Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa
Abstract Background One of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In South Africa, the flagship National Department of Health MomConnect program was launched in 2014 to strengthen the quality of maternal and...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Medical Research Methodology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12874-020-01164-y |
| _version_ | 1818716079842656256 |
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| author | Eveline M Kabongo Ferdinand C. Mukumbang Peter Delobelle Edward Nicol |
| author_facet | Eveline M Kabongo Ferdinand C. Mukumbang Peter Delobelle Edward Nicol |
| author_sort | Eveline M Kabongo |
| collection | DOAJ |
| description | Abstract Background One of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In South Africa, the flagship National Department of Health MomConnect program was launched in 2014 to strengthen the quality of maternal and child health (MCH) services and improve mortality outcomes. MomConnect was rapidly rolled out with a limited understanding of how and why the program was expected to work even though studies had shown the effectiveness of the MomConnect program in improving the uptake of MCH services. This study aimed to unearth the initial program theory of the MomConnect program based on explicit and implicit assumptions of how the program was organized and expected to work. Methods We conducted a document analysis using design- and implementation-related documents of the MomConnect program guided by the principles of Theory of Change (ToC) and Realist Evaluation (RE). Content and thematic analysis approaches were deductively applied to analyze the documents toward constructing ToC and RE-informed models. Abductive thinking and retroduction were further applied to the realist-informed approach to link program context, mechanisms, and outcomes to construct the initial program theory. Results ToC and RE-informed models illustrated how the MomConnect program was organized and expected to work. The process of constructing the ToC provided the platform for the development of the initial program theory, which identified three critical elements: (1) the central modalities of the MomConnect program; (2) the intended outcomes; and (3) the tentative causal links indicating, in a stepwise manner of, how the outcomes were intended to be achieved. The RE approach ‘enhanced’ the causal links by identifying relevant programmatic contexts and linking the postulated mechanisms of action (empowerment, encouragement, motivation, and knowledge acquisition) to program outcomes. Conclusion The application of ToC and RE provided an explicitly cumulative approach to knowledge generation in unveiling the initial program theory of MomConnect rather than delivering answers to questions of program effectiveness. |
| first_indexed | 2024-12-17T19:13:34Z |
| format | Article |
| id | doaj.art-c1f2d5dbbfde4ebfaaae972f9eef94ae |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-12-17T19:13:34Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-c1f2d5dbbfde4ebfaaae972f9eef94ae2022-12-21T21:35:49ZengBMCBMC Medical Research Methodology1471-22882020-11-0120111110.1186/s12874-020-01164-yCombining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South AfricaEveline M Kabongo0Ferdinand C. Mukumbang1Peter Delobelle2Edward Nicol3Division of Health Systems and Public Health, Stellenbosch UniversitySouth African Medical Research CouncilSchool of Public Health, University of the Western CapeDivision of Health Systems and Public Health, Stellenbosch UniversityAbstract Background One of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In South Africa, the flagship National Department of Health MomConnect program was launched in 2014 to strengthen the quality of maternal and child health (MCH) services and improve mortality outcomes. MomConnect was rapidly rolled out with a limited understanding of how and why the program was expected to work even though studies had shown the effectiveness of the MomConnect program in improving the uptake of MCH services. This study aimed to unearth the initial program theory of the MomConnect program based on explicit and implicit assumptions of how the program was organized and expected to work. Methods We conducted a document analysis using design- and implementation-related documents of the MomConnect program guided by the principles of Theory of Change (ToC) and Realist Evaluation (RE). Content and thematic analysis approaches were deductively applied to analyze the documents toward constructing ToC and RE-informed models. Abductive thinking and retroduction were further applied to the realist-informed approach to link program context, mechanisms, and outcomes to construct the initial program theory. Results ToC and RE-informed models illustrated how the MomConnect program was organized and expected to work. The process of constructing the ToC provided the platform for the development of the initial program theory, which identified three critical elements: (1) the central modalities of the MomConnect program; (2) the intended outcomes; and (3) the tentative causal links indicating, in a stepwise manner of, how the outcomes were intended to be achieved. The RE approach ‘enhanced’ the causal links by identifying relevant programmatic contexts and linking the postulated mechanisms of action (empowerment, encouragement, motivation, and knowledge acquisition) to program outcomes. Conclusion The application of ToC and RE provided an explicitly cumulative approach to knowledge generation in unveiling the initial program theory of MomConnect rather than delivering answers to questions of program effectiveness.http://link.springer.com/article/10.1186/s12874-020-01164-ymHealthMomConnectTheory of changeRealist evaluationMaternal and child health |
| spellingShingle | Eveline M Kabongo Ferdinand C. Mukumbang Peter Delobelle Edward Nicol Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa BMC Medical Research Methodology mHealth MomConnect Theory of change Realist evaluation Maternal and child health |
| title | Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa |
| title_full | Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa |
| title_fullStr | Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa |
| title_full_unstemmed | Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa |
| title_short | Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa |
| title_sort | combining the theory of change and realist evaluation approaches to elicit an initial program theory of the momconnect program in south africa |
| topic | mHealth MomConnect Theory of change Realist evaluation Maternal and child health |
| url | http://link.springer.com/article/10.1186/s12874-020-01164-y |
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