Melbourne School of Population and Global Health - Theses

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Type: Masters Coursework thesis × Start date: 2000 × End date: 2009 × Subject: realist ×

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    Do growth monitoring and promotion programs motivate mothers to change behaviour? A systematic review using a combination of Cochrane-style systematic reviews and realist reviews
    Sulistyo, Sigit ( 2008)
    Background: The failure of GMP for not achieving its intended outcomes is in part due to the lack of implementation quality. A systematic review on how to maximise the potential of GMP services to improve child nutrition status is needed. The question is to go beyond whether GMP programs work (or do not work), but on how and why GMP programs work (or do not work). There is, however, no single agreed method for synthesising diverse forms of evidence on social interventions such as GMP. This thesis argues that combining Cochrane-style systematic reviews and realist reviews to synthesise the evidence in GMP is feasible and able to produce credible information for decision makers. Objectives: This paper aims to explore how a systematic review combining both Cochrane-style systematic reviews and realist reviews can help explain one aspect of the GMP program theory and to use this information to inform the evaluation process of the Indonesian Management Malnutrition Program. Methods: To combine Cochrane-style review and the realist review, the realist review is first used to identify the review focus. The Cochrane approach then is applied to guide the searching process for high quality evidence. After finishing the quality appraisal, the realist approach will be applied in the data extraction and synthesis stages. Main Results: There is weak evidence that use GMP as a tool to personalise risk information alone motivates mothers’ to change behaviour in improving caring practices. Incorporating multiple theoretical concepts, including HBM, tailoring intervention strategies, self-efficacy, and role modelling enhance the likelihood of behaviour change. In addition, this review identified contextual factors that need to be taken into account in applying the mechanisms in different settings. It is clear that the incorporation of multiple theoretical concepts combined with addressing the contextual constraints is important to gain positive outcomes. The nature of these results will be useful to policy makers who need to know not merely whether GMP programs work but these supplies practical theories on what needs to be attended to in constructing better GMP programs. Conclusion: The review demonstrates that combining Cochrane-style reviews and realist reviews is feasible and helpful as an alternative method to synthesise a complex social intervention where only few evidence on the related topic available such as GMP. The review emphasises the importance of incorporating multiple theoretical concepts and of addressing contextual constraints to maximise the implementation of the GMP activities.