{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:39:23Z","timestamp":1760834363358,"version":"build-2065373602"},"reference-count":44,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T00:00:00Z","timestamp":1711152000000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008627","name":"Global Affairs Canada","doi-asserted-by":"publisher","award":["D-002085"],"award-info":[{"award-number":["D-002085"]}],"id":[{"id":"10.13039\/501100008627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,28]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>This is a study protocol that tests and refines realist theories regarding the uptake and scale-up of the linked maternity waiting home (hereafter MWH) and facility birth intervention in the Mozambican context. The theories were developed through a realist review of MWH\u2013facility birth literature from low-income and middle-income countries. The aim of the proposed study is to contribute to a contextually refined understanding of the causal chains underlying MWH\u2013facility birth adoption by pregnant women and their families, communities, the health system and donors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>The overarching methodology is mixed-methods realist evaluation. The study will adopt a comparative embedded case study design comparing three new masonry MWHs built by the Mozambique-Canada Maternal Health Project in Inhambane province with three older MWHs selected based on variation in the built environment. Baseline data on participating MWH\u2013facility birth interventions will be collected through observations, reviews of routine data and analysis of statistics and reports from provincial and district health authorities and the Mozambique-Canada Maternal Health project. Realist interviews will be conducted with MWH users and non-users, companions of MWH users and non-users, partners of MWH users and non-users, and stakeholders within the health system and the non-governmental organisation sector. Realist focus groups will be used to collect data from community-level implementers. The analysis will be retroductive and use the context\u2013mechanism\u2013outcome configuration heuristic tool to represent generative causation. We will analyse data from intervention and comparator MWHs independently and compare the resulting refined programme theories. Data analysis will be done in NVivo 12.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Ethics approval for the project has been obtained from the Mozambique National Bioethics Committee (CNBS-Comit\u00e9 Nacional de Bio\u00e9tica para a Sa\u00fade) and the University of Saskatchewan Bioethical Research Ethics Board. The evaluation will adhere to the International Ethical Guidelines for Biomedical Research Involving Human Subjects and the African adaptation of evaluation ethics and principles. Evaluation results will be disseminated to stakeholders' practice audiences through peer-reviewed publications, plain-language briefs, theory validation\/feedback meetings and conference presentations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-075681","type":"journal-article","created":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T12:40:19Z","timestamp":1711197619000},"page":"e075681","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9296-0396","authenticated-orcid":false,"given":"Nadege Sandrine","family":"Uwamahoro","sequence":"first","affiliation":[{"name":"Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"},{"name":"Mozambique-Canada Maternal Health Project, Inhambane, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessie","family":"Forsyth","sequence":"additional","affiliation":[{"name":"Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"},{"name":"Mozambique-Canada Maternal Health Project, Inhambane, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Andre","sequence":"additional","affiliation":[{"name":"Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"},{"name":"Mozambique-Canada Maternal Health Project, Inhambane, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D\u00f3rcia Ant\u00f3nio","family":"Mandlate","sequence":"additional","affiliation":[{"name":"Inhambane Provincial Directorate of Health, Inambane, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4496-9254","authenticated-orcid":false,"given":"Brynne","family":"Gilmore","sequence":"additional","affiliation":[{"name":"UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, University College Dublin, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6781-5421","authenticated-orcid":false,"given":"Nazeem","family":"Muhajarine","sequence":"additional","affiliation":[{"name":"Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"},{"name":"Mozambique-Canada Maternal Health Project, Inhambane, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,23]]},"reference":[{"key":"2025101813045044000_14.3.e075681.1","unstructured":"World Health Organization . 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