ArticleBMC medical research methodology2020
Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa.
Article in BMC medical research methodology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
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- The FemTech revolution: Unlocking the potential of new technology for optimizing pregnancy outcomes in low- and middle-income countries and remote areas.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Making space for happenstance: a proposal for a different 'Theory of Change' to help understand and guide NTD policymaking practices.International journal for equity in health · 2026Article
- Mental health policy implementation in low- and middle-income countries: a realist review protocol.PloS one · 2025Article
- mHealth interventions for postpartum family planning in LMICs: A realist review.PLOS global public health · 2024Article
- Using the multiple streams model to elicit an initial programme theory: from policy dialogues to a roadmap for scaling up integrated care.BMJ global health · 2023Article
- Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis.BMJ global health · 2023Article
- Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2023Review
- Improving child health service interventions through a Theory of Change: A scoping review.Frontiers in pediatrics · 2023Article
- A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting.The International journal of health planning and management · 2022Review
- Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: a realist synthesis.BMC pregnancy and childbirth · 2021Article
- Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative.International journal of integrated careArticle
- Article
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Authors and funding
4 authors.
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Abstract
backgroundOne 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.
methodsWe 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.
resultsToC 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.
conclusionThe 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.
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