Developing shared understanding of pre-eclampsia in Haiti and Zimbabwe using Theory of Change

Abstract

Pre-eclampsia, a complex and multi-system disorder specific to pregnancy, is a leading cause of preventable maternal and perinatal deaths in low-resource settings. Early detection and appropriate intervention with management of hypertension, prevention of eclampsia and timely delivery are effective at reducing mortality and morbidity. Outcomes can be greatly improved with the provision and uptake of good quality care. Cultural contexts of maternal care, social practices and expectations around pregnancy and childbirth profoundly shape understanding and prioritisation when it comes to seeking out care. Few studies have addressed health education specifically targeting pre-eclampsia in low resource settings. The existing literature has limited descriptions of contextual barriers to care or of the intervention development processes employed. More engaging, holistic approaches to pre-eclampsia education for women and families that recognise the challenges they face and that support a shared understanding of the disorder, are needed. We describe our experience of developing a Theory of Change (ToC) as part of the co-production of educational resources for pre-eclampsia in Haiti and Zimbabwe.

Conducting co-creation for public health in low and middle-income countries: a systematic review and key informant perspectives on implementation barriers and facilitators

“… HIV patients, healthcare workers, clinical and evaluation team To design a text-based system of tailored reminders and messages. Robbins et al [ 34 ] 2022 Haiti and Zimbabwe Pre-eclampsia High maternal mortality ratios in Haiti and Zimbabwe. Community members, health professionals, representatives from non-governmental organizations (NGOs) and representatives from the ministries of health To develop culturally relevant, context-specific educational resources through interdisciplinary collaboration and community engagement.…”

“…Most interventions were designed directly in the LMIC setting [ 32 , 34 , 36 – 38 , 40 – 43 , 45 – 47 , 50 , 53 , 54 ], while two interventions were initially designed and implemented in another LMIC and then transferred and adapted to the study’s LMIC setting [ 35 , 48 ], one transition occurring within the same continent, moving from Ghana and Nigeria to Uganda [ 35 ], while the other involving a transfer from Vietnam and Kyrgyzstan to Uganda [ 48 ]. Three interventions were initially designed in a HIC setting and transferred and adapted to an LMIC setting [ 33 , 44 , 51 ].…”

“…Several authors have been engaging with representatives of the people living in socio-economically vulnerable circumstances to conduct needs and contextual assessment before the intervention’s design [ 34 , 35 , 38 , 45 , 47 , 53 , 55 ] while some have also involved representatives from the target population also when co-designing the intervention [ 34 , 36 , 38 , 41 – 43 , 49 , 50 , 52 , 53 ].…”

“…Systemic conditions related to the participants’ context, such as the individual’s socioeconomic status, including factors related to household composition, parental education and difficulty to absent from work for participation in the sessions, are mentioned, by several authors, as an important influential condition which must be taken into account when developing and implementing co-creation [ 32 , 37 , 44 , 50 – 52 ]. Several studies [ 34 , 35 , 38 , 45 , 47 , 53 , 55 ], in fact, recommend conducting a needs assessment and investigating contextual factors influencing the context and issue, as described in the ‘Needs assessment’ paragraph in the implementation facilitators section of this manuscript.…”

“…The impact of existing entrenched power dynamics and social hierarchies within the settings and between stakeholders has been said to influence the project dynamics [ 34 , 46 ]. Some authors experienced difficulties gaining policymakers’ support [ 47 , 50 ] or top administrators’ buy-in [ 45 ].…”