Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.
Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.
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DOI：
10.1136/bmjgh-2017-000408
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发表时间：
2017
影响因子：
8.1
通讯作者：
Colbourn T
中科院分区：
文献类型：
--
作者：
Djellouli N;Mann S;Nambiar B;Meireles P;Miranda D;Barros H;Bocoum FY;Yaméogo WME;Yaméogo C;Belemkoabga S;Tougri H;Coulibaly A;Kouanda S;Mochache V;Mwakusema OK;Irungu E;Gichangi P;Dembo Z;Kadzakumanja A;Makwenda CV;Timóteo J;Cossa MG;de Melo M;Griffin S;Osman NB;Foia S;Ogbe E;Duysburgh E;Colbourn T
在撒哈拉以南非洲，在许多旨在改善孕产妇和新生儿健康的干预措施中，产后护理仍然相对受到忽视。在四个非洲国家，“母婴保健中错失的机会”项目制定并实施了一套针对具体情况的加强保健系统和产生需求的一揽子计划，目的是改善获得PPC的机会和质量。进行了现实主义的评价，使微妙的理解不同的背景因素对干预措施的执行和影响的影响。混合方法被用来收集数据和测试假设的上下文机制结果配置：16个案例研究（包括访谈，观察，监测数据的关键医疗保健过程和结果），监测数据的所有研究卫生设施和社区，文件分析和参与性评估研讨会。在对个别国家进行评价之后，进行了跨国分析，从而形成了四种中等范围理论。社区卫生工作者（CHW）是通过“桥接”社区和设施来转移PPC需求的关键资产。因为他们是从他们所服务的社区中挑选出来的，他们获得了社区的信任和内在的责任感。此外，如果由于社区卫生工作者的桥梁作用，大量妇女寻求产后保健，就会产生一种要求改变的“嗡嗡声”，最终导致接受PPC的可接受性和感知价值超过了接受保健设施的费用。在供应方面，严格的垂直等级制度和卫生设施工作人员的明确角色阻碍了母婴保健服务的一体化。此外，HFW害怕被负面评价，这会压倒可能从PPC培训中获得的自我效能。相反，保健工作者提供综合PPC的动机的主要驱动力取决于其他方案建立的提供PPC的问责制度。现实主义的评价提供了对一些背景因素的深入了解，这些因素对于使社区一级和服务一级的干预措施有效至关重要。
Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective.
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利用理论和形成性研究来设计干预措施，以改善莫桑比克和乌干达的社区卫生工作者动机，保留和表现。
影响因子：
4.5
作者：
Strachan DL;Källander K;Nakirunda M;Ndima S;Muiambo A;Hill Z;inSCALE study group
通讯作者：
inSCALE study group
影响因子：
3.1
作者：
Duysburgh E;Kerstens B;Kouanda S;Kaboré CP;Belemsaga Yugbare D;Gichangi P;Masache G;Crahay B;Gondola Sitefane G;Bique Osman N;Foia S;Barros H;Castro Lopes S;Mann S;Nambiar B;Colbourn T;Temmerman M
通讯作者：
Temmerman M
影响因子：
5.4
作者：
Franco, LM;Bennett, S;Kanfer, R
通讯作者：
Kanfer, R
影响因子：
168.9
作者：
Lawn, Joy E.;Blencowe, Hannah;Cousens, Simon N.
通讯作者：
Cousens, Simon N.
影响因子：
2.4
作者：
Westhorp, Gill
通讯作者：
Westhorp, Gill