ArticleBMJ global health2025
We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- How to do (or not to do) realist evaluations to advance theory, practice, and justice in health systems research.Health policy and planning · 2026Article
- Urban-Rural Disparities in Non-Adherence to Iron Supplementation Among Pregnant Women Aged 15 to 49 in Sub-Saharan Africa.International journal of environmental research and public health · 2025Article
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Authors and funding
7 authors.
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Abstract
introductionIn Zambia, where less than half of pregnant women complete the continuum of care for maternal health, community engagement initiatives like the Safe Motherhood Action Groups (SMAGs) are used to mobilise communities and support maternal and newborn health (MNH) care-seeking. However, there is a lack of documented evidence on communication in community engagement and its implementation across diverse settings. This study examines how communication in community engagement influences MNH care-seeking in Zambia's Eastern Province.
methodsThis realist evaluation used two iterative multi-method case studies to evaluate the SMAG programmes at Chibolya Urban Health Clinic and Jerusalem Rural Health Clinic. Data were collected from facility metrics, in-depth interviews, realist photovoice discussions, focus-group discussions and observations. Participants, including SMAGs (n=10), local leaders (n=2), pregnant women (n=10), community members (n=20), healthcare providers (n=4) and Ministry of Health stakeholders (n=4) were purposively sampled.
resultsSeven programme theories, informed by 50 context-mechanism-outcome configurations, were refined and organised to explain how the SMAG programme in Zambia works when communities are actively involved, messaging is relevant and relatable, SMAGs are trusted, SMAGs are familiar, the programme and facility are well-coordinated, the community perceives benefits from the messaging and SMAGs are motivated.
conclusionThis realist evaluation offers research, practice and policy recommendations to enhance communication in community engagement for MNH, with potential applicability to other health domains. It emphasises trust and strong community-programme relationships as key drivers of effective and sustainable community engagement.
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