Department of Public Health, Institute of Tropical Medicine, Health Systems and Equity Unit, Antwerp, Belgium.
Curatio International Foundation, Tbilisi, Georgia.
BMJ Open. 2019 Apr 14;9(4):e030257. doi: 10.1136/bmjopen-2019-030257.
In 2016, Georgian researchers and policymakers were developing a policy to improve the performance of the national tuberculosis (TB) control programme. The research programme 'Designing and Evaluating Provider Results-Based Financing for Tuberculosis Care in Georgia: Understanding Costs, Mechanisms of Effect and Impact (Results4TB)' was initiated to inform the policy formulation phase, document the policy implementation and assess the effectiveness, cost-effectiveness and the processes of change. To achieve this, the research team intends to combine an impact evaluation, a cost-effectiveness study and a realist evaluation (RE) within an overarching theory-informed design. This protocol is the RE component of the programme.
A realist methodological approach will be adopted to guide the research design and evaluation. RE answers the question of 'what works in which conditions for whom?' and starts with the development of an initial programme theory (IPT). The IPT will feed into other phases of the realist research cycle (study design, data collection, data analysis and synthesis and theory refinement). Data will be collected in a multiple embedded case study design (five intervention and three control sites) through document reviews, in-depth interviews, non-participant observations and context mapping at facility and national levels. Additional data from other research components (cost-effectiveness and impact evaluation) will aid data triangulation.
The Institutional Review Boards of the National Centre for Disease Control and Public Health in Georgia (ref. IRB # 2018-019) and the Institute of Tropical Medicine, Antwerp (ref. IRB #- 1240/18) have granted ethical approval to the study.
ISRCTN14667607.
2016 年，格鲁吉亚的研究人员和政策制定者正在制定一项改善国家结核病（TB）控制计划绩效的政策。“为格鲁吉亚结核病护理设计和评估基于提供者的成果融资：了解成本、影响机制和影响（Results4TB）”研究计划的启动旨在为政策制定阶段提供信息，记录政策实施情况，并评估效果、成本效益以及变革过程。为此，研究团队打算在一个总体理论指导的设计中结合影响评估、成本效益研究和现实主义评估（RE）。本方案是该计划的 RE 部分。
将采用现实主义方法学方法来指导研究设计和评估。RE 回答了“在什么条件下对谁有效？”的问题，并从初始方案理论（IPT）的开发开始。IPT 将为现实主义研究周期的其他阶段（研究设计、数据收集、数据分析和综合以及理论完善）提供信息。通过文件审查、深入访谈、非参与观察和设施及国家层面的背景映射，在一个多嵌入式案例研究设计（五个干预和三个对照地点）中收集数据。来自其他研究部分（成本效益和影响评估）的附加数据将有助于数据三角剖分。
格鲁吉亚国家疾病控制和公共卫生中心（IRB # 2018-019）和安特卫普热带医学研究所（IRB #- 1240/18）的机构审查委员会已批准该研究。
ISRCTN64263126。
