Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
BMJ Open. 2021 Jun 10;11(6):e046992. doi: 10.1136/bmjopen-2020-046992.
Health systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps.
In this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses.
Ethics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam.
CRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.
卫生系统反应性是任何卫生系统的一个关键目标，但它是所有目标中研究最少的，特别是在低收入和中等收入国家。卫生系统反应性研究强调了其多个要素，例如尊严和保密性。然而，对于卫生系统反应性的潜在理论以及反应性发挥作用的机制知之甚少。这项现实主义综合研究有助于弥合这两个知识差距。
在这项现实主义综合研究中，我们将使用四步流程，包括：理论基础映射、方案理论制定、理论细化以及使用来自加纳和越南的文献和实证数据对方案理论进行测试。我们将包括理论和概念部分、评论、实证研究和灰色文献，以及主要数据。我们将探索反应性，认为它需要卫生系统内部和外部的相互作用。搜索策略将是有目的和迭代的，不断筛选和细化理论。数据提取将与质量评估相结合，使用适当的工具。每个证据片段都将在提取时进行评估，以确定其与新兴方案理论和方法严谨性的相关性。与上下文、机制和结果相关的数据提取将进行综合，以识别模式和矛盾。结果将按照既定的现实主义综合报告指南，以叙述性解释的形式报告。
这项综述是更大的“RESPONSE（改善加纳和越南弱势人群被忽视的健康需求的卫生系统反应性）”研究的一部分，该研究的所有部分都获得了以下机构伦理委员会的批准：伦敦卫生与热带医学学院（编号：22981）、利兹大学医学院（编号：MREC19-051）、加纳卫生局（编号：GHS-ERC 012/03/20）和河内公共卫生大学（编号：020-149/DD-YTCC）。我们将通过在加纳和越南的学术论文、会议演讲和利益相关者研讨会来传播研究结果。
PROSPERO 注册号：CRD42020200353。完整记录：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353。
