Show notes
How can realist evaluation help us understand why exercise interventions work, for whom, in what circumstances, and why? And what happens when patients and interest group holders are not just consulted, but actively involved in shaping programme theories, intervention design, and implementation?In this reflective conversation, Alejandro is joined by Dr Deirdre McGrath, lecturer in nursing at Queen’s University Belfast, whose work brings together realist evaluation, co-design, patient and public involvement, oncology, palliative care, and cancer rehabilitation.Deirdre reflects on her journey from clinical practice in oncology and palliative care to realist research, focusing particularly on exercise interventions for women with ovarian cancer. Drawing on her PhD work, she explains why traditionalevaluations of exercise interventions often struggle to explain variation in participation, adherence, and outcomes, and how realist approaches can help us ask deeper questions about what works, for whom, in what circumstances, and why.The conversation explores how co-design can strengthen realist evaluation by bringing patients, carers, clinicians, academics, and other interest group holders into the research process in meaningful ways. Deirdre discusses how women with ovarian cancer helped reshape her assumptions about what an exercise intervention should look like, including the move from an initially imagined in-person intervention to a home-based programme shaped by lived experience, practical constraints, psychological safety, trust, relevance, and flexibility.Deirdre also reflects on the challenges of making realist terminology accessible, avoiding tokenistic involvement, managing different interest group holder perspectives, and creating safe spaces where people feel genuinely able to contribute. She highlights the importance of humility, listening, feedback loops, and recognising patients as experts in their own care.Whether you’re an evaluator, researcher, clinician, public health practitioner, student, PhD researcher, or someone interested in realist evaluation, co-production, cancer rehabilitation, patient involvement, or complex interventions, this episode offers valuable insights into how realist thinkingand co-design can work together to produce more grounded, useful, and meaningful research.Note: Although the terms “co-production” and “co-design” are sometimes used interchangeably in the conversation, this podcast episode specifically focuses on co-design.