

This methodological work is gaining recognition: I have been invited to guest-edit a special collection, "Advances in Qualitative and Mixed Methods Methodology for Realist Evaluation and Synthesis", at the International Journal of Qualitative Methods, and was a guest on The Realist Lens podcast to discuss integrating behavioural science with realist research.