Realist grounded theory: an oxymoron?
To increase the researchers’ understanding of health promotion through community sports, we drew on assumptions related to complexity theory (Plsek & Greenhalgh, 2001). Following a complexity perspective, social problems are embedded in different layers of complex adaptive systems (CAS), which are time-bound, dynamic and open systems marked by emergence, and are therefore capable of self-organization (Buckley & Schwandt, 2008; Byrne & Uprichard, 2012; Cilliers, 1998, 2005). Community sports settings have all the characteristics of a CAS:
open and dynamic, they evolve, change and self-organize according to the needs and interests of their participants. Studying this setting requires insights at individual, relational and
structural levels that influence health and wellbeing in vulnerable populations. Scientific realism provides excellent opportunities to acquire such insights.
The research strategy we used to develop the first program theory (MRT1) clearly draws from realist thinking yet also uses steps from the Grounded Theory Approach (GTA), a commonly used methodology for theory development. GTA can be used for theory-building, aiding conceptualization from data ‘so that the end result is a theory, that the scientist produces from data collected by interviewing and observing everyday life’ (Morse et al., 2009. While
empirical applications of the GTA in health sciences are largely inductive, this is a narrow interpretation of the classical GTA, originally developed by Glaser and Strauss in 1967 as a
The ‘plus’ in sport-plus Discussion
post-positivist mix of inductivism (i.e., open and flexible research design, data collection in the natural environment, and data analysis starting from raw, unstructured data) and
deductivism (i.e., tendency for a systematic approach, verification and theory-building) (de Boer, 2011; Glaser & Strauss, 1967).
In Study 1, GTA is actually used as an extra step to build theory from case studies in an overall realist inquiry study design. This is possible because realist inquiry has no preconceived preference for any method. Instead, the subject of research determines the method’s choice. Pawson and Tilley, influential realist scientists who were among the first to operationalize realist thinking, argued that realism is not a research technique, but rather a
‘logic of inquiry that generates distinctive research strategies and designs, and then utilizes available research methods and techniques within these’ (Pawson & Tilley, 2004).
The illustration of theory building in the field of health promotion for socially vulnerable populations in Study 1 shows that grounded theory as a method and realism as a paradigm can be part of the same complex puzzle. The study has an overall study design inspired by realist inquiry and uses the GTA for theory building. While some scholars argue that it is not possible to reconcile the GTA with realism due to a different underlying scientific paradigm, we wish to argue for a potentially fruitful, pragmatic marriage of the two.
A first argument for a combination of the two lies in the question whether realism should be considered a methodology or a ‘philosophy in search of a method’ (Yeung, 1997). While a method is a tool to rigorously collect, analyze and report on data in the most systematic way available to the researcher, the research paradigm or perspective only enters the game the moment data are analyzed and interpreted. In a realist-inspired GTA, the positivist view of social constructs existing as an observable reality external to human reasoning is accepted, while extensive attention is given to individual meaning making (Oliver, 2012). It holds the middle between positivist and constructivist thinking.
The method used in Study 1 is similar to what has been called ‘critical realist grounded theory’ (Hoddy, 2019; Oliver, 2012). Especially in the fields of social work and health, dealing with complex social problems, the combined inductive/deductive and retroductive approach as applied in realist grounded theory seems useful for several reasons (Bunt, 2018;
Lee, 2012; Oliver, 2012). First, it embraces the complexity inherent to societal problems via
an elaborated contextualization of identified social changes. If the main assumption of realist inquiry is to obtain detailed information on all context factors, either triggering or hampering potential mechanisms that would lead to change, it urges the researcher to ‘ground’ the developed theory in its specific context(s), which makes the GTA a particularly suitable method. Second, the GTA sticks to raw data but also allows for deductive comparison with existing theory. This is a necessary step in bringing theory to a more abstract level (e.g., developing a middle-range theory). Lastly, combining GTA with a realist perspective may strengthen data validity and reliability because data are collected and analyzed in practice, in real-life settings. Since complex studies do not allow controlling the variables, gathering knowledge about the context in which the identified mechanisms function is important. It enables program and policymakers to design or adapt programs accordingly.
Yet, although the study data were grounded in practice, analyzing them was a process of constant cross-pollination, both because of the transdisciplinary approach of the project (bringing together practitioners, academics and policy makers) and because of the fact that social scientists are always in contact with and influenced by existing theory, even when not aware of it (Dhand, Luke, Carothers, & Evanoff, 2016). The resemblances between Context-Mechanism-Outcome configurations grounded in real-life setting data at the one hand, and existing health promotion theory at the other hand, reinforced the reliability of the study data and oriented the shaping of program theory.
Participatory action research using a realist perspective
For the studies in this dissertation, we have used a realist perspective, matching well with (participatory) action research because of a common focus on context (Westhorp, Stevens, &
Rogers, 2016). While realist methods originate in evaluation practices, in action research they are not only useful in the evaluation phase but also in the planning phase, informing the design and implementation modalities of interventions (cf. supra - Fig. 3). Thus, the realist theory (MRT1) developed in Study 1, has informed the development and realization of the intervention as described in Study 2, and from that intervention, lessons were learnt through a realist-informed evaluation, that were useful in revising or strengthening the hypotheses of MRT1.
There have been several advantages in combining realist methods with participatory action research. Working in dialogue with practitioners and participants of sport-plus practices has
The ‘plus’ in sport-plus Discussion
facilitated detailed knowledge of the context; it has allowed setting realist training objectives and timely revision of these objectives; and it has helped the trainees to adhere to the
delivered training, since training content was built upon their interests and training modalities were chosen in consultation with trainees.
In action research, there is often thought to be a ‘right’ response to specific scenarios,
delivered by the ‘expert’ practitioner (Boutilier & Mason, 2007; Ruch, 2002). This approach, however, does not permit an understanding of the local production of health that is required in order to develop more appropriate strategies for tackling social inequalities, such as strategies involving reflexivity with regard to the agency, practices and social structural location of practitioners as well as the vulnerable populations one seeks to serve (Frohlich & Potvin, 2010).
In our action research, the approach and mindset of both practitioners and researchers involved in the training development and delivery was open and flexible, favorable of changes proposed all along the process (and not only during the conception phase), which contributes to success in a genuine participatory approach (Kidd & Kral, 2005). In accordance with the critical need for researchers and community groups to build mutually beneficial and respectful relationships (Spaaij, Schulenkorf, Jeanes & Oxford, 2018), the researchers
involved in the CATCH health studies tried to increase the level of participation by taking the time to experience the SfD context and by taking the perspectives and knowledge of local stakeholders (participants, coaches, social workers…) seriously. For example, both the planning and the contents of the training in Community Sports Bruges (cf. Study 2), have been adapted after four sessions, because the involved researchers / trainers picked up signals of an unexpressed need and therefore invited participants to express their thoughts and concerns.
Participation, however, should not be limited to the liberty for stakeholders to speak up. It is important that researchers dare to let go of their logic and the plans they have drawn up, and that they, after discussing the expressed interests of those involved, also act according to those interests. This may cause some unease in researchers and the feeling of loss of control, which can be challenging. A true power-shift whereby participants are empowered to analyze their own situations and to design their own solutions (Kay, 2009; Nicholls et al., 2011) remains a tough nut to crack for many researchers, for it involves the affirmation that people’s own
knowledge is valuable and a repositioning of the role of the researcher from director or
evaluator to facilitator and collaborator (Spaaij, Oxford & Jeanes, 2016). In that regard, Spaaij et al. (2018) encourage researchers to be critically aware of how they are facilitating
involvement and to what degree participants are genuinely co-constructers of the process.
This is all the more important in SfD research because the risk of reproducing power relations is particularly significant in SfD contexts, because of the structure and culture of sport
situating professional knowledge as superior to participants’ knowledge (Luguetti & Oliver, 2017).
Another persistent challenge in participatory research, especially when it involves an intervention (PAR), is that it is “inherently open-ended, messy, and long-term” and, as a result, may lack the support of academic institutions that are characterized by a ‘culture of speed’” (Spaaij et al., 2018, p. 29). In the remediation of the potentially conflicting
relationship between participatory or activist research and traditional academic culture, Spaaij et al. (2018) see an important role for senior scholars with more established projects and secure funding. They are in a better position to change the status quo, to train, mentor, and support junior scholars and to “navigate dual accountability to activist community
organizations and academic institutions” (Spaaij et al., 2018, p. 35).
Study limitations and future research opportunities
The contextualized and tailored approach to sport-plus practices has focused attention on lower context levels (micro- and meso-level). Yet factors at higher levels fully determine the context at micro level. If sport-plus is to realize lasting change, its potential for social
transformation should be studied, which means that the unit for analysis needs to shift from the individual to, e.g., the community.
Darnell and colleagues rightfully commented that research on SfD mostly uses little politicized social concepts and theoretical frameworks, such as social capital theory and positive youth development, and such as the concepts embedded in our program theory, creating the impression that development through sport is achievable if only the right tools, conditions and processes are deployed (Darnell, Chawansky, Marchesseault, Holmes, &
Hayhurst, 2016). This may be seen as a somewhat utilitarian approach though, overlooking the structural imbalances determining people’s reasoning on the resources offered through SfD-programs. Therefore, Haudenhuyse et al. (2018) suggest using frameworks more apt to
The ‘plus’ in sport-plus Discussion
explain social transformation, such as those based on political economy, critical pedagogy and governmentality. In the same line, Schaillée, Haudenhuyse, & Bradt (2019, p.11) encourage
“to think and act on structural exclusion and inclusion beyond the individual, interpersonal or programmatic level”, hence to build more deeply on transgressive and dialogical conceptions of social inclusion ((Deluca, 2013) to make SfD research and practice progress.
Since sport-plus is a complex intervention, and social exclusion a complex problem, it is quite a challenge to measure the impact of sport-plus, and to assign effects on social exclusion to sport-plus related mechanisms and processes. In this respect, there are interesting research perspectives to be explored. Future research opportunities include reflections on what could be relevant and precise indicators to measure effects in terms of health, health determinants and health equity. In regard with outcome measurement, it would be interesting to follow up on sport-plus participants (e.g. through a cohort study), in order to monitor long-term and structural effects of sport-plus, including changes in social inclusion. Realist methods or other methods drawing from complexity thinking will definitely have a place in such studies, so that measured effects can be explained within their context and be allocated to specific sport-plus, or other, mechanisms. Concretely, as an extension of the CATCH project, the outcome of the intervention implemented in Bruges (cf. Study 2) on sport-plus participants could be studied.
In parallel, this evaluation would represent another test of our program theory claiming that an optimal experiential learning environment (a safe context, with constructive group dynamics and positive coaching) motivates participants to set goals for behavior change leading to improved health and wellbeing.
Other research opportunities lie in the identification and study of those cases in which sport-plus failed in having any positive effect on health promotion, or also, the application of the transferable mechanisms of sport-plus to another domain than sport-plus (e.g. art), in order to evaluate whether and under what circumstances the desired effects are still triggered. In this way, the arsenal of effective instruments for health promotion can possibly be expanded, in order to also reach the part of the target group that cannot be reached through sport-plus.