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other·pediatrics, public health, research methods, epidemiology, pediatric ophthalmology·PMC10016238

Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya

BMJ Open · 10 authors, 9 centres

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This is a study protocol describing a mixed-methods realist evaluation of how informal social ties among health workers influence neonatal care delivery at two large public hospitals in Kenya.

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The Pathways Study protocol outlines a two-phase realist evaluation of staff social ties and communication in neonatal care at two large public hospitals in Kenya. Phase 1 involves non-participant observation, social network questionnaires, in-depth interviews, key informant interviews, and focus group discussions with health workers, using multistage and purposive sampling. An initial programme theory derived from a realist synthesis will guide data collection and analysis, with interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. Phase 2 will convene a stakeholder codesign workshop to refine programme theory and develop recommendations for practice. Study findings are intended to inform theory-informed behavioural change interventions for quality improvement in Kenyan neonatal care.

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other

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pediatrics

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ORIGINAL PAPER

PMC10016238

Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya

BMJ Open

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ABSTRACT

Abstract Introduction The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these ‘software’ aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare. This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers’ behaviours. Methods and analysis We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings. Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals. Ethics and dissemination The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals. Keywords: Health policy, Quality in health care, NEONATOLOGY

CITATION EXPORT

Conrad Wanyama, Claire Blacklock, Juliet Jepkosgei et al.. Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-066150

AUTHORS

10 · 9 CENTRES

Conrad Wanyama, Claire Blacklock, Juliet Jepkosgei, Mike English, Lisa Hinton, Jacob McKnight, Sassy Molyneux, Mwanamvua Boga, Peris Muoga Musitia, Geoff Wong

1Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
2Nuffield Department of Medicine, University of Oxford, Oxford, UK
3Nuffield Department of Medicine and Department of Paediatrics, Univerity of Oxford Nuffield Department of Medicine, Oxford, UK
4The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
5Tropical Medicine, University of Oxford Nuffield Department of Medicine, Oxford, UK
6University of Oxford Nuffield Department of Clinical Medicine, Oxford, UK
7Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
8Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
9Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK