Study protocol: realist evaluation of effectiveness and sustainability of a community health workers programme in improving maternal and child health in Nigeria
Study protocol: realist evaluation of effectiveness and sustainability of a community health workers programme in improving maternal and child health in Nigeria
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DOI：
10.1186/s13012-016-0443-1
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发表时间：
2016-06-07
影响因子：
7.2
通讯作者：
Ensor, Timothy
中科院分区：
文献类型：
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作者：
Mirzoev, Tolib;Etiaba, Enyi;Ensor, Timothy
背景：改善孕产妇和儿童健康（MCH）成果仍然是国际优先事项，特别是对于尼日利亚等撒哈拉以南非洲国家而言。有证据表明，在这些国家，使用社区卫生工作者 (CHW) 可以有效扩大卫生服务的获取和覆盖范围，并改善 MCH 结果。 方法/设计：在本文中，我们报告了一项为期 5 年的研究方法，旨在评估尼日利亚 CHW 计划的背景、过程、结果和长期可持续性。对复杂干预措施的评估需要全面了解干预背景、机制和结果。多学科和混合方法的现实主义方法将促进这种评估。开展研究的有利政策环境将确保研究结果成功纳入政策和实践。现实主义评估为这项将在阿南布拉州进行的多学科和混合方法研究提供了总体方法框架。该研究将利用卫生经济学、社会科学和统计学。研究分为三个步骤：（1）初步理论发展； (2) 理论验证和 (3) 理论完善和经验教训的发展。数据收集的具体方法将包括与有目的地确定的关键利益相关者（管理者、服务提供者和服务用户）进行深入访谈和焦点小组讨论、文件审查、来自 CHW 计划和卫生信息系统的定量数据分析以及小规模调查。该计划对关键产出和结果指标的影响将通过对卫生信息系统和计划报告中的每月定量数据进行间断时间序列分析（ITS）来评估。这项研究获得了利兹大学和尼日利亚大学的伦理批准。讨论：这项研究将为加强尼日利亚东南部阿南布拉州以及整个尼日利亚更广泛的卫生系统做出及时而重要的贡献。对采用稳健方法来评估复杂卫生系统干预措施感兴趣的研究人员应该会对本文感兴趣。本文对于有兴趣委托和参与此类复杂评估以告知政策和实践的政策制定者和从业者也将很有用。
Background: Achievement of improved maternal and child health (MCH) outcomes continues to be an issue of international priority, particularly for sub-Saharan African countries such as Nigeria. Evidence suggests that the use of Community Health Workers (CHWs) can be effective in broadening access to, and coverage of, health services and improving MCH outcomes in such countries.Methods/design: In this paper, we report the methodology for a 5-year study which aims to evaluate the context, processes, outcomes and longer-term sustainability of a Nigerian CHW scheme. Evaluation of complex interventions requires a comprehensive understanding of intervention context, mechanisms and outcomes. The multidisciplinary and mixed-method realist approach will facilitate such evaluation. A favourable policy environment within which the study is conducted will ensure the successful uptake of results into policy and practice.A realist evaluation provides an overall methodological framework for this multidisciplinary and mixed methods research, which will be undertaken in Anambra state. The study will draw upon health economics, social sciences and statistics. The study comprises three steps: (1) initial theory development; (2) theory validation and (3) theory refinement and development of lessons learned. Specific methods for data collection will include in-depth interviews and focus group discussions with purposefully identified key stakeholders (managers, service providers and service users), document reviews, analyses of quantitative data from the CHW programme and health information system, and a small-scale survey. The impact of the programme on key output and outcome indicators will be assessed through an interrupted time-series analysis (ITS) of monthly quantitative data from health information system and programme reports. Ethics approvals for this study were obtained from the University of Leeds and the University of Nigeria.Discussion: This study will provide a timely and important contribution to health systems strengthening specifically within Anambra state in southeast Nigeria but also more widely across Nigeria. This paper should be of interest to researchers who are interested in adapting and applying robust methodologies for assessing complex health system interventions. The paper will also be useful to policymakers and practitioners who are interested in commissioning and engaging in such complex evaluations to inform policies and practices.