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2007;21:554–72. Whereas in realist review the primary data comes from documents (e.g. The project will be implemented according to standard governance practices at the University of Leeds and University of Nigeria. Google Scholar. Two aspects of the environment within which the study is being implemented are worth noting. Findings from step 1 will be used to hypothesise the likely changes (interruptions in trends and levels) in the time series to make predictions to be verified during the ITS analyses. One SURE-P component focused on maternal and child health (SURE-P/MCH), which comprised supply and demand components. We will use the understanding of the context in which interventions are operating to identify these consequences. Bhutta ZA, Memon ZA, Soofi S, Salat MS, Cousens S, Martines J. Evaluation. Uzochukwu B, Obikeze E, Onwujekwe O, Onoka C, Griffiths U. Methods will be used that adjust, where necessary, for problems typical to time-series estimation (e.g. Specific emphasis will be placed on confidentiality and other data protection issues, which will include security of data storage and access rights to data. exploring the intervention mechanisms); identify the key contextual facilitators and constraints and analyse in what ways these contextual influences affected the achievement of outcomes. Evaluation of complex interventions such as SURE-P and their longer-term impact on MCH outcomes requires a comprehensive understanding of intervention context, implementation, mechanisms and outcomes. Green A, Thomas C, Newell JN, Baral SC, Byanjankar L. The contribution of volunteers to a successful community-orientated tuberculosis treatment centre in an urban setting in Nepal: A qualitative assessment of volunteers' roles and motivations. Informed consent will be obtained from all study participants, and in the case of refusal, alternative means of data collection will be explored (e.g. The-Presidency. An example of the latter is: ‘financial incentives, combined with increased access to MCH care following deployment of CHWs and improved infrastructure will improve the uptake of antenatal care by pregnant mothers (by over 50 %)’. The Logic Model Guidebook: Better Strategies for Great Results. In this paper, we report a protocol for realist evaluation study of DeteRminants of Effectiveness and sustainability of a noVel Community HeAlth Workers (CHWs) programMe in imProving maternal and child health in Nigeria (REVAMP project). 1, the mixed methods approach will enable us to also analyse the intervention implementation outcomes, e.g. Jokhio AH, Winter HR, Cheng KK. Therefore, instead of attributing changes in health outcomes to the SURE-P/MCH only, we will explore the contribution of the interventions to achievement of desired effects within the real context. Ricketts JA. As a … Saving newborn lives in Nigeria: Newborn health in the context of the Integrated Maternal, Newborn and Child Health Strategy. 2013;28(4):358–66. Only members of teams identified by the PIs in each institution will have access to the data. The multidisciplinary and mixed-method realist approach will facilitate such evaluation. The uncertainty and likely variability of costs and effectiveness, particularly the spill-over effects, mean that sensitivity analysis will form an important part of the reporting of the economic evaluation. Thus, the final explanation of a programme considers context-mechanism-outcome.. 2010;88:364–70. 2011;6(1):11. The NDP comprises a range of organisational and service delivery changes to support evidence-based practices and policies. The impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. We will explore context at the macro level (e.g. UNICEF, WHO. PubMed Realist impact evaluation draws on the realism school of philosophy. The eventual decision was to continue with the study, using the original methodology, though with the addition of assessment of sustainability of achieved changes and effects of on-going lobbying and advocacy efforts on entrenching the MCH on the political agenda in Nigeria. Its overall place in the toolkit of evaluation approaches is not yet fully established. middle-range theories) that link intervention inputs to processes, outputs and outcomes within the context of Anambra state. Cookies policy. The multidisciplinary and mixed methods realist approach that will be used in the study will facilitate such evaluation. it is a form of primary research. This realist evaluation protocol sets out the approach that will be used to identify and explain which aspects of the programme are working, for whom and in what circumstances to produce the outcomes intended. it First, small-scale facility exit survey (about 300 respondents) will use structured questionnaire to explore user perceptions about the programme and their experiences in accessing MCH care. Onwujekwe O, Dike N, Ojukwu J, Uzochukwu B, Ezumah N, Shu E, et al. The aim of the ITS analysis is to identify discontinuities in the time series associated with, and potentially caused by, the introduction of the SURE-P programme to health facilities. Preliminary evidence indicates that paying CCTs to pregnant mothers is linked to increase antenatal care visits and facility deliveries . The is an error term. The qualitative and quantitative methods will be integrated throughout to answer the eight study research questions. Research Methodology. BMJ. These hypotheses will be developed in discussions with programme managers and implementers. However, the interest from Nigerian health officials in learning lessons for improving MCH outcomes remained high. The study will draw upon health economics, social sciences and statistics. In RE, researchers develop middle-range theories that take account of how Context (at micro, meso and macro levels) influences intervention processes or Mechanisms (e.g. The additional costs on the supply side are likely to be training midwives and CHWs, salaries, equipment and other supplies (Table 2). The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. In October 2015, 6 months after being elected, the new President of Nigeria announced his decision to reverse fuel subsidy reduction in order to catalyse the economic growth, effectively withdrawing government funding to SURE-P. Realist Synthesis: An Introduction: This paper presents an introductory overview of realist synthesis as applied to the review of primary research on healthcare systems. 2013;13(1):847. An example involving the first two indicators might be: ‘deployment of CHWs, combined with improvement in infrastructure and supplies when implemented within the health systems context of Nigeria, will help reduce maternal and neonatal mortalities to 320/100,000 and 7/1000 live births respectively’. This includes ensuring regular communication between the partners and engagement with policymakers and practitioners; quality assurance through regular peer-review within and between the teams; appropriate mentoring and coaching support to more junior researchers and equal opportunities to both genders. Methods and analysis The study will be conducted in four phases.
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