Using critical realism in primary care research: an overview of methods

Primary care research seeks to answer a wide variety of complex questions: how do we most effectively manage patients with multiple illnesses? When is the practice nurse the best-placed health professional to provide patient support? What is the likelihood that medicines found to be effective in randomized trials will benefit my patient?

To answer primary care research questions, we need diverse research methods that are responsive to the context and nested complexities of patients, their settings and the broader health system (1). Primary care occurs within a social reality—that is—it is embedded in how people, and their actions, influence the multiple interconnected parts of a social system (2). No patient, part of the health care system or community exists in isolation: each is made up of and influenced by the actions of people (3). These actions produce a social reality. This paper explores one approach to research methods that seek to understand the complexity of how and why things work (or do not work) in primary care settings whilst incorporating the perspective of social reality….more