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Mbuo M, Okello I, Penn-Kekana L, Willcox M, Portela A, Palestra F, Mathai M. Community engagement in maternal and perinatal death surveillance and response (MPDSR): Realist review protocol. Wellcome Open Res 2023; 8:117. [PMID: 37654740 PMCID: PMC10465996 DOI: 10.12688/wellcomeopenres.18844.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 09/02/2023] Open
Abstract
Background: While there has been a decline in maternal and perinatal mortality, deaths remain high in sub-Saharan Africa and Asia. With the sustainable development goals (SDGs) targets to reduce maternal and perinatal mortality, more needs to be done to accelerate progress and improve survival. Maternal and perinatal death surveillance and response (MPDSR) is a strategy to identify the clinical and social circumstances that contribute to maternal and perinatal deaths. Through MPDSR, an active surveillance and response cycle is established by bringing together different stakeholders to review and address these social and clinical factors. Community engagement in MPDSR provides a strong basis for collective action to address social factors and quality of care issues that contribute to maternal and perinatal deaths. Studies have shown that community members can support identification and reporting of maternal and/or perinatal deaths. Skilled care at birth has been increasing globally, but there are still gaps in quality of care. Through MPDSR, community members can collaborate with health workers to improve quality of care. But we do not know how community engagement in MPDSR works in practice; for whom it works and what aspects work (or do not work) and why. This realist review answers the question: which strategies of community engagement in MPDSR produce which outcomes in which contexts? Methods : For this realist review, we will identify published and grey literature by searching relevant databases for articles. We will include papers published from 2004 in all languages and from all countries. We have set up an advisory group drawn from academia, international organizations, and practitioners of both MPDSR and community engagement to guide the process. Conclusion: This protocol and the subsequent realist review will use theoretical approaches from the community engagement literature to generate theory on community engagement in MPDSR. Prospero registration number: CRD42022345216.
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Affiliation(s)
- Mary Mbuo
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Immaculate Okello
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Loveday Penn-Kekana
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Merlin Willcox
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Anayda Portela
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Francesca Palestra
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Welch V, Pottie K, Gaudet C, Thuku M, Mallard R, Spenceley S, Amjed N, Wadhwani A, Ghogomu E, Scott C, Dahrouge S. Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review. Arch Public Health 2023; 81:115. [PMID: 37353828 DOI: 10.1186/s13690-023-01105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND There are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents. OBJECTIVE To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations. METHODS A realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening. RESULTS We included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the "reach" of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered. CONCLUSION Realist reviews can help guide the development of locally adapted primary health care interventions.
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Affiliation(s)
- Vivian Welch
- Bruyère Research Institute, Methods Centre, 85 Primrose, Ottawa, ON, K1R 7G5, Canada.
| | - Kevin Pottie
- Bruyère Research Institute, C.T. Lamont Primary Health Care Research Centre (CTLC), 85 Primrose, Ottawa, ON, K1R 7G5, Canada
| | - Caroline Gaudet
- Bruyère Research Institute, Methods Centre, 85 Primrose, Ottawa, ON, K1R 7G5, Canada
| | - Micere Thuku
- Bruyère Research Institute, C.T. Lamont Primary Health Care Research Centre (CTLC), 85 Primrose, Ottawa, ON, K1R 7G5, Canada
| | - Ryan Mallard
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Shannon Spenceley
- University of Lethbridge, 4401 University Dr W, Lethbridge, AB, T1K 6T5, Canada
| | - Nida Amjed
- Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Arpana Wadhwani
- Bruyère Research Institute, Methods Centre, 85 Primrose, Ottawa, ON, K1R 7G5, Canada
| | - Elizabeth Ghogomu
- Bruyère Research Institute, Methods Centre, 85 Primrose, Ottawa, ON, K1R 7G5, Canada
| | - Cathie Scott
- PolicyWise for Children & Families, #1000, 9925 109 Street, Edmonton, AB, T5K 2J8, Canada
| | - Simone Dahrouge
- Bruyère Research Institute, C.T. Lamont Primary Health Care Research Centre (CTLC), 85 Primrose, Ottawa, ON, K1R 7G5, Canada
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Booth A, Barnes A, Laar A, Akparibo R, Graham F, Bash K, Asiki G, Holdsworth M. Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya. Int J Health Policy Manag 2021; 10:828-844. [PMID: 33619936 PMCID: PMC9309963 DOI: 10.34172/ijhpm.2020.255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/12/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances.
Methods: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualise the evidence base. Programme theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science and Scopus. Programme theories were tested and refined to produce a synthesised model.
Results: The five policies operate through complex, inter-connected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy and beliefs. Contextualised data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation.
Conclusion: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.
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Affiliation(s)
- Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Amy Barnes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Amos Laar
- School of Public Health, University of Ghana, Accra, Ghana
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Graham
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit, IRD-Univ Montpellier, Montpellier, France
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Hut-Mossel L, Welker G, Ahaus K, Gans R. Understanding how and why audits work: protocol for a realist review of audit programmes to improve hospital care. BMJ Open 2017; 7:e015121. [PMID: 28615270 PMCID: PMC5541620 DOI: 10.1136/bmjopen-2016-015121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Many types of audits are commonly used in hospital care to promote quality improvements. However, the evidence on the effectiveness of audits is mixed. The objectives of this proposed realist review are (1) to understand how and why audits might, or might not, work in terms of delivering the intended outcome of improved quality of hospital care and (2) to examine under what circumstances audits could potentially be effective. This protocol will provide the rationale for using a realist review approach and outline the method. METHODS AND ANALYSIS This review will be conducted using an iterative four-stage approach. The first and second steps have already been executed. The first step was to develop an initial programme theory based on the literature that explains how audits are supposed to work. Second, a systematic literature search was conducted using relevant databases. Third, data will be extracted and coded for concepts relating to context, outcomes and their interrelatedness. Finally, the data will be synthesised in a five-step process: (1) organising the extracted data into evidence tables, (2) theming, (3) formulating chains of inference from the identified themes, (4) linking the chains of inference and formulating CMO configurations and (5) refining the initial programme theory. The reporting of the review will follow the 'Realist and Meta-Review Evidence Synthesis: Evolving Standards' (RAMESES) publication standards. ETHICS AND DISSEMINATION This review does not require formal ethical approval. A better understanding of how and why these audits work, and how context impacts their effectiveness, will inform stakeholders in deciding how to tailor and implement audits within their local context. We will use a range of dissemination strategies to ensure that findings from this realist review are broadly disseminated to academic and non-academic audiences. PROSPERO REGISTRATION NUMBER CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
| | - Gera Welker
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
| | - Kees Ahaus
- University of Groningen, University Medical Centre Groningen, Centre of Expertise on Quality and Safety, Groningen, The Netherlands
- Department Operations, University of Groningen, Faculty of Economics and Business, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Meads C, Nyssen OP, Wong G, Steed L, Bourke L, Ross CA, Hayman S, Field V, Lord J, Greenhalgh T, Taylor SJC. Protocol for an HTA report: Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic modelling. BMJ Open 2014; 4:e004377. [PMID: 24549165 PMCID: PMC3932001 DOI: 10.1136/bmjopen-2013-004377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis. METHODS Included are any comparative study of therapeutic writing compared with no writing, waiting list, attention control or placebo writing in patients with any diagnosed LTCs that report at least one of the following: relevant clinical outcomes; quality of life; health service use; psychological, behavioural or social functioning; adherence or adverse events. Searches will be conducted in the main medical databases including MEDLINE, EMBASE, PsycINFO, The Cochrane Library and Science Citation Index. For the realist review, further purposive and iterative searches through snowballing techniques will be undertaken. Inclusions, data extraction and quality assessment will be in duplicate with disagreements resolved through discussion. Quality assessment will include using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data synthesis will be narrative and tabular with meta-analysis where appropriate. De novo economic modelling will be attempted in one clinical area if sufficient evidence is available and performed according to the National Institute for Health and Care Excellence (NICE) reference case.
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Affiliation(s)
- C Meads
- Health Economics Research Group, Brunel University, Middlesex, UK
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