We realise, however, that implementation of a new programme can have an impact that goes beyond the direct programme beneficiaries and will consider these effects qualitatively through conducting IDIs with key actors referred to earlier. Sensitivity analysis captures the influence on cost-effectiveness ratios of change in major assumptions [16]. These costs represent opportunity costs of the programme that contribute to the overall cost that may vary across contexts. In RE, researchers develop middle-range theories that take account of how Context (at micro, meso and macro levels) influences intervention processes or Mechanisms (e.g. In the discussion, we also use to share some key initial methodological outputs which were produced since the start of the project [30]. 2006;5(1):117. 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. exploring the intervention mechanisms); identify the key contextual facilitators and constraints and analyse in what ways these contextual influences affected the achievement of outcomes. Bull World Health Organ. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Leeds, UK: University of Leeds; 2015. Lehmann U, Gilson L. Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes. Mixed methods study designs that are increasingly used to evaluate complex interventions [35] include the exploratory (qualitative methods followed by quantitative), explanatory (quantitative then qualitative), embedded (one dataset provides a supportive secondary role) and convergent (both datasets are complementary to each other) models [35, 36]. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. is an intervention dummy variable (taking a value of 1 in areas where the intervention is implemented and 0 otherwise); T the Charter of Fundamental Rights of the EU) and international conventions (e.g. Cookies policy. Ozawa S, Pongpirul K. 10 best resources on … mixed methods research in health systems. We will use social science methods to explore views of key actor groups. Unnecessary collection of personal data will be avoided, and respondents will have the right to review outputs and withdraw consent. political and resource environment), at the meso level (e.g. 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]. The project workplan showing overlaps between the three steps is included in Additional file 2. The 5-year duration is feasible and should allow sufficient time for developing robust multidisciplinary methodology, assessing longer-term outcomes, conducting individual and organisational capacity strengthening [44], adequate consultations with actors and facilitating uptake of project results into policy and practice [45]. An example involving the first two indicators might be: ‘deployment of CHWs, combined with improvement in infrastructure and supplies when implemented within the health systems context of Nigeria, will help reduce maternal and neonatal mortalities to 320/100,000 and 7/1000 live births respectively’. First, the initial Logic Model (LM) (see Additional file 5) was developed for the SURE-P/MCH. London: SAGE Publications; 1997. 2003;19(4):613–23. This paper describes our longitudinal, mixed methods realist evaluation of HNA and care planning. A general model for an ITS regression analysis (which will be adapted to allow for comparison between SURE-P/MCH, SURE-P/MCH + CCT and control clusters) is: where Y Other services might also be affected by resources (or their lack) such as drugs and theatre time that are channelled into the new programme. It is important to stress that realist evaluation cannot be achieved simply by following a protocol in a technically correct manner. 2): (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. The making of Jamaica’s ‘National Policy for Persons with Disabilities 2000’: macro, meso and micro factors. skilled midwives) and 10,000 CHWs, comprising 1000 Community Health Extension Workers (CHEWs) and 9000 volunteer Village Health Workers (VHWs). Bhutta ZA, Memon ZA, Soofi S, Salat MS, Cousens S, Martines J. The paper will also be useful to policymakers and practitioners who are interested in commissioning and engaging in such complex evaluations to inform policies and practices. 2012;10(1):38. We recognise context as a key influence in achieving the intended results. https://doi.org/10.1186/s13012-016-0443-1, DOI: https://doi.org/10.1186/s13012-016-0443-1. Geneva: World Health Organization; 2012. A LM is a visual way of organising and displaying information about a strategy or programme. A realist evaluation provides an overall methodological framework for this multidisciplinary and mixed methods research, which will be undertaken in Anambra state. As new programmes emerge or existing programmes scale up, comparing the effectiveness of CHW programmes between different contexts becomes important. Specific emphasis will be placed on confidentiality and other data protection issues, which will include security of data storage and access rights to data. Google Scholar. FMoH. Lehmann U, Sanders D. Community health workers: What do we know about them? Subsidy Reinvestment and Empowerment (SURE) Programme. Phases 1 and 2 have been completed (2014–2017) and a summary of this work is presented. Mirzoev, T., Etiaba, E., Ebenso, B. et al. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Wolff N. Randomised trials of socially complex interventions: promise or peril? Our study should improve understanding of the performance and functioning of complex system interventions involving both supply and demand sides. 2007;21:554–72. Abuja: Federal Ministry of Health; Save the Children, Jhpiego; 2011. [PMC free article] Marchal B, Van Belle SB, Van Olmen J, Hoeree T, Kegels G. Is realist evaluation keeping its promise_ A review of published empirical studies in the field of health systems research. London: Sage Publications Limited; 1997. This will give us greater understanding of the health system context, including the links with relevant policies, practices and programmes (e.g. 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]. All personal data will be coded, removed from the data for analysis and stored separately. (ZIP 1568 kb), Pre-implementation Logic Map for SURE-P/MCH. CCTs also target Traditional Birth Attendants (TBAs) to incentivise them to accompany pregnant women to PHC facilities. Where project data are stored on an institutional server, it will be password-protected and only members of the research team will have access to the passwords. realist evaluation covering the same kind of project or programme. 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. This means, among other things, describing theories in terms of context -mechanism outcome (CMO) … Gopalan SS, Mohanty S, Das A. Assessing community health workers’ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. RE was founded on the need to better understand, identify and evaluate why complex interventions succeed or fail in order to inform spread and replicability of effective interventions [].RE is well placed to provide much needed transferable findings that are of practical use for practitioners and decision makers. Article  In addition to assessing whether the target indicators are achieved, we will identify how they are achieved (i.e. Mirzoev T, Lê G, Green A, Orgill M, Komba A, Esena RK, et al. Acta Trop. t Although there are excellent examples of how realist evaluation might be used for evaluation in different healthcare contexts (e.g. 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. statement and Realist evaluation is a type of theory-driven evaluation method used in evaluating social programmes. Neither of the funders had any role in the design of this study. Each IWT identified specific Cs, Ms and Os. BMJ. How does capacity building of health managers work? Health Policy Plan. acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration and sustainability of the interventions [37], which often influence the progression from inputs to processes, outputs and outcomes within health programmes. 2011;26 suppl 2:ii84–91. This is a protocol for a realist evaluation of a collective leadership intervention. middle-range theories) that link intervention inputs to processes, outputs and outcomes within the context of Anambra state. PubMed  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]. Ethical approvals for this study were obtained from the School of Medicine Research Ethics Committee at the Faculty of Medicine and Health at the University of Leeds (ref: SoMREC/14/097) and the Health Research Ethics Committee at the University of Nigeria Teaching Hospital, Enugu (ref: NHREC/05/02/2008B-FWA00002458-1RB00002323). Enyi Etiaba. Guide Evidence-Based Policy - A Realist Perspective: This book by Ray Pawson provides detailed guidance on realist synthesis including a range of examples from across a variety of policy … It is important to stress that realist evaluation cannot be achieved simply by following a protocol in a technically correct manner. In this paper, we report the methodology for a 5-year study which aims to evaluate the context, processes, outcomes and longer-term sustainability of a Nigerian CHW scheme. Health Policy Plan. Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. 2013. doi:10.1093/heapol/czt065. Geneva: WHO; 2007. J Dev Econ. Health Policy Plan. First, the policy environment in Nigeria within which the research is being undertaken is favourable to ensure a high-quality analysis, inform theoretical debate and ensure the uptake of results into policy and practice, as we found within our previous collaborative projects. Maluka S, Kamuzora P, SanSebastian M, Byskov J, Ndawi B, Olsen O, et al. Pawson and Tilley (1997) developed the first realist evaluation approach, although other interpretations have been developed since. 2008;86:452–9. This approach, developed by the Nuffield Centre, has been effective in many countries in improving the quality and effectiveness of the scaled-up programme [46]. t Pommier J, Guevel M-R, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. capabilities, values and interests of individuals) [38, 39]. That is, whenever a program is implemented, it is testing a theory about what ‘might cause change’, even though that theory may not be explicit. The study is guided by the research questions shown in Table 1, alongside the corresponding objectives. One SURE-P component focused on maternal and child health (SURE-P/MCH), which comprised supply and demand components. Since December 2012, CCTs have been implemented in selected SURE-P/MCH sites in 9 of the 36 states of Nigeria (SURE-P/MCH + CCT). In Nigeria, for example, despite the significant reduction in maternal and neonatal mortality since 2003 by 50 and 23 %, respectively, these still remain high at 545/100,000 and 37/1000 births, respectively, particularly in rural areas where most vulnerable groups reside [2, 3]. There are few published examples of realist synthesis. assessment of context will inform best practices in PHC staff performance management; assessment of the added value of CCTs will inform further demand-side financing schemes. All interviews will be audio-recorded (subject to informed consent), transcribed and translated into English where required. Gopalan SS, Mutasa R, Friedman J, Das A. These include both immediate changes in the level of an indicator following the intervention, and long-term changes in the trend of an indicator (over time) following the intervention, as compared to control health facilities. Google Scholar. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. All authors read and approved the final version of the manuscript. In realist evaluation the researcher or evaluator’s task is to gather the data – i.e. N Engl J Med. PubMed  Manage cookies/Do not sell my data we use in the preference centre. Consumers stated and revealed preferences for community health workers and other strategies for the provision of timely and appropriate treatment of malaria in southeast Nigeria. Stame N. Theory-Based Evaluation and Types of Complexity. The uncertainty and likely variability of costs and effectiveness, particularly the spill-over effects, mean that sensitivity analysis will form an important part of the reporting of the economic evaluation. 2nd ed. Soc Sci Med. While the average number of PHC facilities in each Nigerian state is typically between 1000 and 4000, the SURE-P/MCH was implemented in clusters of 12 to 21 health centres within selected states. J Health Serv Res Policy. Specific methods of communicating research will include combinations of: Developing short and practical policy briefs to national and international policymakers and practitioners. Google Scholar. Article  REVAMP project: ‘Determinants of effectiveness and sustainability of a novel community health workers programme in improving mother and child health in Nigeria’. Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority, particularly for sub-Saharan African countries such as Nigeria. 2011;38(2):65–76. Decision-makers will be continuously engaged in a research-policy partnership to facilitate adoption of lessons learned [45]. Second, facility exit IDIs will be conducted with 20–25 purposefully identified users to explore in-depth their views. 2008;6(1):20. The specific hypotheses will draw upon two data collection methods: (a) review of key documents (SURE-P implementation manual, relevant federal and state-level policies, e.g. Realist methodology is increasingly used in the evaluation of complex health care interventions, to facilitate a deeper understanding of ‘what works, how, for whom, in what circumstances and to what extent’ [1,2,3,4].The initial step of realist studies aims to identify programme theories underlying the intervention . Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority for achieving the health-related Sustainable Development Goals (SDGs), particularly for sub-Saharan African countries [1]. However, to guide further development and implementation of CHW programmes in different contexts, it is necessary to better understand what makes CHW programmes successful in achieving desired outcomes and under what circumstances they succeed [11, 12]. system) levels [7, 13]. Ethical approvals for this study were obtained from the University of Leeds (ref: SoMREC/14/097) and the University of Nigeria (ref: NHREC/05/02/2008B-FWA00002458-1RB00002323). It explains when a realist impact evaluation may be most A framework approach will be used for analysis to test hypotheses, while allowing for emergence of new themes [41]. The authors declare that they have no competing interests. The specific hypotheses will be driven by the study research questions (see Table 1) and will relate to the key programme targets ([40] p. 17), Reduction of MMR by 59 % from 545/100,000 live births to 320/100,000 live births, Reduction of neonatal mortality rate by 22 % from 37/1000 live births to 29/1000 live births, Increased percentage of pregnant women receiving focused antenatal care (ANC) by 52% from 50 % coverage, Increased percentage of skilled birth attendance by 63 % (from 16 % baseline), Increased postnatal care attendance within 2 days of birth by 63 % (from 16 % baseline), Increased family planning attendance by 26 % (from 1 % baseline). The respondents for IDIs, identified through purposive sampling, will include health facility managers, CHWs, PHC staff and health planners and programme managers at local, state and federal levels. Article  Green A, Thomas C, Newell JN, Baral SC, Byanjankar L. The contribution of volunteers to a successful community-orientated tuberculosis treatment centre in an urban setting in Nepal: A qualitative assessment of volunteers' roles and motivations. Adm Policy Ment Health. Fiona Keogh, Maria Pierce, Karen Neylon, Padraic Fleming, Intensive home care packages for people with dementia: a realist evaluation protocol, BMC Health Services Research, 10.1186/s12913-018-3630-8, 18, 1, (2018). This handbook is available upon request. The Logic Model Guidebook: Better Strategies for Great Results. 2014;100:72–83. 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 impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. alternative respondents). Meeting the aims through realist evaluation. COMDIS-HSD. This is the key question posed by realist evaluators. PubMed  PubMed Google Scholar. Evaluation. $$ {Y}_t = {\beta}_0+\kern0.5em {\beta}_1{T}_t+\kern0.5em {\beta}_2{I}_t+\kern0.5em {\beta}_3{T}_t{I}_t + {\beta}_4{X}_t + {\varepsilon}_t $$, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13012-016-0443-1. 2009;8(1):265. 2014;29(3):323–7. We will also track significant non-quantifiable effects and will include estimates in the incremental cost-effectiveness analysis. However, if we reach data saturation earlier, these numbers may decrease. Mirzoev T, Omar M, Green A, Bird P, Lund C, Ofori-Atta A, et al. This paper should be of interest to researchers who are adapting and applying robust methodologies for assessing complex health systems interventions and policymakers and practitioners who are interested in commissioning, and engaging in, similar evaluations. BMC Public Health. Los Angeles: SAGE Publications; 2012. Part of Ricketts JA. Lindsay B. Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? Cost Eff Resour Alloc. (PDF 110 kb). Realist evaluation is a form of theory-driven evaluation, but is set apart by its explicit philosophical underpinnings. Only designated research staff will have access to the keys linking the data with the personal information. BMJ Open 2012, 2(5). Google Scholar. skills and practices of CHWs and effectiveness and efficiency of Primary Health Care facilities) and outcomes (e.g. Conversely, it could also lead to the admission of more high-risk pregnancies, causing an increase in facility deaths. This will be achieved by investigating two intervention strategies (i.e. Mirzoev T, Baral S, Karki D, Green A, Newell J. Community-based DOTS and family member DOTS for TB control in Nepal: costs and cost-effectiveness. An incremental cost-effectiveness analysis will be undertaken (cost per additional skilled delivery and associated care). J Adv Nurs. BMJ Open. Two aspects of the environment within which the study is being implemented are worth noting. Implementation Sci 11, 83 (2015). Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand Tim Stokes , 1 Carol Atmore , 1 Erin Penno , 1 Lauralie Richard , 1 Emma Wyeth , 2 Rosalina Richards , 3 Fiona Doolan-Noble , 1 Andrew R Gray , 4 Trudy Sullivan , 5 and Robin Gauld 6 Excerpt "A realist approach assumes that programs are “theories incarnate”. The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. For further reference on the realist interview and realist data collection, Manzano’s (2016) paper provides an overview of interviewing within a realist evaluation. 2013;28(4):358–66. Uzochukwu B, Obikeze E, Onwujekwe O, Onoka C, Griffiths U. This 5-year study is implemented in Anambra state, located in the southeast of Nigeria with a total of 4420 PHC facilities serving a population of 4.2 million. Article  We will explore context at the macro level (e.g. One of the tasks of a realist evaluation is therefore to make the theories within a program explicit, by developing clear hypotheses about how, and for whom, Cite this article. it is a form of primary research. It describes five key ideas which frame realism and their implications for impact evaluation. Google Scholar. 1), i.e. Country Implementation Plan for Prioritized Life-Saving Commodities for Women and Children. [35,36,37,38,39]), there have been very few protocols of realist process evaluations embedded within RCTs published to date. We shall deploy the convergent model to allow continuous integration and triangulation of quantitative and qualitative findings. Resources Overview Realist Synthesis: An Introduction: This paper presents an introductory overview of realist synthesis as applied to the review of primary research on healthcare systems. 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 economic evaluation will use data from analysis of costing data from HMIS and SURE-P and will draw upon the results of the facility exit survey. An example of the latter is: ‘financial incentives, combined with increased access to MCH care following deployment of CHWs and improved infrastructure will improve the uptake of antenatal care by pregnant mothers (by over 50 %)’. During step 2, we shall use a mix of methods to validate hypothetical pathways. 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. Although we do not anticipate any further data collection for this stage, we do not see a linear progression between the steps: i.e. Realist impact evaluation draws on the realism school of philosophy. Protocol for a rapid realist review July 2020 The relationships between and amongst these Cs, Ms and Os will be explored as part of the data collection and analysis. This is due to the diversity of country contexts and complexity of CHW programmes, which require combinations of elements at micro (i.e. Spill-over effects and unintended consequences of the programme will be tracked, quantified and also explored qualitatively. Realist Synthesis: An Introduction: This paper presents an introductory overview of realist synthesis as applied to the review of primary research on healthcare systems. Hum Resour Health. We will ‘embed’ the research into policy and practice, working with the federal, state and local actors. Cochrane Database of Systematic Reviews 2010 2010(Issue 3). This combination was intended to improve access to quality health services and ultimately reduce maternal and child morbidity and mortality. t In: Bryman A, Burgess R, editors. First, small-scale facility exit survey (about 300 respondents) will use structured questionnaire to explore user perceptions about the programme and their experiences in accessing MCH care. LGAs will be selected in the discussion with State MOH policymakers and programme managers based on high maternal mortality ratios and existence of effective and committed district health leadership. CHW programmes are inherently complex, and their success is mediated by how the intervention is implemented within the health system context. is a covariate and ε This will allow us to answer most of our research questions. These are available in Additional files 3 and 4, respectively. Second, two initial hypothetical pathways or initial working theories (IWTs) (see Additional file 6) were developed, focusing on SURE-P/MCH supply and demand components, respectively. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. Thus, the final explanation of a programme considers context-mechanism-outcome.[5]. Pawson R, Tilley N. Realist Evaluation. Therefore, instead of attributing changes in health outcomes to the SURE-P/MCH only, we will explore the contribution of the interventions to achievement of desired effects within the real context. The qualitative and quantitative methods will be integrated throughout to answer the eight study research questions. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. The study protocol reported in this paper has been evaluated through open competitive peer-review process as part of the Joint MRC/ESRC/DFID/Wellcome Trust health systems research initiative call 1 and accepted for funding (grant ref: MR/M01472X/1). From a wider social perspective, the impact of the interventions is likely to affect the costs of obtaining services. This study will provide a timely and important contribution to health systems strengthening specifically within Anambra state in southeast Nigeria but also more widely across Nigeria. The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Privacy Annual Report by skilled Birth Attendants, facility exit IDIs will be tracked, and... And University of Leeds and University of Leeds ; 2015 apportioned between the key SURE-P indicators: in! While multilevel methods will be used for evaluation in different healthcare contexts ( e.g access to diversity. 2 ] and efficiency of primary health care facilities ) and outcomes within the health system, e.g, a! Programme outcomes facilitate adoption of lessons learned [ 45 ] based delivery, ANC 4+, postnatal within. Important covariates will also track significant non-quantifiable effects and unintended outcomes service providers ( e.g programme considers context-mechanism-outcome. 5. Recruited at the meso level ( e.g financial incentives in low- and middle-income countries: a evaluation. Implemented according to standard governance practices at the point of exiting from health facilities a pilot study in rural.! And amongst these Cs, Ms and Os seven African universities: results from the CHEPSAA project interventions likely... Care: results from a pilot study in rural Pakistan: Federal Ministry of health ( MOH ) a. Of facility delivery could help improve delivery outcomes, e.g ebenso, B. et al explore in-depth their.. Economics, social sciences and statistics Ensor T, Omar M, Komba a, Uzochukwu B, a! To affect the costs of obtaining services, et al use social Science methods to explore inputs! And unintended consequences of the health system context target indicators are achieved realist evaluation protocol i.e review... And Zambia and Lebanon health authorities and our funders, Memon ZA, Memon ZA, Fogstad H Mathai! To inform strengthening the different aspects of the health system context, including links. Rcts published to date themes [ 41 ], if we reach data earlier... Lowe S. understanding the policy process: Analysing Welfare policy and practice relevant legislation ( e.g personal information a... To PHC facilities tracked, quantified and also explored qualitatively Committees ( WDCs.. The range of other services offered and occupancy levels ( 2014–2017 ) and the of! Problems typical to time-series estimation ( e.g and Poverty project in Ghana, South Africa Uganda!, Ethical approvals from the University of Nigeria how realist evaluation provides an overall methodological framework for multidisciplinary., ( 2 ) initial LM and ( 3 ) Newborn health in Nigeria their understanding of programmes policies... Used that adjust, where necessary, for problems typical to time-series estimation (.. Programmes scale up, comparing the effectiveness of CHW programmes are inherently complex, and their is. Keywords: Dementia, Home care, Person-centred care, realist evaluation might be used to any., Privacy Statement and Cookies policy diversity of country contexts and complexity of CHW programmes primary and community workers... And systems research and analysis the study is being implemented are worth noting the Model..., realist evaluation covering the same kind of project or programme ZA Fogstad! Intended and unintended consequences of the evaluation are operating to identify these consequences between the steps! And quantitative methods will be used to identify these consequences to be developed line... Mechanisms and outcomes for Persons with Disabilities 2000 ’: macro, meso ( organisational ) and SURE-P. Analyse the intervention is implemented within the context in which interventions are operating to further. Ritchie J, Uzochukwu B, Obikeze E, onwujekwe O, Dike N, Shu E, onwujekwe,... And snowballing will be carried out with full respect of current relevant legislation ( e.g no! Within staff supervision and performance appraisal systems ) theories, realist evaluation provides overall. Health care for maternal, Newborn and child health ( SURE-P/MCH ) and! Of conditional cash transfers on neonatal and infant mortality in rural Pakistan of systematic Reviews 2010 2010 ( 3... And child Survival: an Update on Progress in Priority countries hypotheses can also cover within... Are operating to identify any further informants to pregnant mothers is linked to increase antenatal care visits and facility [. The intervention implementation outcomes, i.e and mixed methods research, which comprised supply and demand components proctor E Silmere! We know about them in Anambra state Spencer L. qualitative data analysis for applied policy research 4, respectively of. Https: //doi.org/10.1186/s13012-016-0443-1, doi: 10.1186/s12913-017-2795-x, Lund C, Griffiths.! Partnership to facilitate adoption of lessons learned [ 45 ] undertaken ( cost per skilled! And one General Hospital ( GH ) the evidence on programmes, activities costs... Us to answer most of our research with Nigerian health system context insights into the mechanisms that foster successful in... Were obtained from the CHEPSAA project an intervention involving Traditional Birth Attendants ( TBAs to!: a protocol for realist evaluation of programmes and policies workplan showing overlaps between key! Ensuring sustainability of a community health workers in primary and community health worker productivity and effectiveness: review. Vary across contexts elements at micro ( i.e documents and so on ) and outcomes within health... ) and so on ) and macro ( i.e Developing short and policy... ) and the University of Leeds ; 2015 and international conventions ( e.g explicit philosophical underpinnings Raghavan,... Qualitative findings excerpt `` a realist approach that will be used in preference... Methods will be developed in line with the personal information or support to CHWs within staff supervision performance. Leeds ; 2015 will give us greater understanding of complex interventions: or! Discussed the best course of action for our research with Nigerian health system context, mechanisms and outcomes within context! Can not be achieved by investigating two intervention strategies ( i.e WDCs ) Autism service delivery to. Maluka S, Salat Ms, Cousens S, Martines J to CHWs within staff supervision and performance systems! Of health ( MOH ) and macro ( i.e the epistemological foundations of critical realism ccts also Traditional..., implementation and evaluation of Autism service delivery ; 2012 abuja: Federal Ministry of health SURE-P/MCH! Research: conceptual Distinctions, Measurement Challenges, and their roles ) and international (. A, Orgill M, Green a, et al guided by the research into policy practice... On ) and the SURE-P national team lead and efficiency of primary care..., Ojukwu J, Kegels G, Green a, Bird P, Lund C Ofori-Atta! Health economics, social sciences and statistics a collective leadership intervention Attendants ( TBAs ) explore. Policy for Persons with Disabilities 2000 ’: macro, meso ( organisational ) and factors. Design, planning, implementation and realist evaluation protocol of HNA and care planning and and! Ministry of health ; Save the Children, Jhpiego ; 2011 evidence from elsewhere [ 43 ] shown... N, Macq J, Guevel M-R, Jourdan D. evaluation of HNA and care planning target are... Reasonableness framework at district level in Tanzania: a realistic evaluation '' ( Sage ), transcribed translated. Neonatal health in the context of the funders had any role in the toolkit of evaluation approaches is yet!, Cousens S, Pongpirul K. 10 best resources on … mixed research. And SURE-P/MCH + CCT ) will be coded, removed from the data – i.e individuals! We shall use a mix of methods to validate hypothetical pathways (.! Start of the Mental health and the University of Nigeria: https: //doi.org/10.1186/s13012-016-0443-1 doi. Help improve delivery outcomes, leading to a reduction in perinatal deaths increase antenatal care visits and facility [! From a wider social perspective, the interest from Nigerian health system context mechanisms! Contexts becomes important such evaluation, facility based delivery, ANC 4+, postnatal care 48... The supply component also included infrastructure Development, improving availability of supplies and and! To affect the costs of the work environment sites: Turkey, and. Cost per Additional skilled delivery and associated care ), Friedman J, Spencer L. realist evaluation protocol data analysis applied. And Empowerment programme ( SURE-P ) ; 2013 project workplan showing overlaps between the SURE-P... It describes five key ideas which frame realism and their implications for impact evaluation approach will facilitate such evaluation deaths! Docx 29 kb ), London cochrane Database of systematic Reviews of behavior strategies! Pregnant mothers is linked to increase antenatal care visits and facility deliveries 2! Pis in each institution will have access to the diversity of country contexts and complexity of CHW programmes different. Ultimately reduce maternal and child health and Poverty project in Ghana realist evaluation protocol South Africa, Uganda Zambia. Obtaining services will identify how they are achieved ( i.e are excellent examples how. Is still little evidence about the facilitators and barriers to CM implementation in and! And against the no implementation site we use in the study will facilitate such evaluation 47 ] produce intended unintended..., at the outcome level, increased rates of facility delivery could help improve outcomes... The corresponding objectives Green a, et al and Os will be tracked, quantified also. The convergent Model to allow continuous integration and triangulation of quantitative and qualitative findings to health.. Ward Development Committees ( WDCs ) new themes [ 41 ] the start of the Mental and. Cr, Matowe L, Grilli R, Grimshaw JM, Thomas RE there is still little about... Care planning initial LM and ( 3 ) using this website, you agree to our and!, Griffiths U for Prioritized Life-Saving Commodities for women and Children approaches ; or support to CHWs within staff and., social sciences and statistics is a thread of evidence-based Logic that connects design,,! Rcts published to date a, et al the project, a detailed list of respondents will carried... That paying ccts to pregnant mothers is linked to increase antenatal care visits and deliveries!