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Table 2 Intervention, context, actors, mechanism and outcome elements of realist evaluation

From: Combining the theory of change and realist evaluation approaches to elicit an initial program theory of the MomConnect program in South Africa

Modalities Identified themes
Intervention (I) - Stage-based health information up to a child’s first birthday
- Interaction with the health system (service ratings and feedback)
Context (C) Health systems context
- Political clout: NDOH leadership and ownership of MomConnect
- Awareness-raising
Facility responsiveness
- Staff training sessions on helpdesk, registration procedures and telephonic support
- Staff adoption and adaptation of the new technology
- Staff availability
Intervention-related context
- Anonymous nature of the SMS helpline
- Network availability & ownership of a mobile phone
- Length of the registration process
Actors (A) - Pregnant women
- Mothers of newborns
- Community health workers
- Health care providers
Mechanism (M) - Encouragement
- Empowerment
- Motivation
- Knowledge acquisition
Outcome (O) - (Perceived) improvement in quality of MCH services
- Improved health-seeking behavior and MCH services uptake