Dealing with context in logic model development: Reflections from a realist evaluation of a community health worker programme in Nigeria

doi:10.1016/j.evalprogplan.2018.12.002

Evaluation and Program Planning

Volume 73, April 2019, Pages 97-110

https://doi.org/10.1016/j.evalprogplan.2018.12.002 Get rights and content

Under a Creative Commons license

open access

Highlights

•
We describe the process of developing a logic model as part of an ongoing realist evaluation of a community health workers programme in Nigeria.
•
We also reflect on how other scholars explored context during logic modelling in theory-driven evaluations of complex healthcare programmes.
•
Creating a logic model is a key step in modelling relations between a programme, its outcomes and contextual conditions that can affect outcomes.
•
Logic models can also inform identification of initial working theories and evaluation measures for verifying underlying programme theories.
•
Lessons for researchers and programme planners who wish to develop and use logic models in future evaluations are discussed.

Abstract

Logic models (LMs) have been used in programme evaluation for over four decades. Current debate questions the ability of logic modelling techniques to incorporate contextual factors into logic models. We share experience of developing a logic model within an ongoing realist evaluation which assesses the extent to which, and under what circumstances a community health workers (CHW) programme promotes access to maternity services in Nigeria. The article contributes to logic modelling debate by: i) reflecting on how other scholars captured context during LM development in theory-driven evaluations; and ii) explaining how we explored context during logic model development for realist evaluation of the CHW programme in Nigeria. Data collection methods that informed our logic model development included documents review, email discussions and teleconferences with programme stakeholders and a technical workshop with researchers to clarify programme goals and untangle relationships among programme elements. One of the most important findings is that, rather than being an end in itself, logic model development is an essential step for identifying initial hypotheses for tentative relevant contexts, mechanisms and outcomes (CMOs) and CMO configurations of how programmes produce change. The logic model also informed development of a methodology handbook that is guiding verification and consolidation of underlying programme theories.

Keywords

Programme theory

Realist evaluation

Logic model

Community health workers programme

Maternal and child health

Nigeria

Context

Cited by (0)

Bassey Ebenso is a Research Fellow in health policy and systems research in low- and middle-income countries. He has worked extensively within the Nigerian health system. His expertise includes methodology development for mixed-methods evaluation of complex applied healthcare interventions.

Ana Manzano is Lecturer in Health and Social Policy at the University of Leeds. She is a social research methodologist with an expertise in applied health research. Her specialist area is the evaluation of complex applied healthcare interventions using mixed-methods and the realist evaluation approach.

Benjamin Uzochukwu is a medical doctor and a Professor of Community Medicine, Public Health and Health Systems at the College of Medicine, University of Nigeria, Enugu Campus. He is the pioneer Director of the Institute of Public Health of the same university. His main interests are health policy and systems research and analysis and getting research into policy and practice. He sits on the board of Health Systems Global.

Enyi Etiaba is a medical doctor and lecturer at the College of Medicine, University of Nigeria Enugu Campus. She has skills and competencies in both quantitative and qualitative research. Her research interests include how to tackle barriers to healthcare access and getting research findings into policy and practice.

Reinhard Huss is a senior teaching fellow and Director of the Master in International Health programme at the University of Leeds, UK. He possesses expertise in public health, and has worked extensively as a clinical and public health specialist in Africa. He is leading the methodology development in a number of collaborative mixed methods studies in Africa and Asia.

Tim Ensor is the Director of the Leeds Institute of Health Sciences, and a Professor of International Health Systems Research at the University of Leeds, UK. His interests include in assessing complex health interventions using economic evaluation in low- and middle-income countries.

James Newell is a Professor of International Public Health and the Academic Research Lead for the Leeds Institute of Health Sciences, University of Leeds. His research focuses on improving delivery of health services in low- and middle-income countries.

Obinna Onwujekwe is a medical doctor and a Professor of Health Economics and Policy at the College of Medicine, University of Nigeria, Enugu Campus. He is currently the Co-Chairman of the National Technical Working Group on Health Financing and Equity and a technical facilitator to the ongoing efforts to produce a new National Health Policy for Nigeria.

Nkoli Ezumah is a Professor of Sociology and the Head of Department of Sociology and Anthropology, University of Nigeria, Nsukka Campus. Her research interests are in gender roles, human sexuality and reproductive health issues, access to justice and behaviour change communication.

Joseph Hicks is a Medical Statistician and provides statistical support for research within the Leeds Institute of Health Sciences and collaborative research organisations.

Tolib Mirzoev is an Associate Professor of International Health Policy and Systems at the University of Leeds. He has expertise in qualitative health policy and systems analysis, methodology development for mixed-methods studies and extensive experience in managing successful multidisciplinary and collaborative research in low- and middle-income countries.