The use of a Theory of Change model in a mixed-methods systematic review (MMSR): an example from the Development Aid sector.




Long oral session 11: Qualitative and mixed methods for evidence synthesis


Thursday 14 September 2017 - 11:00 to 12:30


All authors in correct order:

Van Remoortel H1, De Buck E2, Vande veegaete A1, Govender T3, Hannes K4, Vandekerckhove P5, Young T6
1 Centre for Evidence-Based Practice, Belgian Red Cross, Belgium, Belgium
2 Centre for Evidence-Based Practice, Belgian Red Cross, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium, Belgium
3 Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa, South Africa
4 Faculty of Social Sciences, KU Leuven, Leuven, Belgium, Belgium
5 Belgian Red Cross, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, Belgium
6 Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa, South Africa
Presenting author and contact person

Presenting author:

Hans Van Remoortel

Contact person:

Abstract text
Background: A Theory of Change (ToC) is a comprehensive description and illustration of how and why a desired change is expected to happen in a particular context. The use of a ToC, and collecting data on outcomes along the causal chain, can be helpful in attempts to explain effect-size heterogeneity and to better understand differences in findings by context, when developing a systematic review.

Objectives: To describe the added value of a ToC throughout the conduct of a MMSR about the effectiveness (quantitative arm MMSR) and implementation (qualitative arm MMSR) of sanitation and handwashing promotion programmes on behaviour change.

Methods: The development of the initial ToC was based on relevant systematic reviews, existing WASH behavioural models and frameworks on contextual/implementation factors. The ToC was further adapted by stakeholder input (4 development practitioners/1 donor/1 topic expert/2 qualitative research experts). Based on the evidence gathered from the MMSR and more extensive stakeholder involvement (13 development practitioners/consultants/3 policy makers/2 topic experts/2 qualitative research experts/4 donors), final adaptations to the ToC were made (Figure 1).

Results: The ToC helped us in different steps of the MMSR process. Firstly, the ToC was used to fine-tune the selection criteria of our MMSR (e.g. distinction between primary and secondary outcomes). Secondly, it was used as the a-priori model in the 'Best fit framework synthesis' (qualitative evidence synthesis methodology) which synthesised the qualitative research data on implementation factors of sanitation and handwashing programmes. Thirdly, the iterative process of ToC development created a sense of ownership and stakeholder buy-in and clarified the research focus of the MMSR. Finally, we projected the final conclusions of our MMSR on the ToC.

Conclusions: An evidence-based ToC guides researchers before, during and after the conduct of an MMSR and it will help policy makers to understand the important role of implementation, and the processes determining behaviour change in handwashing and sanitation.