(DOCX 29 kb), Ethics approval from the University of Leeds. Excerpt "A realist approach assumes that programs are “theories incarnate”. Specific emphasis will be placed on confidentiality and other data protection issues, which will include security of data storage and access rights to data. The The project uses an input-process-output-outcome continuum (see Fig. is an error term. We will ‘embed’ the research into policy and practice, working with the federal, state and local actors. https://doi.org/10.1186/s13012-016-0443-1, DOI: https://doi.org/10.1186/s13012-016-0443-1. Jokhio AH, Winter HR, Cheng KK. Article  2nd ed. 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. Two supplementary materials are included from this handbook. The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Only designated research staff will have access to the keys linking the data with the personal information. Cost effectiveness analysis of strategies for maternal and neonatal health in developing countries. Lehmann U, Gilson L. Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes. 2012;10(1):38. Second, facility exit IDIs will be conducted with 20–25 purposefully identified users to explore in-depth their views. Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation. It is important to stress that realist evaluation cannot be achieved simply by following a protocol in a technically correct manner. organisations and their roles) and micro level (e.g. PubMed Central  The making of Jamaica’s ‘National Policy for Persons with Disabilities 2000’: macro, meso and micro factors. The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. 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]. 2008;6(1):20. Realist impact evaluation draws on the realism school of philosophy. London: Sage Publications Limited; 1997. Implement Sci. Geneva: WHO; 2007. It is based on the epistemological foundations of critical realism.Based on specific theories, realist evaluation provides an alternative lens to empiricist evaluation techniques for the study and understanding of programmes and policies. 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’. Meeting the aims through realist evaluation. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. 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. Prashanth NS, Marchal B, Hoeree T, Devadasan N, Macq J, Kegels G, Criel B. The specific objectives of the study are to: Develop an in-depth understanding of the context and the process of implementation of the interventions, including relationships between health workforce and infrastructure and supplies, Identify, assess and compare the intervention outputs (e.g. Leeds, U.K: COMDIS-Health Service Delivery; 2012. 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. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. The realist evaluation approach is a relatively new approach to evaluation, especially in some fields (such as health services research). NPHCDA. This paper describes our longitudinal, mixed methods realist evaluation of HNA and care planning. There are few published examples of realist synthesis. Research-policy partnerships - experiences of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. This includes ensuring regular communication between the partners and engagement with policymakers and practitioners; quality assurance through regular peer-review within and between the teams; appropriate mentoring and coaching support to more junior researchers and equal opportunities to both genders. Only members of teams identified by the PIs in each institution will have access to the data. Ethics approvals for this study were obtained from the University of Leeds and the University of Nigeria. 2005;352(20):2091–9. In realist evaluation the researcher or evaluator’s task is to gather the data – i.e. Adequate communication of results is an essential component of this study. Informed consent will be obtained from all study participants, and in the case of refusal, alternative means of data collection will be explored (e.g. Design: A multimethod study design was undertaken using realist evaluation methodology. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 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]. 1, the mixed methods approach will enable us to also analyse the intervention implementation outcomes, e.g. t Countdown to 2015. Although we do not anticipate any further data collection for this stage, we do not see a linear progression between the steps: i.e. 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. First, the initial Logic Model (LM) (see Additional file 5) was developed for the SURE-P/MCH. Ozawa S, Pongpirul K. 10 best resources on … mixed methods research in health systems. acceptability of the intervention by the communities and front-line service providers, appropriateness of the intervention design to the current context of PHC facilities in Anambra state and sustainability of changes achieved from the implementation of interventions in the longer term [37]. 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. Evaluation. financial incentives to pregnant women to register at a Primary Health Care (PHC) centre, receive health check-ups while pregnant, deliver at a health facility and take their baby for vaccinations. 2011;26 suppl 2:ii84–91. I Ramsay CR, Matowe L, Grilli R, Grimshaw JM, Thomas RE. This realist evaluation protocol will contribute to this knowledge in Zambia where there is increased attention towards promoting maternal, neonatal and child health as a means of addressing the current high early pregnancy and marriage rates. 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. The parameter β0 represents the baseline level of the dependent variable; β1 represents the baseline trend in the dependent variable; β2 isolates any shift in the level (intercept) of the dependent variable following the introduction of the policy; β3 isolates any shift in the rate of change (slope) following the introduction of the policy and β4 represents the effect of a covariate. As with all primary research approaches, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency. Stame N. Theory-Based Evaluation and Types of Complexity. 2nd ed. Frehywot S, Mullan F, Payne P, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Hudson J, Lowe S. Understanding the Policy Process: Analysing Welfare Policy and Practice. All personal data will be coded, removed from the data for analysis and stored separately. 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 … 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. Maluka S, Kamuzora P, SanSebastian M, Byskov J, Ndawi B, Olsen O, et al. The study results will also inform strengthening the different aspects of the Nigerian health system, e.g. Realist impact evaluation draws on the realism school of philosophy. studies, policy documents and so on) and so it is a form of secondary research. California Privacy Statement, The study is guided by the research questions shown in Table 1, alongside the corresponding objectives. However, the interest from Nigerian health officials in learning lessons for improving MCH outcomes remained high. Results: A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. 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. J Dev Econ. 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. The study will draw upon health economics, social sciences and statistics. One SURE-P component focused on maternal and child health (SURE-P/MCH), which comprised supply and demand components. skilled midwives) and 10,000 CHWs, comprising 1000 Community Health Extension Workers (CHEWs) and 9000 volunteer Village Health Workers (VHWs). Pawson R, Tilley N. Realist Evaluation. During the data collection and analysis stages, the case studies are used to refine or further generate CMOCs ( Marchal, Van Belle, van Olmen, Hoeree, & Kegels, 2012 ). Specific methods for data collection will include in-depth interviews and focus group discussions with purposefully identified key stakeholders (managers, service providers and service users), document reviews, analyses of quantitative data from the CHW programme and health information system, and a small-scale survey. 2009;8(1):265. These service user views, together with qualitative IDIs, will inform the economic evaluation to understand the costs and cost-effectiveness of the programme and the contextual influences on the drivers of costs and benefits. 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. 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, Uzochukwu B, Obikeze E, Onwujekwe O, Onoka C, Griffiths U. Economic evaluation will be used to identify the programme costs against the outcomes [32, 33], using an incremental approach to compare intervention costs with benefits, compared with standard practice [16, 34]. The study comprises three steps: (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. Evidence suggests that the use of CHWs can be effective in broadening access to, and coverage of, health services and improving MCH outcomes [4–6]. 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, Bull World Health Organ. with and without CCTs) of a Nigerian CHW programme to understand what contextual factors promote equitable access to quality services and examining the conditions under which these changes can be sustained following withdrawal of funding. This is the key question posed by realist evaluators. t These costs will be captured through a small facility exit survey of women who have used services both before and after implementation of the SURE-P/MCH to understand how user costs have changed over time. 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. Specific methods of communicating research will include combinations of: Developing short and practical policy briefs to national and international policymakers and practitioners. How does capacity building of health managers work? PubMed  These are available in Additional files 3 and 4, respectively. [35,36,37,38,39]), there have been very few protocols of realist process evaluations embedded within RCTs published to date. The IWTs subsequently guided the identification of the specific information areas for the data collection and analysis. Health Policy Plan. A cluster is made up of four PHC facilities and one General Hospital (GH). Mirzoev T, Omar M, Green A, Bird P, Lund C, Ofori-Atta A, et al. These are available in Additional files 3 and 4, respectively. it is a form of primary research. Abuja: Federal Ministry of Health; Save the Children, Jhpiego; 2011. A detailed list of respondents will be developed within step 1, and snowballing will be used to identify any further informants. London: Medical Research Council; 2008. individual), meso (organisational) and macro (i.e. t The study methodology will include three steps (Fig. This means, among other things, describing theories in terms of context -mechanism outcome (CMO) … All authors read and approved the final version of the manuscript. We will also track significant non-quantifiable effects and will include estimates in the incremental cost-effectiveness analysis. The aim of this study is to inform strengthening, scaling up and ensuring sustainability of CHW programmes. 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. This is due to the diversity of country contexts and complexity of CHW programmes, which require combinations of elements at micro (i.e. 2007;101(2):95–105. We will select three study clusters, corresponding to Local Government Areas (LGAs): one with SURE-P/MCH, one with SURE-P/MCH + CCT and one with no intervention. Mirzoev, T., Etiaba, E., Ebenso, B. et al. 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.

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