In this episode of The Realist Lens, Alejandro is joined by Dr Robert Sandler, medical doctor and recent PhD graduate from the University of Sheffield, to explore how realist evaluation can help make sense of major changes in healthcare.

Rob shares his doctoral research examining the impact of ETI for people with cystic fibrosis in the UK, a treatment that has rapidly transformed health outcomes and, in turn, reshaped clinical care, patient experiences, and treatment decision-making. The conversation explores what it means to conduct realist research in a fast-moving and uncertain context. Rob reflects on how the introduction of ETI, alongside the wider disruption of COVID-19 and the shift toward virtual care, created a dynamic environment that required continual theory development and adaptation.

Rob discusses how he developed and refined programme theory using multiple methods, including multi-centre interviews with clinicians, targeted single-site interviews, a national patient survey, focus groups, and secondary quantitative analysis. He explains how realist logic guided the sequencing of these methods and how each contributed to theory refinement. The episode also explores keyfindings from the study, including tensions between clinicians and patients in how health and treatment decisions are understood, what Rob describes as “epistemological dissonance.” He reflects on the role of habit formation intreatment adherence, the challenges of maintaining intervention fidelity in changing contexts, and the importance of reflexivity as a clinician-researcher.

Rob concludes by sharing practical advice for clinicians and researchers working with realist approaches, including the value of formal training, building supportive networks, and staying grounded in real-world complexity.

This episode will be valuable for anyone conducting realist evaluation, working with mixed methods, researching complex interventions, or navigating research in rapidly changing healthcare environments.