How beneficiaries see complex health interventions: a practice review of the Most Significant Change in ten countries

Archives of Public Health

Juan Pimentel¹  Hilah Silver¹  Kendra Tonkin¹  Ivan Sarmiento¹  Neil Andersson²  Anne Cockcroft²  Loubna Belaid³  Anne Marie Chomat³ 

[1] CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada;CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada;Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico;Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico;

关键词: Narrative methods;    Complex interventions;    Participatory research;    Intervention evaluation;    Most significant change;   

DOI  :  10.1186/s13690-021-00536-0

来源: Springer

【 摘 要 】

BackgroundThe Most Significant Change is a story-based evaluation approach used in many international development programs. This practice review summarises practical experience with the approach in complex health interventions in ten countries, with the objective of making it more accessible in evaluation of other complex health interventions.ResultsParticipatory research practitioners and trainees discussed five themes following brief presentations by each of the seven attendees who led the exercise: (i) sampling and recruitment; (ii) phrasing the questions to elicit stories; (iii) story collection strategies; (iv) quality assurance; and (v) analysis. Notes taken during the meeting provided the framework for this article.Recruitment strategies in small studies included universal engagement and, in larger studies, a purposive, systematic or random sampling. Meeting attendees recommended careful phrasing and piloting of the question(s) as this affects the quality and focus of the stories generated. They stressed the importance of careful training and monitoring of fieldworkers collecting stories to ensure full stories are elicited and recorded. For recording, in most settings they preferred note taking with back-checking or self-writing of stories by story tellers, rather than audio-recording. Analysis can combine participatory selection of a small number of stories, deductive or inductive thematic analysis and discourse analysis. Meeting attendees noted that involvement in collection of the stories and their analysis and discussion had a positive impact for research team members.ConclusionsOur review confirms the plasticity, feasibility and acceptability of the Most Significant Change technique across different sociopolitical, cultural and environmental contexts of complex interventions. Although the approach can surface unexpected impacts, it is not a 360-degree evaluation. Its strength lies in characterising the changes, where these happen, in the words of the beneficiaries. We hope this distillation of our practice makes the technique more readily available to health sector researchers.

【 授权许可】

CC BY