In considering the selection of an appropriate methodology and methods to answer the study questions, several key issues have been addressed. With regards to methodological choices, these issues relate to where, or with whom the desired knowledge resides, and with regards to methods, how that information can be appropriately sourced, collected, and analysed.
This study aims to uncover the programme theory for an IP SRC. Pawson and Tilley (1997) describe programmes as theory incarnate and suggest that the implementation of such programmes follows a theoretical implementation chain. They posit, that programmes begin in the minds of those individuals who originate the idea, who start with an initial theory of what the programme is intended to achieve, and how the programme might operate to produce such change. However, as the programme passes from the hands of those who conceived it, to those who deliver it, those who further develop it, and those who experience it, programmes evolve and change, as does the programme theory or theories. As such programmes undergo significant adaptation during their implementation, and therefore in evaluating how a programme works it is important to ascertain both how it was intended to work, and how it actually played out in practice.
With regards to the IP SRC being examined in this study, it is argued that knowledge of the implementation chain and the underlying theory or theories at work, may be held in the minds of those who designed the clinic who may have knowledge of how it was intended to work. Those who delivered, developed, or experienced the clinic may hold valuable
knowledge of how it works in practice. There may also be artefacts, in the form of documents that may describe the design, development, and implementation. To access such knowledge, a qualitative approach was selected for this study.
3.2.1. Rationale for a qualitative approach
The role of qualitative methods in seeking and providing an explanation for complex
phenomenon has been well established, and an evaluative qualitative approach has played an important role in the generation of explanatory hypotheses, (Lofland and Lofland 1995; Miles and Huberman 1994). Qualitative methods are particularly adept at looking at how things operate and can help to identify the processes and consequences that lead to different outcomes (Ritchie and Lewis 2003). Snape and Spencer, (in Ritchie & Lewis, 2003) suggested this approach is particularly useful when one is attempting to:
“Identify the factors that contribute to the success or unsuccessful delivery of a programme, service or intervention; when one wishes to identify the effects of taking part in a programme or initiative on participants, and how they occur; when
examining the nature of the requirements of different groups within the target population; when exploring a range of organizational aspects surrounding the delivery of a programme, service or intervention; and when exploring the contexts in which interventions are received and their impact on effectiveness “(Snape and Spencer 2003, p.17).
These closely resemble the intents of this study and would suggest that this is an appropriate approach to addressing the study questions.
One of the central features of the qualitative approach is the focus on how individuals in a particular context "understand and interpret their social reality" (Bryman 1988, p.8). The focus is on making sense of or interpreting phenomena in terms of the meanings that people bring to them. Hammersley (1992) suggests that the social world exists independent of an individual’s subjective understanding, however, in trying to gain an understanding of that social world, the only route open to us is through the various interpretations that individuals bring. Their different vantage points yield different types of understanding. Hammersley highlights the diverse and multifaceted nature of external reality and suggests that diversity brings richness to understanding the various ways in which reality is
experienced. The aim of a qualitative approach is, therefore, to produce as full a picture as possible of the nature of the programme.
Qualitative research involves the study of phenomenon within their natural setting, and as such, this approach is contextually grounded. As context is a critical feature of a realist evaluation approach to uncovering programme theory, appreciation of the natural setting is therefore vitally important to this study. Creswell (1998) suggests that qualitative enquiry is amicably suited to the exploration of a phenomenon in its naturalistic setting and offers the potential for an in-depth enquiry. Both of these strengths of a qualitative approach are integral to addressing the study research questions.
3.2.2. Rationale for a single case design
An explanatory single case study design was adopted for this study. Yin (2003) proposes that such an approach is particularly useful when the research questions seek to explain causal links in real-life interventions that are too complex for survey or experimental approaches. This approach attempts to explain the linkage or linkages between the programme intervention and its outcomes. A qualitative case study examines a phenomenon within its real-life context (Yin, 1994) and can be a suitable approach for studying complex social phenomena.
The use of a single case design afforded the opportunity for in-depth exploration of the clinic and the generation of diverse accounts from those who designed, developed, delivered, and participated in it. Such an approach allowed for thorough exploration of the IP SRC and explanation of the factors that shaped its outcomes across different participants and under the influence of different contexts. Using varied data sources and addressing the many players involved in the programme helped ensure the clinic was explored through multiple lenses and assisted in uncovering the many and varied facets of the clinic, a key feature of case study research.