The LM for SURE-P/MCH was developed using a combination of documents review, informal consultations with SURE-P/MCH manager and a technical workshop that involved researchers from the Universities of Leeds and Nigeria. In addition to clinical service outcomes shown in Fig. The use of CHWs was promoted in an attempt to implement interventions using lower cadres of workers to accelerate achievement of universal healthcare coverage [7–10]. Maluka S, Kamuzora P, SanSebastian M, Byskov J, Ndawi B, Olsen O, et al. BMJ Open 2012, 2(5). is a dependent outputs (e.g. Google Scholar. Health Policy Plan. Lindsay B. Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? Based on specific theories, realist evaluation provides an alternative lens to empiricist evaluation techniques for the study and understanding of programmes and policies. This combination was intended to improve access to quality health services and ultimately reduce maternal and child morbidity and mortality. 2012;18(2):176–91. Article  Since the start of the project, a detailed methodology handbook has been developed to guide data collection and analysis [30]. Although there are excellent examples of how realist evaluation might be used for evaluation in different healthcare contexts (e.g. Design: A multimethod study design was undertaken using realist evaluation methodology. neonatal and perinatal deaths); T J Health Organ Manag. The Health Policy Research Group, University of Nigeria has developed three models for getting research into policy and practice (GRIPP), which will also be applied in this study. J Health Serv Res Policy. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. middle-range theories) that link intervention inputs to processes, outputs and outcomes within the context of Anambra state. A realist approach emphasises the contingent nature of programme outcomes and addresses questions about what works, in which setting, for whom, in what circumstances and why [26]. Protocol for a rapid realist review July 2020 All interviews will be audio-recorded (subject to informed consent), transcribed and translated into English where required. In: Bryman A, Burgess R, editors. 1) provides an overarching hypothesis, and more specific hypothetical pathways will represent the middle-range theories (MRT) to help us explore the C-M-O configurations within the programme. This realist evaluation protocol sets out the approach that will be used to identify and explain which aspects of the programme are working, for whom and in what circumstances to produce the outcomes intended. This will give us greater understanding of the health system context, including the links with relevant policies, practices and programmes (e.g. SURE-P/MCH and SURE-P/MCH + CCT) will be assessed against each other and against the no implementation site. Realist evaluation reports need to be developed in line with the realist nature of the evaluation. Quantitative methods will include analysis of quantitative and costing data from (a) HMIS, (b) SURE-P M&E and (c) a structured facility exit survey. Hum Resour Health. Neither of the funders had any role in the design of this study. Rather, becoming competent at realist evaluation involves acquiring the ability to think, reflect and interpret data in a way that is resonant with realist philosophy and principles. The eventual decision was to continue with the study, using the original methodology, though with the addition of assessment of sustainability of achieved changes and effects of on-going lobbying and advocacy efforts on entrenching the MCH on the political agenda in Nigeria. Malar J. ‘How To’ Guide On Research & Development: The Embedded Approach. Theory-driven forms of evaluation help understanding such complexity by studying how the different elements are intertwined [20] and recognising the role of context as a key influence in the production of outcomes [21]. Realist evaluation is a type of theory-driven evaluation method used in evaluating social programmes. Health Policy Plan. How does capacity building of health managers work? Meeting the aims through realist evaluation. Rather, becoming competent at realist evaluation involves acquiring the ability to think, reflect and interpret data in a way that is resonant with realist … This is the key question posed by realist evaluators. A cluster is made up of four PHC facilities and one General Hospital (GH). Excerpt "A realist approach assumes that programs are “theories incarnate”. During step 1, we will develop specific hypothetical pathways (i.e. Adam T, Lim SS, Mehta S, Bhutta ZA, Fogstad H, Mathai M, et al. Evaluation. The-Presidency. Specific methods of communicating research will include combinations of: Developing short and practical policy briefs to national and international policymakers and practitioners. The study results will also inform strengthening the different aspects of the Nigerian health system, e.g. From a wider social perspective, the impact of the interventions is likely to affect the costs of obtaining services. METHODS AND ANALYSIS: The study will be conducted in four phases. Findings from step 1 will be used to hypothesise the likely changes (interruptions in trends and levels) in the time series to make predictions to be verified during the ITS analyses. 1), i.e. Implementation Sci 11, 83 (2015). Malar J. The qualitative and quantitative methods will be integrated throughout to answer the eight study research questions. A framework approach will be used for analysis to test hypotheses, while allowing for emergence of new themes [41]. The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. Thus, the final explanation of a programme considers context-mechanism-outcome.[5]. Lehmann U, Gilson L. Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes. it is a form of primary research. Onwujekwe O, Uzochukwu B, Ojukwu J, Dike N, Shu E. Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: An analysis of activities, costs and outcomes. London: SAGE Publications; 1997. The aim of the ITS analysis is to identify discontinuities in the time series associated with, and potentially caused by, the introduction of the SURE-P programme to health facilities. studies, policy documents and so on) and so it is a form of secondary research. The project uses an input-process-output-outcome continuum (see Fig. 2011;26 suppl 2:ii84–91. Disabil Soc. A detailed list of respondents will be developed within step 1, and snowballing will be used to identify any further informants. (PDF 110 kb). 2014;100:72–83. R Pawson, N. Tilley, "Realistic Evaluation" (Sage), London. Cite this article. Ozawa S, Pongpirul K. 10 best resources on … mixed methods research in health systems. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. Realist evaluation provides an overall methodological approach for the project and will guide development, testing and refining of middle-range theories through the analysis of the relationships between the context (at macro, meso and micro levels), mechanisms and outcomes [31]. 2nd ed. The data will be collected using three methods. The realist evaluation is a relatively new approach to evaluation and its overall place in the is not yet fully established. This means, among other things, describing theories in terms of context -mechanism outcome (CMO) … MRC. PubMed Google Scholar. $$ {Y}_t = {\beta}_0+\kern0.5em {\beta}_1{T}_t+\kern0.5em {\beta}_2{I}_t+\kern0.5em {\beta}_3{T}_t{I}_t + {\beta}_4{X}_t + {\varepsilon}_t $$, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13012-016-0443-1. The assessment of the ITS design against standard quality checklist [42] is shown in Additional file 1. ANC, antenatal care; CCT, conditional cash transfers; CHEWs, Community Health Extension Workers; CHWs, Community Health Workers; FGD, focus group discussion; HMIS, health management information system; IDI, in-depth interview; IWT, initial working theory; M&E, monitoring and evaluation; MCH, maternal and child health; MOH, Ministry of Health; MRT, middle-range theory; PHC, Primary Health Care; REVAMP, deteRminants of Effectiveness and sustainability of a noVel Community HeAlth Workers programMe in imProving maternal and child health in Nigeria; SURE-P, Subsidy Reinvestment and Empowerment Programme; VHWs, Village Health Workers; WDCs, Ward Development Committees. Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. This realist technique acknowledges that intervention programmes and policy changes do not necessarily work for everyone, since people are different and are embedded in different contexts. On the demand side, there are costs of the cash transfers themselves (conditional on using services), transportation to the health facility and opportunity costs of facility use to the women and their carers. Article  A LM is a visual way of organising and displaying information about a strategy or programme. The development of interview question guides will be informed by the study conceptual framework and structured around the study research questions to explore the specific hypothetical pathways identified in step 1.