Making it Work (MIW) is a Community-Based Research (CBR) project that is looking at integrated services for people living with HIV, hepatitis C, and/or challenges with mental health and substance use, with a particular focus on Indigenous service delivery models and cultural safety. The project uses a Two-Eyed Seeing approach and Realist Evaluation to help us understand why, how, when, and for whom these services work best.
Two-eyed seeing foregrounds Indigenous knowledge with the understanding that to improve and advance Indigenous wellbeing, research needs to honour diverse and evolving Indigenous approaches to health and wellbeing while also recognizing the value of Western, scientific approaches to health. In this project, Indigenous ways of knowing and leadership from Indigenous team members guide our work through a Western approach, Realist Evaluation. Our study team has been learning where these approaches complement each other as well as how to make sure our values and commitment
to CBR and decolonizing research methods are not compromised. We shared some initial lessons learned in a poster presented at this year’s virtual CAHR conference, and discuss here more about our learning as a team.
How we are learning to use the Realist Evaluation Framework
As the MIW project moved along we finally landed on the Realist Framework to guide us on how we would carry out this project. However, most of us didn’t have any experience in using this framework – a daunting challenge! Then came along an opportunity to learn more about it – a three-day course with realist evaluation expert Geoff Wong was being offered at UBC in September 2019. This offered an intensive dive into the deep end of learning, and we thank UBC for this opportunity and timeliness for us on the project. Three intense days left our minds full and wondering how we adapt this framework to our project. Gamely forward we went; context + mechanism = outcome over and over, a whole lot of information generated from the pilot study and looking somewhat like a mud puddle someone dropped a rock into.
Realist evaluation works to show what are known as “Context + Mechanism = Outcome” configurations, or CMOs, to describe why things happen for whom and in what context. CMOs are typically presented in a very linear fashion – a straight line from left to right. However, our team felt that it was important to show that services do not work in a strictly linear way, as they are relational and shift constantly. For this reason, we have been working to develop spirals to represent our CMOs – showing how these processes are ongoing.
As well, in working to use a Two-Eyed Seeing approach, our team decided to ground our CMOs in the framework of the Medicine Wheel. We are working to place our CMOs onto the Medicine Wheel, to show that organizations offer services that support whole wellness in clients – physical, mental, spiritual and emotional.
An example of a CMO configuration spiral
UBC brought Geoff Wong back in early March 2020 for follow-up consultations. We were able to present to Geoff and the group about how we applied realist evaluation in MIW, including our decisions to use the Medicine Wheel and the spirals to lay out CMOs. We are happy to report that we are on the right track and doing some pretty interesting stuff in how we were laying out our work utilizing this framework. This all feels pretty heady when we reflect back on how much work it takes (and how much work is still to be done) when marrying a Two Eyed Seeing Way with Realist Evaluation.
Read more about how we are merging these two approaches and our lessons learned so far in the presentation we made for this year’s virtual CAHR conference.
By: Darren Lauscher, Madeline Gallard & Joanna Mendell
Questions? Feedback? Get in touch!
Joanna Mendell, Research Manager for the Making it Work Project [email protected]