How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol

Abstract

IntroductionThe proposed research is part of ongoing operations research within World Vision's Access: Infant and Maternal Health Programme. This study aims to identify key context features and underlying mechanisms through which community health committees build community capacity within the field of maternal and child health. This may help to improve programme implementation by providing contextually informed and explanatory findings forhowcommunity health committees work,whatworks best and forwhomdo they work for best for. Though frequently used within health programmes, little research is carried out on such committees’ contribution to capacity building—a frequent goal or proposed outcome of these groups.Methods and analysisThe scarce information that does exist often fails to explain ‘how, why, and for whom’ these committees work best. Since such groups typically operate within or as components of complex health interventions, they require a systems thinking approach and design, and thus so too does their evaluation. Using a mixed methods realist evaluation with intraprogramme case studies, this protocol details a proposed study on community health committees in rural Tanzania and Uganda to better understand underlying mechanisms through which these groups work (or do not) to build community capacity for maternal and child health. This research protocol follows the realist evaluation methodology of eliciting initial programme theories, to inform the field study design, which are detailed within. Thus far, the methodology of a realist evaluation has been well suited to the study of community health committees within these contexts. Implications for its use within these contexts are discussed within.Ethics and disseminationInstitutional Review Boards and the appropriate research clearance bodies within Ireland, Uganda and Tanzania have approved this study. Planned dissemination activities include via academic and programme channels, as well as feedback to the communities in which this work occurs.

Transdisciplinary research for impact: protocol for a realist evaluation of the relationship between transdisciplinary research collaboration and knowledge translation

“…21 To achieve this, we will analyse qualitative data from interview and document sources, following a coding framework of intervention description, observed outcomes, context conditions and underlying mechanisms. 17 Observational data will be coded according to a framework informed by Spradley’s 20 dimensions. This coding will be conducted with continual reference to potential CMO configurations that either support or refute the working hypothesis.…”

“… 15 16 Data collection is pragmatic and method-neutral—selection of data sources and methods is guided by what is needed to test the working hypothesis. 17 …”

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset

“…Realist evaluations can include qualitative and quantitative data collection and analysis, but may be purely quantitative or qualitative [ 27 ]. In reality most realist evaluations in health are qualitative in nature and any quantitative analysis focuses on outcomes, tending to either be descriptive or use hypothesis testing to assess statistical significance before and after intervention implementation [ 28 ]. Few use more advanced statistical modelling techniques, such as interrupted time series or regression [ 29 , 30 ].…”

Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher

“…Realist evaluations are increasingly being employed within low- and middle-income countries by academics, non-governmental organisations (NGOs) and other programme implementers as evidenced by the rapid growth of the number of published realist evaluations from these countries 17–25. There remains, however, little precedent for its use within these countries.…”