TY - JOUR
T1 - Eliciting the Initial Programme Theory in a Realist Evaluation of Facility-Based Maternal Death Reviews in Benin
T2 - Methodological Process, Challenges and Lessons Learned
AU - Hounsou, Christelle Boyi
AU - Dossou, Jean Paul
AU - Delvaux, Thérèse
AU - Beňová, Lenka
AU - Ouendo, Edgard Marius
AU - Zweekhorst, Marjolein
AU - Marchal, Bruno
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/1/3
Y1 - 2025/1/3
N2 - The initial program theory (IPT) is a core element of realist evaluation. An IPT presents a hypothesis about how, for whom, why, and in what contexts an intervention is effective. Despite their importance within realist studies, methodological guidance on how to develop an IPT is relatively scarce. We describe the methodological process of eliciting an IPT of facility-based maternal death reviews (FbMDRs), a multicomponent intervention to improve the quality of maternal care. We used a four-step approach to elicit the IPT through a combination of literature review, document review, and in-depth interviews with key stakeholders while drawing on the experience of the research team. The literature and document reviews enabled us to identify facilitators and barriers influencing the functioning of FbMDRs. We used the causal pathway approach to deconstruct the maternal death review procedure and we elicited a causal explanation for each component on the basis of the results of the document review, the literature review and key respondent interviews. We organised stakeholder consultations that provided insights of key actors and validated its real-world relevance. We discuss the challenges encountered during its development and the lessons learned. The challenges include the fact that maternal death reviews are multicomponent interventions, for which a ‘simple’ programme theory cannot be defined, the positionality of the research team, and the visual representation of a programme theory with multiple components.
AB - The initial program theory (IPT) is a core element of realist evaluation. An IPT presents a hypothesis about how, for whom, why, and in what contexts an intervention is effective. Despite their importance within realist studies, methodological guidance on how to develop an IPT is relatively scarce. We describe the methodological process of eliciting an IPT of facility-based maternal death reviews (FbMDRs), a multicomponent intervention to improve the quality of maternal care. We used a four-step approach to elicit the IPT through a combination of literature review, document review, and in-depth interviews with key stakeholders while drawing on the experience of the research team. The literature and document reviews enabled us to identify facilitators and barriers influencing the functioning of FbMDRs. We used the causal pathway approach to deconstruct the maternal death review procedure and we elicited a causal explanation for each component on the basis of the results of the document review, the literature review and key respondent interviews. We organised stakeholder consultations that provided insights of key actors and validated its real-world relevance. We discuss the challenges encountered during its development and the lessons learned. The challenges include the fact that maternal death reviews are multicomponent interventions, for which a ‘simple’ programme theory cannot be defined, the positionality of the research team, and the visual representation of a programme theory with multiple components.
KW - Benin
KW - complex and multicomponent intervention
KW - facility-based maternal death reviews
KW - initial programme theory
KW - maternal health
KW - quality improvement
KW - realist evaluation
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U2 - 10.1177/16094069241309277
DO - 10.1177/16094069241309277
M3 - Article
AN - SCOPUS:85215531525
SN - 1609-4069
VL - 24
SP - 1
EP - 12
JO - International Journal of Qualitative Methods
JF - International Journal of Qualitative Methods
ER -