Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa
Date
2020-11-26
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
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 REinformed
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.
Description
CITATION: Kabongo, E. M., et al. 2020. 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, 20:282, doi:10.1186/s12874-020-01164-y.
The original publication is available at https://bmcmededuc.biomedcentral.com
The original publication is available at https://bmcmededuc.biomedcentral.com
Keywords
mHealth, Mothers -- Mortality -- South Africa, Wireless communication systems in medical care, MomConnect -- Evaluation, Maternal health services -- South Africa, Child health services -- South Africa
Citation
Kabongo, E. M., et al. 2020. 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, 20:282, doi:10.1186/s12874-020-01164-y