A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes
Barnish, MS; Tan, SY; Robinson, S; et al.Taeihagh, A; Melendez-Torres, GJ
Date: 13 November 2023
Article
Journal
Social Science & Medicine
Publisher
Elsevier
Publisher DOI
Abstract
Background:
Child and maternal health, a key marker of overall health system performance, is a policy priority
area by the World Health Organization and United Nations, including in the Sustainable
Development Goals. Previous realist work has linked child and maternal health outcomes to
globalization, political tradition, and the ...
Background:
Child and maternal health, a key marker of overall health system performance, is a policy priority
area by the World Health Organization and United Nations, including in the Sustainable
Development Goals. Previous realist work has linked child and maternal health outcomes to
globalization, political tradition, and the welfare state. It is important to explore the role of other key
policy-related factors. This paper presents a realist synthesis, categorising policy instruments
according to the established NATO model, to develop an explanatory model of how policy
instruments impact child and maternal health outcomes.
Methods:
A systematic literature search was conducted to identify studies assessing the relationships between
policy instruments and child and maternal health outcomes. Data were analysed using a realist
framework. The first stage of the realist analysis process was to generate micro-theoretical initial
programme theories for use in the theory adjudication process. Proposed theories were then
adjudicated iteratively to produce a set of final programme theories.
Findings
From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers
were included in the review. Evidence from 132 studies was available to address this research
question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81%
analysed data at the ecological level. Eighty-eight initial candidate programme theories were
generated. Following theory adjudication, five final programme theories were supported. According
to the NATO model, these related to treasure, organisation, authority-treasure and treasureorganisation instrument types.
Conclusions:
This paper presents a realist synthesis to develop an explanatory model of how policy instruments
impact child and maternal health outcomes from a large systematically identified international body
of evidence. Five final programme theories were supported, showing how policy instruments play an
important yet context-dependent role in influencing child and maternal health outcomes.
Public Health and Sport Sciences
Faculty of Health and Life Sciences
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Except where otherwise noted, this item's licence is described as © 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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