critical realist thematic analysis

Our document analysis was informed by the ToC and RE approaches [24]. A framework illustrating the features of ToC and RE (Dhillon and Vaca [24]). Mobile health messaging service and helpdesk for south African mothers (MomConnect): history, successes, and challenges. PubMed  The study has several limitations as both ToC and RE have their challenges. ToC can be viewed as both a product and process [27]. 0000006998 00000 n S Afr Med J. Procedural recommendations for researchers who may wish to conduct a critical realist thematic analysis were provided, alongside a further methodological innovation which related to the critical realist notion of theoretical generalisability. Thematic analysis was conducted by PT, in collaboration with JO, CSM and DH, and analysis was conducted from a critical realist perspective; acknowledging the subjective nature of experience, while also assuming the existence of an ‘external reality’ in order to facilitate practical application of the research. 0000023862 00000 n WHO U, UNFPA WBG, the United Nations Population Division. Our study identified three main contextual conditions – facility responsiveness to provide care including human resource availability, health system context such as political clout, and mobile connectivity related context – and four causal mechanisms – empowerment and perceived quality of MCH services, encouragements, motivation, and knowledge acquisition. 2016;6:1–11. This assisted in actualizing the next phases of our study, which is the development of a program theory using a scoping review and stakeholders’ interviews. 5). J Obstet Gynecol Neonatal Nurs. Thematic analysis is another qualitative data analytic method which most researchers consider very useful in capturing the intricacies of meaning within a data set (Guest 2012). We also found that the interaction with the health system (service rating and feedback) provided by the MomConnect program is likely to empower users, since they feel that it can improve the quality of services offered at healthcare facilities, thus improving the perceived quality of MCH services and, in turn, the uptake of health services. MAMA SA focused on the prevention of mother-to-child transmission (PMTCT) of HIV and consisted of a multi-channel mHealth approach to communicate healthy pregnancy and newborn child support including mobile phone-based chats and voice messages [16]. 2018;18:47. 2019;25:294–316 Sage Publ. The pregnancy-related stage-based information was envisaged to encourage and empower (M) users through knowledge acquisition to motivate them (M) thus improving their health-seeking behavior (O). Critical realism (CR) is a useful philosophical framework for social science; however, little guidance is available on which precise methods – including methods of data collection, coding, and analysis – are best suited to applied CR research. Craig Sutherland supported the recruitment of participants. J Mob Technol Med. Udjo EO, Lalthapersad-Pillay P. Estimating maternal mortality and causes in South Africa: national and provincial levels. 2016;106:3. 2019;8:1–13. Terms and Conditions, The MomConnect program was specifically adopted to address the peripartum factors perpetuating the high maternal and infant mortality rates in SA [12]. However, there are few examples of such studies, which may discourage nurses from considering it to be a viable option. The empowerment and encouragement derived from MomConnect’s messages allow clients to become motivated toward perinatal health care, which in turn improves the uptake of MCH services. Massyn N, Day C, Peer N, et al. SAML Res. The book outlines critical realism and considers its implications for how we conceptualize meaning and culture, causation, and diversity. 2019;1:e1. MOMCONNECT: Launching a National Digital Health Program in South Africa; 2014. p. 28. Abstract . Using the realist interview approach to maintain theoretical awareness in realist studies. Peter JE, Barron P, Pillay Y. Epistemologically, CR provides principles that can be applied by researchers developing theoretical explanations about phenomena in the world. Critical realism is an integration of realist ontology (there is a real world that exists independently of our perceptions and theories) with an interpretivist epistemology (our understanding of this world is inevitably a construction from our own perspective). Evans WD, Abroms LC, Poropatich R, et al. 0000005531 00000 n 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. A final limitation is that this study only included document reviews and excluded studies such as RCTs and systematic reviews. Phase 2 will be based on testing the initial program theory, while Phase 3 will entail refining the initial program theory [22]. 1). Our data analysis involved skimming (superficial examination), reading (thorough examination), and identifying themes within the documents associated with the elements of ToC and the concepts of RE theory formulation. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Our model differs from the TDF in that the TDF offers little conceptual configurations (causal links) between the elements in their different domains. Evaluation. Pawson R, Manzano-Santaella A. Based on the experience from our study, we concur that ToC and RE approaches can be practically employed together and that their synergism can partially overcome the critiques of each methodology. 2017;3:39. Mayne J. As a product, its inquiry results in specific outcomes in a narrative and/or visual form and offers a framework for sense-making that needs to be used, revisited, and adapted as the project or program progresses. https://www.hst.org.za/publications/District%20Health%20Barometers/District%20Health%20Barometer%202015_16.pdf. Critical realists also engage constructively with social theory, but they are more than just theorists. 542 0 obj <>stream In this chapter I list and describe various innovative methodological contributions made in recent years by realists. 1989;12:299–306. A realist approach to eliciting the initial programme theory of the antiretroviral treatment adherence club intervention in the Western Cape Province , South Africa. 2013, https://dl.acm.org/doi/pdf/10.1145/2517899.2517920. This paper is part of Phase 1 whereby we sought to glean the initial program theory of MomConnect based on analysis of program-related documents using a combined Theory of Change (ToC) and Realist Evaluation (RE) approaches. Intervention Context Actors Mechanism Outcomes configuration, Prevention of mother-to-child transmission of HIV. Inductive coding and deductive categorizing were performed to uncover and align themes related to the ToC framework (Fig. By combining the ToC and RE approaches we intended to unearth, in a systematic manner, the assumptions underlying the MomConnect program and speculate the changes likely to take place as a result of the intervention [40]. Barron P, Peter J, LeFevre AE, et al. Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa, South African Medical Research Council, Cape Town, South Africa, School of Public Health, University of the Western Cape, Cape Town, South Africa, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium, You can also search for this author in Sage Publ 2004; 1–36. The context can also be defined as circumstances that configure the settings in which the intervention takes place, and the action sets of activities that will trigger the change [24]. 2017;22:895–907. https://www.communitymatters.com.au/RE_chapter.pdf. PubMed Google Scholar. We aimed to glean an initial program theory of the MomConnect initiative to understand how and why the program works (or not). Thematic framework analysis enabled comparison on a case-by-case basis. To achieve this goal, mobile health technology (mHealth) was integrated into the healthcare system as a strategy to overcome barriers to universal health coverage and promote MCH [11]. participants, data collection, data analysis and write up of the project. Abstract. 2019;9:1–9. Futur Foresight Sci. 1). The second part (peripheral route) relies on clues embedded in the information delivery method, which contributes to its relative acceptability by the user. The formulation of the ToC and initial program theory was achieved in an iterative process – moving back and forth between the data, the ToC, and developing the initial program theory. Critical Realism (CR) is a philosophy of science that is based around a number of ontological principles. Joseph Maxwell argues for critically applying a realist ontology to a number of important theoretical and methodological issues. The clear description of the coding and reliability testing used … All authors read and approved the final manuscript. Article  Adapted from Eastwood et al., [31]. https://www.hst.org.za/publications/Pages/DISTRICT-HEALTH-BAROMETER-201819.aspx. Cookies policy. Thematic analysis (TA) is one of a cluster of analytic approaches you can use, if you want to identify patterns of meaning across a qualitative dataset. 2014;30:512–8. Eval Progr Planning. 0000005323 00000 n 0000000016 00000 n Google Scholar. RE aims to unearth theories to explain how and why the intervention is supposed to trigger change [34]. Syst Rev. The output themes speak to interactions with the health system and knowledge acquisition. Atik ARA. RE is a theory-driven approach to evaluation informed by principles of critical realism – social structures and agents having underlying causal powers that interact to cause an observed behavior [33]. Rolfe AS. Interview transcripts were analysed using inductive thematic analysis following the seven steps outlined by Braun and Clarke (2013), within a qualitative paradigm and a critical realist framework. 2) integrating the features of both ToC and RE approaches and how they complement each other to inform the elicitation of a robust and testable program theory. Relationship between implementation theory and program theory. However, we considered the two approaches together in our study to obtain a more robust initial program theory for the MomConnect program. Data from SA show that the rate of ANC visits within 20 weeks of gestation was 44.0% in 2012/2013 [9], 53.8% in 2014, and 68.1% 2018/2019 with a different point percent of 14.3 since 2014 [4]. These findings are consistent with the work by Ruton et al. Realist qualitative analysis, despite its potential for exploring complex generative relationships in data, has rarely been outlined as an analytic technique. The benefit of combining the ToC and RE is shown by the fact that ToC makes it easier to trace causes if outcomes are not achieved at the management level. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. BMC Medical Research Methodology 2012;17:22–9. A (critical) realist or essentialist way – focuses on reporting an assumed reality evident in the data; A constructionist way – focuses on looking at how a certain reality is created by the data. Atkins L, Francis J, Islam R, et al. To this end, we adopted a framework proposed by Dhillon and Vaca [24] (Fig. 2015;30:119–42. As a process, the ToC model shows how a goal will be reached [27]. In RE, on the other hand, it can be difficult to identify and conceptualize mechanisms and separate context from mechanisms. Goicolea I, Vives-Cases C, Hurtig AK, et al. Interaction with the health system (service rating and feedback) (I) is influenced by health system conditions such as facility readiness to provide care (C) and health care worker availability and buy-in (C). Background. For instance, the ToC model tends to be linear and lacking detail, particularly around causality. Training, supervision, workload, and remuneration motivated HCPs to perform well in their duties. The characteristics of the selected documents are summarized in Additional file 1. about thematic analysis . Because both approaches take an explicitly cumulative approach to knowledge generation, they have been usually applied in isolation. Mechanisms that trigger a good health-care response to intimate partner violence in Spain. District Health Barometer DHB 2013/2014: Health System Trust; 2015. https://www.hst.org.za/publications/District%20Health%20Barometers/DHB_2013_14_web.pdf. After screening by title and abstract, 358 documents and duplicates were removed. Combining realist evaluation and qualitative comparative analysis approaches. The aim of this thesis is to understand the important components of a set of sustainable interventions to prevent obesity at the community level by using realistic evaluation, which draws on the philosophy of critical realism. The TDF supports our model in the sense that, some of the TDF domains were included in our model, such as knowledge acquisition, which is a central modality provided by MomConnect messages through health education and information (I). The study conducted in Rwanda by Musabyimana et al. Thematic analysis has been poorly branded, yet widely used in qualitative research (Braun & Clarke, 2006), and has been rarely appreciated in the same way as grounded theory, ethnography, or phenomenology.Braun and Clarke (2006) argued that thematic analysis should be a foundational method for qualitative analysis, as it provides core skills for conducting many other forms of qualitative analysis. There are multiple definitions of ‘mechanism’. National Department of Health South Africa. in India [45], which used a ToC approach to explain how the use of mHealth supported and improved the quality of counseling delivered by HCPs. %%EOF mHealth. ToC is also time and resource-intensive and has some difficulties in dealing with multiple perspectives, unexpected outcomes, and critical analysis. Cite this article. The description of analysis is embedded within the philosophical standpoint of critical realism and pragmatism, which adds depth to the utilisation of these methods in previous discussions [2, 7]. [48] focused on Mobile Video intervention, which stipulates that the changes in attitude that predict a desired behavioral outcome such as exclusive breastfeeding can be explained in two pathways. Although SA failed to achieve the Millennium Development Goals (MDG) 4a and 5a of reducing under-five mortality by two-thirds and maternal mortality by three-quarters between 1990 and 2015, significant progress was observed [5]. The model can be too descriptive and ignore issues of power and conflicting theories. Dr. Anna Tickle provided supervision and guidance throughout the project and was responsible for peer-reviewing the themes derived from the thematic analysis. Our intention to glean the initial program theory of the MomConnect program informed by ToC and RE approaches was based on harnessing the overlapping and complementary features of these two approaches. Following critical realism (Fletcher, 2017) and thematic analysis techniques (Denzin and Lincoln, 2000), data analysis included abduction and retroduction to identify structural, cultural, and personal emergent properties, and how these influenced … Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Overview of synthesis methods BMC Health Serv Res. Sustain Dev. Prinja S, Nimesh R, Gupta A, et al. A Critical Realist informed Thematic Analysis was used to analyse the interviews. Le Blanc D. Towards integration at last? The TDF also considers the notion of the ‘mechanism of action’ in the domain of beliefs about capabilities and emotion (M). S Afr Health Rev. 2019, https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Screening of the documents for eligibility hence identified 22 documents, which were included in the final analysis (Fig. Background Healthcare research acknowledges a range of paradigms, including postpositivism and critical realist methodologies. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. The world as we know and understand it is constructed from our perspectives and experiences, through what is 'observable'. Part of In RE terms, a mechanism (M) relates to a combination of intended and unintended resources provided by the program and the response to those resources by stakeholders [36]. Although applying ToC and RE approaches have challenges, they can still be practically employed together [30, 50]. Moodley J, Cheb MB, Fawcus S, et al. Of importance, nevertheless, is the notion that the Intervention (I) must be accepted by the users, Actors (A), for it to be successful. Development and formative evaluation of an innovative mHealth intervention for improving coverage of community-based maternal, newborn, and child health services in rural areas of India. Curationis. The impact was identified as reductions in maternal, neonatal, and child morbidity and mortality. Blamey A, Mackenzie M. Theories of change and realistic evaluation: peas in a pod or apples and oranges? RE theories are formulated by conceptualizing the relationship between the context (C) within which the program is implemented, the generative mechanisms of change (M), and the observed outcomes (O). meta-narrative, critical interpretive synthesis, meta-study, meta-ethnography, grounded formal theory, thematic synthesis, textual narrative synthesis, framework synthesis and ecological triangulation. Improvements in maternal mortality in South Africa. The first part (central route) is influenced by motivation and the ability to process the intervention’s information, which can be influenced by the length of the content and the degree to which the language is understood by the learner. Eighteen documents relating to the MomConnect program were found by searching the NDoH website. Blamey and Mackenzie [30] propose that the ToC can be used as a means of explicating intervention implementation theory for program planning, improvement, and the development of robust monitoring systems at a whole program level; while RE can be used to examine, in detail, how and why the different aspects of the program leads to the observed or intended outcome – program theory (Fig. RE lacks substantive theory in some fields, multiple and conflicting theories in others, and uses inaccessible jargon. We used the ToC and RE approaches to elicit the initial program theory [41]. This iterative process combined elements of content and thematic analyses [23]. © 2020 BioMed Central Ltd unless otherwise stated. Secondly, it clearly articulated the intended outcomes (short-term and long-term) of the MomConnect program. PLoS One. We then provide an example to illustrate the use of critical realism and outline the position’s key aspects to consider in future directions of CA. It is used to analyse classifications and present themes (patterns) that relate to the data. Our initial program theory is consistent with some existing models such as the Elaboration likelihood model (ELM) and the extensive Elaboration likelihood model (eELM) [48], and the Theoretical Domains Framework (TDF) [49] in behavior change. Evaluation. The ToC was used to explicate the implementation theory for program planning, improvement, and the development of robust monitoring systems at a macro program level [30]. Chen H-T, Rossi H. Issues in the theory-driven. After obtaining the ToC, further data coding was applied to identify statements or portions of the texts attributable to the constructs of mechanism and contexts. Although SA’s MMR has improved from 2014 to 2019, complications of hypertension in pregnancy and obstetric hemorrhaging are still the main issues causing maternal mortality, which can be prevented through early uptake of antenatal care (ANC) and postnatal care (PNC) services [8]. Overall, our study has established theoretical foundations and comprehensive requirements for the development of program theory in mHealth interventions (MomConnect), to support decision making, and decision support capabilities. Unstructured interviews with use of academic grade documents as a point of reference. We found that the application of both ToC and RE enhances learning and the unveiling of the initial program theory rather than delivering answers to questions of program effectiveness. ToC and RE-informed models illustrated how the MomConnect program was organized and expected to work. The lack of impact of RapidSMS on ANC services uptake was attributed to the infidelity in the implementation of the program. An outcome (O), which can be represented in short and intermediate terms, is what is observed resulting from the interaction between the context and mechanism that is triggered by the intervention, and could be measured as the impact of the intervention [39]. Massyn N, et al. Flynn R, Rotter T, Hartfield D, et al. <<6BF625D8A89CC44789F93C83C7AC7F1B>]/Prev 1319391>> Trends in maternal and neonatal mortality in South Africa: a systematic review. ... Leung D.Y., Chung B.P.M. '(Braun & Clark 2006 p.79). Tugas Translate Jurnal Assessing the Perspectives of Users and Beneficiaries of a Community Health Worker Mhealth Tracking System for Mothers and Children in Rwanda Pekerja Kesehatan Masyarakat Sistem Pelacakan Mhealth Untuk Ibu Dan Anak-Anak Di Rwanda Pe. Google Scholar. 0000002987 00000 n Derbyshire J. RE focuses on providing a ‘causation-based explanation’ – depiction of cause-effect relationships among elements [24] – to provide explanations of program effectiveness [32]. Context (C) is the physical or perceived conditions, which allow the mechanisms to come into operation or remain inactive. Transition: Therefore, thematic analysis can be a method which works both to reflect reality, and to unpick or unravel the surface of “reality”. In keeping with the SDG 3 target, SA developed a strategic plan to reduce maternal and child mortality by improving the uptake of maternal and child (MCH) services. 2014;20:445–52. Mukumbang FC, Van Belle S, Marchal B, et al. 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. This conceptualization is achieved by formulating the Context-Mechanisms-Outcome configurations (CMOs) [35]. Article  Dalious SCWAR and M. Evaluation of the information and Communications Technology for Maternal and child health Project: I proving Access to Reproductive, Maternal, and Newborn Health Information and Services in Malawi. Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol. 1, additional elements are required to make the shift from a ToC to a realist program theory. xref analysed using a social constructionist thematic analysis (Braun & Clarke, 2006) also informed by the work of Michel Foucault (1972), set within critical realist ontology. 2017;12:1–18. Although no study has shown the effectiveness of the MomConnect program in improving the uptake of MCH services, there is evidence that the national ANC visits within 20 weeks of gestation rate have been increasing in the 3 years following the implementation of MomConnect [4, 10]. Document analysis is a systematic procedure for reviewing or evaluating both printed and electronic (computer-based and Internet-transmitted) material [23]. 2017;46:e56–64. Sustainable development goals and the ongoing process of reducing maternal mortality. All authors held discursive weekly meetings to conceptualize and finalize the ToC and initial program theory. Pawson R, Tilley N. Realistic evaluation: Sage Publ; 2004. p. 1–36. Seebregts C, Barron P, Tanna G, et al. By using this website, you agree to our Article  Sage, 1997. https://uk.sagepub.com/en-gb/afr/realistic-evaluation/book205276. A realist diagnostic workshop. Reflexive TA | the basics ... »Why are we critical of the notion that ‘themes emerged’ from data? Understanding mHealth Impact among Aponjon (MAMA Bangladesh) Subscribers through a Phone Survey in Bangladesh. Eastwood JG, Woolfenden S, Miller E, et al. 0000006518 00000 n Therefore, we considered adding elements of the Actors (A) and intervention (I) modalities to the original CMOs heuristic tool and adopted the intervention-context-actor-mechanism-outcomes (ICAMO) configuration [33]. It illustrates the data in great detail and deals with diverse subjects via interpretations (Boyatzis 1998). Content and thematic analysis approaches were deductively applied to analyze the documents toward constructing ToC and RE-informed models. 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. According to Taplin et al. BMC Med Res Methodol 20, 282 (2020). With an institutional MMR of 133.3% per 100,000 live births in 2013/2014 [3] and 105.9 in 2018/2019 [4], South Africa (SA) has made notable progress in reducing its MMR. from the year that MomConnect was implemented until the year the document review was initiated. ... (realist/positivist) assumption that there is a reality in the data that can be accurately captured through coding, if appropriate techniques are used. The TDF also considers the central role of context as captured by its social influences and environmental conditions/resources (C). 0 BMJ Open. ToC and RE are members of the theory-driven evaluation (TDE) or theory-based evaluation (TBE) family. [47] on implementers’ and community health workers’ experiences of the RapidSMS program also identified challenges to the successful implementation of the program, which included lack of motivation and incentives, high turnover rates of CHWs, and lack of regular CHW training. Mmusi-Phetoe RMM. Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India. Maternal Mortality 2000 to 2017. Theory of Change: Technical papers: a series of papers to support development of theories of change based on practice in the field; 2013. p. 23. Massyn N. Maternal, Child & Women’S Health Barometer, 2016: Health System Trust; 2018. p. 116. https://www.hst.org.za/publications/HST%20Publications/MCWH%20Publication%20Final%20web%20(04%2006%202018).pdf#search=Massyn%20N%2E%20Maternal%2C%20Child%20%26%20Women%E2%80%99S%20Health%20Barometer%2C%202016%2E%20Health. Qual Res. Evaluation. Digital health vision : could MomConnect provide a pragmatic starting point for achieving universal health coverage in South Africa and elsewhere ? 0000003024 00000 n The MomConnect program was also guided by an emergent body of work around the use of mobile phones to enhance MCH programs [16,17,18,19,20,21]. Thematic Analysis We (Virginia Braun & Victoria Clarke) have developed an extensive reading list, organised into sections, to help guide you through the diversity of approaches and practices around thematic analysis. Table 2 illustrates a thematic analysis of the data based on RE principles and the ICAMO heuristic tool. 2015;23:176–87. The sustainable development goals as a network of targets. Document analysis as a qualitative research method. In South Africa, the flagshi 2018;108:4–8. TDF explains that the social influences and environmental context and resource domains point to organizational and systems context for change [49]. 0000002825 00000 n J Eval Clin Pract. Using mobile technology to improve maternal, child, and youth health and treatment of HIV patients. Thus, according to critical realists, unobservable … Bowen GA. Others have defined mechanisms as the underlying entities, process, or structures, which operate in a particular context to generate outcomes of interest [38]. Barnett, I., Brockerhoff, S., Medardi, D., Gordon, J. and Srivastava S. Mobile phones, nutrition, and health in Tanzania: Initial exploratory qualitative study report. 2016;39:1571. %PDF-1.4 %���� M Kabongo, E., Mukumbang, F.C., Delobelle, P. et al. Dhillon L, Vaca S. Refining theories of change. Being sensitized can encourage and motivate them to attend clinic appointments, ultimately decreasing maternal and child mortality. Using the terms ‘MomConnect intervention’ OR ‘MomConnect program’ resulted in 266 hits. Target 3.1 of the Sustainable Development Goals (SDGs) aims to reduce the global maternal mortality ratio (MMR), defined as the number of maternal deaths attributed to pregnancy-related complications per 100,000 live births, to less than 70 deaths per 100,000 live births by the year 2030 [1]. 2019. https://doi.org/10.1177/1468794119881985 Epub ahead of print. Monitoring MAMA: Gauging the impact of MAMA South Africa. 2017, https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/13566/mNutrition_Tanzania_final_23_Aug_2017.pdf?sequence=821&isAllowed=y. Abduction – inventive thinking required to imagine the existence of mechanisms and retroductive thinking – a mechanism-focused approach to inference making, which seeks to clarify the basic prerequisite or conditions of a phenomenon, were applied to explore and link elements of intervention modalities, context, actors, mechanisms, and outcomes to obtain the ICAMO configuration. 0000024671 00000 n Callister LC, Edwards JE. Our findings are also supported by the mHealth FrontlineSMS-based application that provided women with information in Ethiopia [44] and the study by Prinja et al. All data generated or analyzed during this study are included in this published article and its supplementary information files - Additional file 1. 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. The high MMR in SA is in part attributed to the lack of adequate maternal health care complemented by underlying social determinants of poor nutrition and poverty [6, 7]. BMC Health Serv Res. TDF posits that a good understanding of psychological capability and reflective motivational processes in knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, goals and memory, attention and decision processes can influence behavior. It also aims to clearly discuss the approach to determining rigour and validly within thematic analysis as part of a research project. The 'real' can not be observed and exists independent from human perceptions, theories, and constructions. These findings are indicative of important contextual elements that can influence the success of the MomConnect program. Dis Colon Rectum. Eveline M Kabongo. Springer Nature. 2009;9:27–40. [42] in which CHWs were given mobile phones to report data on MCH indicators using text messages (Rapid SMS a two-way communication). Trop Med Int Health. The MomConnect program is a digital health communication program [13], which was informed by lessons, experiences, and successes of the MAMA SA program [14, 15]. Massyn N, Peer N, Padarath A, et al. Our study contributes to the cumulative theory development activities, mHealth, MCH services, and decision support. https://doi.org/10.1186/s12874-020-01164-y, DOI: https://doi.org/10.1186/s12874-020-01164-y. By rating the services received at the facility level, women and mothers are expected to feel empowered (M), which in turn would result in improved quality of health care delivery (O) and improved uptake of MCH services (O). Evidence suggests that communicating with pregnant women and new mothers via regular SMS and/or voice-based messages supports the adoption of healthy behaviors and increases the uptake of health services [12]. The program aimed at (i) registering all pregnant women using the public health sector; (ii) sending targeted health promotion messages during pregnancy and up until the first year of age to encourage healthy and health-seeking behavior [14]; and (iii) providing pregnant women with a feedback platform to rate the services they received [18]. Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two south African provinces: a realist evaluation protocol. PNC visits within the first 6 days of delivery’ were 73.0% in (2013/2014) [10]. Towards a programme theory for fidelity in the evaluation of complex interventions. California Privacy Statement, 2013, http://www.villagereach.org/wp-content/uploads/2017/07/ICT_for_MNCH_Report_131211md_FINAL.pdf. Realist data analysis is driven by the principles of realism: realist evaluation explains change brought about by an intervention by referring to the actors who act and change (or not) a situation under specific conditions and under the influence of external events (including the intervention itself). J Multidiscip Eval. 2018;3:1–5. 6), which links the Intervention (I), context (C), causal pathways of outcomes (O), and the mechanisms (M) describing the causal chains, or causal pathways that explain how, when and/or why the MomConnect program messages trigger the expected results. 528 0 obj <> endobj 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. 2019;4:1–11. The article presents how a study that investigated the acquisition of second language academic literacy skills practised the qualitative methodology, interpretative phenomenological analysis (IPA), from a realist … Google Scholar. 0000000596 00000 n A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on the sustainability of a lean intervention in pediatric healthcare. A critical realist ‘intensive’ approach employing qualitative methods was used with pre-registration 3rd year nursing students as participants. 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. we. The program theory and connection between mHealth, improved MCH services, and decision making is highlighted in our ToC and RE, and the implications for developers of mobile-based interventions are that the model provides a holistic approach to system thinking, systems analysis, and design. 0000005947 00000 n Despite this limited understanding, MomConnect was rapidly rolled out. Mehl GL, Tamrat T, Bhardwaj S, et al. 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). Also, the merging of these two approaches promote a better understanding of the successes and challenges of the MomConnect program. Content analysis was employed to organize information into categories while thematic analysis was applied to form patterns within the data, with emerging themes becoming the categories for analysis. PubMed Central  Musabyimana A, Ruton H, Gaju E, et al. The larger study has three phases: Phase 1 will focus on eliciting the initial program theory using three different approaches: a scoping review, document review, and stakeholders’ interviews. However, it is important that the theoretical position of a thematic analysis is made clear, as this is all too often left unspoken (and is … List of documents containing clauses for MomConnect program (n = 22) the Document was ordered by date of publication. (2019) Content Analysis: Using Critical Realism to Extend Its Utility. Combining theories of change and realist evaluation in practice : lessons from a research on evaluation study. Mukumbang FC, Marchal B, Van Belle S, et al. E. District Health Barometer 2018/2019: Health System Trust; 2020. p. 1–462. [27], ToC makes underlying assumptions explicit by delineating the different components: input, outputs, outcomes, and impact [28, 29]. Implement Sci. It therefore functions at a level similar to that occupied by such philosophies as Positivism and Interpretivism. We examine the philosophical and theoretical position of critical realism with CA. Using thematic analysis in psychology Virginia Braun 1 and Victoria Clarke 2 1 University of Auckland and 2 University of the West of England Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. Hategeka C, Ruton H, Law MR. Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda. Notably, the identification of mechanisms and contextual elements are critical to establishing a generative causality – how the intervention modalities are interpreted and acted upon by the actors (mechanisms) and under what conditions (context) leading to the hypothesized impact. Garret R. Theory of change thinking in practice. The first ANC visit allows for easy detection of pregnant women requiring special attention, referral, and more ANC visits. A key component of the program consists of sending pregnancy-related stage-based messages (I) to pregnant women and mothers (A), facilitated by health systems conditions such as facility readiness to provide care (C), and intervention-related resources and mobile connectivity (C). The process of constructing the ToC provided three critical features toward developing an initial program theory of the MomConnect program. Social factors determining maternal and neonatal mortality in South Africa: a qualitative study. The RE approach was then used on a more micro-level (user-oriented understanding) of how and why the intervention would work or not. Taplin DH, Clark H, Collins E, et al. The draft manuscript was written by EMK. A study conducted by Hategeka et al. It minimally organizes and describes your data set in (rich) detail. Glob Health Action. Combining the terms (‘MAMA South Africa’ AND ‘MomConnect program’) resulted in 86 additional documents, resulting in 352 documents. Using Interpretative Phenomenological Analysis from a Realist Perspective . PubMed  Outcomes were related to health-seeking behavior; improved MCH services uptake, and improved quality of MCH services. MomConnect: an exemplar implementation of the Health normative standards framework in South Africa. statement and Even though MomConnect has a framework for explaining how the program is expected to contribute to expected outcomes, the mechanisms underlying and health systems context that influence the outcome of the MomConnect program remain elusive. »Why don’t . 2019;19:1–13. The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia. The reminders for clinic appointments on ANC, the probable delivery date, and PNC were generated automatically. Figure 4 presents a summary of the themes obtained from the content and thematic analyses. 528 15 2015;10:1–17. Pawson R, Tilley N. Realistic evaluation. PubMed  The Google Scholar search covered the period 2014–2019, i.e. Defining critical realism is not an easy task. trailer Useful theory of change models. The widely-used version of ... contextualist/critical realist approaches (e.g., Ussher, 1997), or critical/constructionist As highlighted in Fig. Can J Program Eval. RapidSMS influenced the use of MCH services, whereby an additional support package was provided such as training of health care providers (HCPs), equipment, and supervision [42]. Pawson R, Tilley N. Realistic evaluation. Our ToC underpinned the process of developing the initial program theory, which is based on the RE methodological approach. Aim To provide a detailed overview of Bhaskar’s critical realism and illustrate its methods with published examples. 2018;14:64–87. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. MomConnect is a two-way communication channel, providing women the opportunity to rate the MCH services received at the clinics and ask questions regarding their health and that of their babies. 2004;10:58–76. An important step in improving the impact of MomConnect is by unearthing its program theory – the explicit and implicit assumptions of how the program is expected to work.

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