RESUMO
Introduction: Realist evaluation studies have spanned different aspects of medicine, especially in the field of public health. However, very few of these studies explicitly detailed how program implementation triggered outcomes that could strengthen understanding of its effect on Health System Strengthening in specific settings. In low- and middle-income countries, like Nigeria, there is a paucity of realist evaluation studies, despite the implementation of multiple intervention programs and projects in these countries. This article is aimed at unveiling the black-box of program implementation and Health System Strengthening of the "Abiye" Safe Motherhood Program in Ondo State, Nigeria. Specifically, it identified the role of contextual factors in the "Abiye" program in Ondo State, determined the mechanisms that facilitated or constrained outcomes of the "Abiye" program, and developed a Context Mechanism Outcome (CMO) Configuration from which a Middle Range Theory (MRT) can be framed. Methodology: This was qualitative research structured along with the realist domains (Context, Mechanism, and Outcome). The Initial Program Theory was validated by the qualitative study, after which a new MRT was developed. The study population comprised key stakeholders, secondary stakeholders, and primary stakeholders in the Abiye safe motherhood program. Data was collected through 10 key informant interviews, 28 in-depth interviews, and six focus group discussions sessions. Thematic analysis was used to analyze all the qualitative data collected, and seven themes with 19 subthemes emerged in the study. Results: We identified 13 contextual factors under five principal areas, with most of the factors playing enabling roles, some playing inhibitory roles, while very few played both roles. We elicited eight mechanisms, and some of these facilitated the outcomes, while some constrained the outcomes of the program. Health system strengthening was a key feature of the outcome of the program. We developed a middle-range theory based on the 6 CMO configurations we elicited from the study. Conclusion and Policy Implications: Realist evaluation is an iterative process that looks beyond the surface to generate evidence. By applying the realist approach, we generated pieces of evidence that can be adapted for policymaking in public health interventions in LMIC.
RESUMO
BACKGROUND: Intimate partner violence (IPV) is an under-diagnosed public health problem affecting women with attendant negative bio-psycho-social ramifications, and unfortunately there is no universally agreed recommendation for routine hospital IPV screening currently. AIM: This study was carried out to determine the prevalence of IPV among women and their perceptions towards screening. SETTING: The study was carried out in a hospital in Southwest, Nigeria. METHODS: The study was a descriptive, cross-sectional study of 347 consenting women. Respondents were recruited using systematic random sampling. Data were collected using questionnaire adapted from the World Health Organization's (WHO) Multi-Country Study Questionnaire on Women's Health and Domestic Violence against women. Descriptive and inferential statistics were used and a p-value 5% was considered significant. RESULTS: The prevalence of IPV among the sample was 71.2%. The most common IPV pattern was controlling behaviour (49.6%) while sexual violence (19.6%) was the least. The majority (85.0%) of the respondents agreed that routine IPV screening should be done for women while 96.5% believed that it would enable doctors to help identify victims. The belief that it will help physicians in making a correct diagnosis, shared by 10.7% of the respondents, was statistically significant (odd ratio [OR] = 2.592, 95% confidence interval [CI] = 1.180-5.694, p-value = 0.018). A total of 37 respondents (10.7%) were about three times more likely to have experienced IPV than others. CONCLUSION: There was a high prevalence of IPV and the women are open to routine hospital IPV screening, with the belief that it will help physicians to make an accurate diagnosis of IPV.Contribution: This research was done by majority of family health specialists, in Nigeria, an African country. The focus of the research was distinctly with an African perspective, in the field of family medicine which has a public health implication and effect on the community.