We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia
Introduction In Zambia, where less than half of pregnant women complete the continuum of care for maternal health, community engagement initiatives like the Safe Motherhood Action Groups (SMAGs) are used to mobilise communities and support maternal and newborn health (MNH) care-seeking. However, the...
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/4/e015961.full |
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| author | Brynne Gilmore Sara Dada Aoife De Brún Bellington Vwalika Nachela Chelwa Natasha Okpara Mirriam Zulu |
| author_facet | Brynne Gilmore Sara Dada Aoife De Brún Bellington Vwalika Nachela Chelwa Natasha Okpara Mirriam Zulu |
| author_sort | Brynne Gilmore |
| collection | DOAJ |
| description | Introduction In Zambia, where less than half of pregnant women complete the continuum of care for maternal health, community engagement initiatives like the Safe Motherhood Action Groups (SMAGs) are used to mobilise communities and support maternal and newborn health (MNH) care-seeking. However, there is a lack of documented evidence on communication in community engagement and its implementation across diverse settings. This study examines how communication in community engagement influences MNH care-seeking in Zambia’s Eastern Province.Methods This realist evaluation used two iterative multi-method case studies to evaluate the SMAG programmes at Chibolya Urban Health Clinic and Jerusalem Rural Health Clinic. Data were collected from facility metrics, in-depth interviews, realist photovoice discussions, focus-group discussions and observations. Participants, including SMAGs (n=10), local leaders (n=2), pregnant women (n=10), community members (n=20), healthcare providers (n=4) and Ministry of Health stakeholders (n=4) were purposively sampled.Results Seven programme theories, informed by 50 context-mechanism-outcome configurations, were refined and organised to explain how the SMAG programme in Zambia works when communities are actively involved, messaging is relevant and relatable, SMAGs are trusted, SMAGs are familiar, the programme and facility are well-coordinated, the community perceives benefits from the messaging and SMAGs are motivated.Conclusion This realist evaluation offers research, practice and policy recommendations to enhance communication in community engagement for MNH, with potential applicability to other health domains. It emphasises trust and strong community-programme relationships as key drivers of effective and sustainable community engagement. |
| format | Article |
| id | doaj-art-a8b387d9fa9441198698b3e64d7ee240 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-a8b387d9fa9441198698b3e64d7ee2402025-08-20T03:52:23ZengBMJ Publishing GroupBMJ Global Health2059-79082025-04-0110410.1136/bmjgh-2024-015961We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, ZambiaBrynne Gilmore0Sara Dada1Aoife De Brún2Bellington Vwalika3Nachela Chelwa4Natasha Okpara5Mirriam Zulu6UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, IrelandUCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, IrelandUCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, IrelandSchool of Medicine, University of Zambia, Lusaka, Zambia2 Population Council, Lusaka, ZambiaPopulation Council Zambia, Lusaka, ZambiaUniversity of Zambia, Lusaka, ZambiaIntroduction In Zambia, where less than half of pregnant women complete the continuum of care for maternal health, community engagement initiatives like the Safe Motherhood Action Groups (SMAGs) are used to mobilise communities and support maternal and newborn health (MNH) care-seeking. However, there is a lack of documented evidence on communication in community engagement and its implementation across diverse settings. This study examines how communication in community engagement influences MNH care-seeking in Zambia’s Eastern Province.Methods This realist evaluation used two iterative multi-method case studies to evaluate the SMAG programmes at Chibolya Urban Health Clinic and Jerusalem Rural Health Clinic. Data were collected from facility metrics, in-depth interviews, realist photovoice discussions, focus-group discussions and observations. Participants, including SMAGs (n=10), local leaders (n=2), pregnant women (n=10), community members (n=20), healthcare providers (n=4) and Ministry of Health stakeholders (n=4) were purposively sampled.Results Seven programme theories, informed by 50 context-mechanism-outcome configurations, were refined and organised to explain how the SMAG programme in Zambia works when communities are actively involved, messaging is relevant and relatable, SMAGs are trusted, SMAGs are familiar, the programme and facility are well-coordinated, the community perceives benefits from the messaging and SMAGs are motivated.Conclusion This realist evaluation offers research, practice and policy recommendations to enhance communication in community engagement for MNH, with potential applicability to other health domains. It emphasises trust and strong community-programme relationships as key drivers of effective and sustainable community engagement.https://gh.bmj.com/content/10/4/e015961.full |
| spellingShingle | Brynne Gilmore Sara Dada Aoife De Brún Bellington Vwalika Nachela Chelwa Natasha Okpara Mirriam Zulu We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia BMJ Global Health |
| title | We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia |
| title_full | We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia |
| title_fullStr | We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia |
| title_full_unstemmed | We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia |
| title_short | We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia |
| title_sort | we move together a realist evaluation of the safe motherhood action groups in eastern province zambia |
| url | https://gh.bmj.com/content/10/4/e015961.full |
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