Abstract
Problem
Volunteer doula support has achieved favourable outcomes for socially disadvantaged
women around the world. There is limited explanatory understanding of how, why and when doula support programs improve outcomes.
Background
A community organisation is providing free doula support for women experiencing socioeconomic
disadvantage in Melbourne, Australia. The program aims to complement the mainstream
maternity care system, to promote equity in women’s care, and experiences of pregnancy,
birth and early parenting. This program is the first of its kind in Australia and
has not previously been evaluated.
Aim
To develop hypothesised program theories for the realist evaluation of an Australian
doula program.
Methods
As the first stage of a realist evaluation, three key informant interviews and rapid
realist review of literature were conducted in December 2017 - January 2019.
Findings
Seven theories were developed in four categories: critical elements of implementation
(Attracting and activating the right doulas, and Good matching); outcomes for women (Being by her side, and Facilitating social connection), outcomes in maternity care system (Complementing or enhancing maternity care, and Doula as a witness — demanding accountability in others), and outcomes for doulas (Doulas as beneficiaries). These theories were framed in accordance with a realist understanding of causation,
as Context – Mechanism – Outcome (CMO) configurations.
Discussion and conclusion
The development of theories from multiple sources of evidence provides a strong theoretical
base for program evaluation. The theories hypothesise how, why, for whom and when
the doula program works. Subsequent stages of the evaluation will test and refine
the theories.
Keywords
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Article info
Publication history
Published online: November 24, 2019
Accepted:
October 26,
2019
Received in revised form:
October 25,
2019
Received:
July 2,
2019
Identification
Copyright
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.