The complex ways in which food security actions lead to nutrition and other health outcomes make it important to clarify what programs work and how, with theory-driven evaluation emerging as a promising approach to evaluate complex programs. However, it is unclear how and why theory-driven evaluation is applied in food security contexts. Our objective is to examine the development and use of Theory of Change and Realist Evaluation to support food security programs globally. Using a systematic search and screening process, we included studies that described a food security program, used a Theory of Change or Realist Evaluation, and presented original research or evaluations. We found a total of 59 relevant Theory of Change studies and eight Realist Evaluation studies. Based on our analysis, Theories of Change arose in response to three main problems: 1) the need to evaluate under complexity; 2) challenges with evaluation; and, 3) information gaps surrounding a program. In contrast, Realist Evaluation was reported to be developed primarily to understand a program's outcomes. Reflecting on the problem to be addressed in the evaluation would help improve understandings of the evaluation context, which would then inform the choice and design of an evaluation approach.
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http://dx.doi.org/10.1016/j.evalprogplan.2021.102008 | DOI Listing |
Arch Public Health
January 2025
Section of Social Medicine, Institute of Public Health, University of Copenhagen, Gothersgade 160, 1123, Copenhagen, Denmark.
Background: Breastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. A Danish intervention included a home visit by a health visitor during pregnancy to prolong breastfeeding and reduce social inequality in its rates.
View Article and Find Full Text PDFJ Eval Clin Pract
February 2025
Naamuru Parent and Baby Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.
Rationale: Developing a feasible and sensitive evaluation strategy for a new mental health service is a challenge that requires consideration of what a service is trying to achieve and what a 'good' outcome might look like. Perinatal mental illnesses are complex in their causes and treatment. Mother Baby Units provide specialist perinatal mental health care to parents experiencing mental illness in the perinatal period, with evaluations demonstrating clinical and social outcomes.
View Article and Find Full Text PDFJ Hum Nutr Diet
February 2025
Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
Background: Nutrition Skills for Life (NSFL) provides training and support for communities and organisations to implement Community Nutrition Interventions (CNIs) that meet identified needs. To inform future NSFL evaluation, this scoping review, using a realist approach sought to determine the underpinning initial programme theory (IPT) for how CNIs support socioeconomically disadvantaged (SED) communities to access a healthy diet, as detailed in the protocol doi.org/10.
View Article and Find Full Text PDFInt J Environ Res Public Health
December 2024
École de Santé Publique, Université Libre de Bruxelles, 1070 Bruxelles, Belgium.
Since 2014, the health sector in the Democratic Republic of the Congo has been undergoing reforms aimed at strengthening the Provincial Health Administration (PHA) to better support health district development through technical support to district health management teams (DHMTs). However, there is limited understanding of how, for whom, and under what conditions this support works. Using a realist evaluation approach, this study aimed to test an initial program theory of technical support to DHMTs by PHA staff in Kasai Central Province.
View Article and Find Full Text PDFHealth Syst Reform
December 2025
Department of Health Policy and Management, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel.
In the pursuit of equitable diabetes care, international knowledge exchange (iKE) serves as a crucial mechanism for narrowing the gaps in quality within and between countries. Little is known about the process of quality measurement exchange among stakeholders from high-income countries (HICs), low- and middle-income countries (LMICs), and international organizations. This study aims to analyze recent international exchanges of quality measures in diabetes care and propose a framework for enhancing quality, focusing on LMICs.
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