Understanding the initiation, formation, functioning, and performing of networks to change practices - Realist evaluation of a programme to improve newborn care in Kenya.

Networks are increasingly employed to tackle health system challenges by either explicitly or implicitly targeting the relational aspects of health systems. We undertook a Realist evaluation to test a programme theory developed during a previous Realist review on network initiation, formation, and functioning. Our aim was to further develop an understanding of the processes involved in the initiation, formation, functioning, performing, and sustaining change and impact of networks that enable changes in practice to improve quality of care and services. We undertook a multiple-methods single case study of the Newborn Essential Solutions and Technologies programme in Kenya to evolve the programme theory. The revised programme theory explains how a network evolves through three phases: Initiation & Formation, Functioning & Performing, and Sustaining Change & Impact through interrelated processes (identify a problem; collective vision; taking action to solve a problem; identity and culture), activities (knowledge and skills dissemination; cross-learning; resourcing; leadership; champions; adaptability), foundations (teamwork; psychological safe space; commitment; engaged, motivated, empowered, and confident network members; purposeful relationships, linkages, and partnerships), and cross-cutting factors (communication; trust; energy, effort, and passion). This network programme theory provides a roadmap for the relational work those employing networks should perform to promote success in changing practices to improve quality of care, service delivery, and health system functioning.