scholarly journals Unpacking the black box of the effectiveness of task forces in maternal and neonatal health in Morocco : A realist evaluation protocol 

2021 ◽  
Author(s):  
Zakaria Belrhiti ◽  
Rachid Moulki ◽  
Safwane Mowafaq ◽  
Hassan Chrifi ◽  
Bouchra Assarag
Keyword(s):  
Health Systems ◽  
Local Community ◽  
Governance Structure ◽  
Realist Evaluation ◽  
Regional Governance ◽  
Neonatal Health ◽  
Local Health ◽  
Programme Theory ◽  
Task Forces ◽  
Maternal And Neonatal Health

Abstract Background In low and middle incomes countries (LMICs), health policies failed to reduce significantly maternal and neonatal mortality rates. This was attributed to inequitable access to care and to poor governance of local health systems. In Morocco, there are still regional disparities with access to maternal care, and poor governance of regional maternal and neonatal health programmes (RMNHP). To address these governance issues, the ministry of health implemented in 2017 a multi-actor’s governance structure called “regional task forces”(RTF). They aim at enabling collective concerted actions, active engagement of local community partners and better coordination between health systems managers and frontline workers in the monitoring, assessment and implementation of RMNHP. In this study, we aimed at analysing how regional taskforces were implemented in six heath regions and identify the mechanisms and contextual conditions underlying their effectiveness.Methods We adopted the realist evaluation as a suitable approach to decipher complex intertwined social phenomena. We adopted a multiple embedded case study design that allows a flexible exploration of different levels of analysis and takes into consideration the role of context. First, we developed an initial programme theory based on a literature review and policy document analysis as follows: ”A taskforce is effective whenever there is a fit between its intrinsic technocratic, political, democratic and learning capacities and the characteristics of the institutional context, the complexity of health problems and the engagement and leadership of actors”. Our programme theory will be refined using 10 to 12 individual interviews (IDI) with policy implementers. We will use secondary documents, and 4 to 6 interviews with taskforces members (clinicians, managers, and midwives). We will then carry two in-depth case studies in one low and one high performing taskforce using additional 6 to 12 interviews, 3 focus group discussions with senior managers, clinicians, and midwives. Qualitative data analysis will be informed by Intervention Context Actor Mechanism Outcome (ICAMO) hypothesis coding. We will then compare the different ICAMOs across cases using qualitative comparative analysis . DiscussionThe resulting programme theory will guide the reinforcement of regional governance of MNH programmes in Morocco.

scholarly journals Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045822
Author(s):  
Lynn V Monrouxe ◽  
Peter Hockey ◽  
Priya Khanna ◽  
Christiane Klinner ◽  
Lise Mogensen ◽  
...  
Keyword(s):  
Medical Students ◽  
Success Factors ◽  
Realist Review ◽  
Physician Assistants ◽  
Realist Evaluation ◽  
Health Practitioner ◽  
Local Health ◽  
Medical Council ◽  
Programme Theory ◽  
Quantitative Evidence

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

scholarly journals Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Chama Mulubwa ◽  
Anna-Karin Hurtig ◽  
Joseph Mumba Zulu ◽  
Charles Michelo ◽  
Ingvild Fossgard Sandøy ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Health Systems ◽  
Contextual Factors ◽  
Realist Evaluation ◽  
Health Interventions ◽  
Alternative Theory ◽  
Health Coverage ◽  
Programme Theory ◽  
Community Based ◽  
Sexual Reproductive Health

Abstract Introduction Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights’ needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) ‘ordinary’ community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents. Methods This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. Results We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification’, which was also expected would lead to individuals developing a ‘supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages. Conclusion The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform ‘ordinary’ community-based health systems into systems that are responsive to adolescents.

scholarly journals Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii9-ii21
Author(s):  
Fatuma Manzi ◽  
Tanya Marchant ◽  
Claudia Hanson ◽  
Joanna Schellenberg ◽  
Elibariki Mkumbo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Systems ◽  
Building Blocks ◽  
Realist Evaluation ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Empowerment Theory ◽  
Multiple Sources ◽  
Programme Theory

Abstract Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.

scholarly journals Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden

2021 ◽  
Author(s):  
Frida Jonsson ◽  
Dean B. Carson ◽  
Isabel Goicolea ◽  
Anna-Karin Hurtig
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Rural Areas ◽  
Large Body ◽  
Realist Evaluation ◽  
Evaluation Methodology ◽  
Northern Sweden ◽  
Programme Theory ◽  
Community Health Systems ◽  
Improve Access

Background: Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patient and provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a novel eHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically, this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expected to improve access to person-centred care and strengthen community health systems, especially for elderly residents of rural areas. Methods: The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8 key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematic analysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome (ICAMO) configuration was developed and elicited into an initial programme theory. Results: The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customized facility that connects communities and providers, might improve access to person-centred care and strengthen community health systems for rural populations. This is theorized to occur if mechanisms acting at individual (such as knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered in contexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of rural cohesiveness and creativity. Conclusion: The elicited initial programme theory describes and explains how a novel eHealth initiative in rural northern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continued gradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work as intended, for whom, in what conditions and why.

Medicine between Cultures in the Hellenistic Fayum

2017 ◽  
Author(s):  
Daniel King
Keyword(s):  
Local Community ◽  
Religious Practice ◽  
Local Health ◽  
Medical Culture ◽  
Greek Culture ◽  
The Status ◽  
Local Health Care ◽  
Egyptian Culture ◽  
Medical Documents ◽  
Medical Treatises

This paper looks into the relationship between Greek medicine and Egyptian culture in Tebtynis. Cultural interaction in this context has often been interpreted from a perspective that privileges the status of Greek culture: Hellenistic medical treatises (and other texts) were imported to Tebtynis to ‘improve’ the local community and local health-care. This paper looks at two aspects of Greek medical culture at the site: theoretical Hippokratic treatises and pharmaceutical recipes. These medical documents were associated with the Egyptian community in the village, especially the famous sanctuary of Soknebtynis. Analysis suggests that these documents were part of a medical culture that transcended cultural or ethnic divides; there is, this paper argues, considerable evidence for the co-existence of Greek medicine and Egyptian religious practice and ritual life.

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

scholarly journals Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Jolene Skordis-Worrall ◽  
Noemi Pace ◽  
Ujwala Bapat ◽  
Sushmita Das ◽  
Neena S More ◽  
...  
Keyword(s):  
Health Expenditure ◽  
Cross Sectional Study ◽  
Neonatal Health ◽  
Sectional Study ◽  
Cross Sectional ◽  
Maternal And Neonatal Health

scholarly journals A Coproduction Community Based Approach to Reducing Smoking Prevalence in a Local Community Setting

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
G. J. McGeechan ◽  
D. Woodall ◽  
L. Anderson ◽  
L. Wilson ◽  
G. O’Neill ◽  
...  
Keyword(s):  
Smoking Prevalence ◽  
Local Community ◽  
Community Setting ◽  
Well Being ◽  
Service Development ◽  
Local Health ◽  
Small Community ◽  
Prevalence Survey ◽  
Local Residents ◽  
Health And Well Being

Research highlights that asset-based community development where local residents become equal partners in service development may help promote health and well-being. This paper outlines baseline results of a coproduction evaluation of an asset-based approach to improving health and well-being within a small community through promoting tobacco control. Local residents were recruited and trained as community researchers to deliver a smoking prevalence survey within their local community and became local health champions, promoting health and well-being. The results of the survey will be used to inform health promotion activities within the community. The local smoking prevalence was higher than the regional and national averages. Half of the households surveyed had at least one smoker, and 63.1% of children lived in a smoking household. Nonsmokers reported higher well-being than smokers; however, the differences were not significant. Whilst the community has a high smoking prevalence, more than half of the smokers surveyed would consider quitting. Providing smoking cessation advice in GP surgeries may help reduce smoking prevalence in this community. Work in the area could be done to reduce children’s exposure to smoking in the home.

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