Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

Kabongo, Eveline Muika; Mukumbang, Ferdinand C.; Delobelle, Peter; Nicol, Edward

doi:10.1186/s12874-020-01164-y

Cited by 16 publications

(29 citation statements)

References 42 publications

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“…Moreover, our model is supported by a systematic review by Aker et al that found that users’ perceived platform quality, perceived satisfaction of care, perceived quality interaction and outcomes, influence users’ uptake of mHealth for health care [ 69 ]. Our findings are supported by a realist-informed document review that identified empowerment, perceived quality of MCH care, encouragement, motivation, and knowledge acquisition as the main mechanisms driving the implementation and uptake of MCH care through the MomConnect program [ 70 ].…”

Section: Discussionsupporting

confidence: 64%

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

Kabongo

Mukumbang

Delobelle

et al. 2021

BMC Pregnancy Childbirth

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Background Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers. Method We undertook a realist synthesis. An electronic search of five online databases (PubMed/Medline, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories. Results We formulated two configurational models illustrating how and why mHealth impacts implementation and uptake of maternal and child health care. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation and perceived ease of use and usefulness. These mechanisms are influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms are influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity and awareness. Conclusion Models developed in this study provide a detailed understanding of implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required.

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Section: Discussionsupporting

confidence: 64%

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

Kabongo

Mukumbang

Delobelle

et al. 2021

BMC Pregnancy Childbirth

Self Cite

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“…They identi ed other dimensions, such as system reliability, privacy, availability, adaptability, e ciency, assurance, responsiveness, functional and emotional bene ts to in uence the uptake of mHealth interventions. Our ndings are supported by a realist-informed document review that identi ed empowerment, perceived quality of MCH care, encouragement, motivation, and knowledge acquisition as the main mechanisms driving the implementation and uptake of MCH care through the MomConnect programme [68].…”

Section: Discussionmentioning

confidence: 52%

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A realist synthesis

Kabongo

Mukumbang

Delobelle

et al. 2020

Preprint

Self Cite

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Background: Despite the growing global application of mobile health (mHealth) technology in maternal and child health, contextual factors, and mechanisms by which interventional outcomes are generated, have not been subjected to a systematic examination. In this study, we sought to uncover context, mechanisms, and outcome elements of various mHealth interventions based on implementation and evaluation studies to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and mothers.Method: We undertook a realist synthesis. An electronic search of six online databases (Medline, PubMed, Google Scholar, Scopus, Academic Search Premier, and Health Systems Evidence) was performed. Using appropriate Boolean phrases terms and selection procedures, 32 articles were identified. A theory-driven approach, narrative synthesis, was applied to synthesize the data. Thematic content analysis was used to delineate elements of the intervention, including its context, actors, mechanisms, and outcomes. Abduction and retroduction were applied using a realist evaluation heuristic tool to formulate generative theories.Results: We formulated two configurational models illustrating how and why mHealth impacts the implementation and uptake of maternal and child care services. Implementation-related mechanisms include buy-in from health care providers, perceived support of health care providers’ motivation, and perceived ease of use and usefulness. These mechanisms were influenced by adaptive health system conditions including organization, resource availability, policy implementation dynamics, experience with technology, network infrastructure, and connectivity. For pregnant women and mothers, mechanisms that trigger mHealth use and consequently uptake of maternal and child health care include perceived satisfaction, motivation, and positive psychological support. Information overload was identified as a potential negative mechanism impacting the uptake of maternal and child health care. These mechanisms were influenced by health system conditions, socio-cultural characteristics, socio-economic and demographics characteristics, network infrastructure and connectivity, and awareness.Conclusion: Models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how and why they impact maternal and child health care in low- and middle-income countries. These models provide a foundation for the ‘white box’ of theory-driven evaluation of mHealth interventions and can improve rollout and implementation where required.

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“…Theory of change approaches and realist evaluation are increasingly used in research and evaluation of health services and medical education because they rely on theory to drive the evaluation of complex interventions 16–19 . Stemming from different ontologies, these two approaches provide steps to consider context in the implementation and evaluation of complex interventions.…”

Section: Methodsmentioning

confidence: 99%

“…Stemming from different ontologies, these two approaches provide steps to consider context in the implementation and evaluation of complex interventions. Theory of change evaluations tend to focus on the how change occurs during implementation of a complex intervention (implementation theory) while realist evaluations are interested in the why (programme theory) 18–20 . A combined theory of change/realist evaluation approach can produce a more nuanced output by integrating the respective methods sequentially 20,21 .…”

Section: Methodsmentioning

confidence: 99%

A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting

Wood

Attema

Ross

et al. 2022

Health Planning & Management

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Health care and academic institutions are increasingly committing to social accountability, a strategic shift that requires priorities, activities, and evaluations to be co‐determined with all relevant partners. Consequently, governments, accreditors, funders, and communities are calling for these institutions to communicate their progress towards social accountability. The purpose of this study was to develop a conceptual framework around a socially accountable learning health system. This article presents an integrated analysis of two studies: (i) a narrative review of 11 prominent social accountability and health services conceptual frameworks and (ii) a reflexive thematic analysis of 18 key informant interviews. Using a systematic conceptual framework development and integrated theory of change/realist evaluation methodologies, we describe a synthesis of these findings to develop a conceptual framework for describing and evaluating socially accountable health professional education. The resulting framework describes assessment phases of social accountability, transitions between phases, learning cycles, and the actors and systems that collectively mobilise social accountability at multiple levels in health and education systems. The framework can be used to evaluate interventions or characterise progress towards social accountability in different settings, as illustrated in the example at the end of the paper. The framework emphasises the significance of designing, mobilising, and evaluating social accountability as part of a contextualised learning health system.

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Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

Cited by 16 publications

References 42 publications

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis

Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A realist synthesis

A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting

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