Ezumah, N, Manzano, A orcid.org/0000-0001-6277-3752, Ezenwaka, U et al. (8 more authors) (2022) Role of trust in sustaining provision and uptake of maternal and child healthcare: Evidence from a national programme in Nigeria. Social Science and Medicine, 293. 114644. p. 114644. ISSN 0277-9536
Abstract
Despite increasing attention to implementation research in global health, evidence from low- and middle-income countries (LMICs) using realist evaluations, in understanding how complex health programmes work remains limited. This paper contributes to bridging this knowledge gap by reporting how, why and in what circumstances, the implementation and subsequent termination of a maternal and child health programme affected the trust of service users and healthcare providers in Nigeria. Key documents were reviewed, and initial programme theories of how context triggers mechanisms to produce intended and unintended outcomes were developed. These were tested, consolidated and refined through iterative cycles of data collection and analysis. Testing and validation of the trust theory utilized eight in-depth interviews with health workers, four focus group discussions with service users and a household survey of 713 pregnant women and analysed retroductively. The conceptual framework adopted Hurley's perspective on ‘decision to trust’ and Straten et al.‘s framework on public trust and social capital theory. Incentives offered by the programme triggered confidence and satisfaction among service users, contributing to their trust in healthcare providers, increased service uptake, motivated healthcare providers to have a positive attitude to work, and facilitated their trust in the health system. Termination of the programme led to most service users' dissatisfaction, and distrust reflected in the reduction in utilization of MCH services, increased staff workloads leading to their decreased performance although residual trust remained. Understanding the role of trust in a programme's short and long-term outcomes can help policymakers and other key actors in the planning and implementation of sustainable and effective health programmes. We call for more theory-driven approaches such as realist evaluation to advance understanding of the implementation of health programmes in LMICs.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 Published by Elsevier Ltd. This is an author produced version of an article, published in Social Science and Medicine. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Nigeria; Trust; Maternal and child health services; Low and middle-income countries; Health system's strengthening; Realist evaluation |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Nuffield Centre for International Health and Development (Leeds) The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 17 Dec 2021 09:57 |
Last Modified: | 11 Dec 2022 01:13 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.socscimed.2021.114644 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:181603 |