Theoretical and Practical Implications of Communication in Community Engagement for Maternal and Newborn Health: Middle-Range Theories Developed in a Realist Evaluation

Community engagement has been used in a variety of settings to work with communities to support maternal and newborn health (MNH) care-seeking. Communication is an important component of CE, influencing how information is shared or behavior change is promoted. However, there is limited evidence explaining "how, why and for whom" communication works in these approaches. This study presents middle-range theories (MRTs) explaining how communication in community engagement works to improve MNH care-seeking. Building off of a multi-site realist evaluation conducted in Zambia, this study further synthesizes seven programme theories with the substantive literature to present four MRTs. The MRTs, aligning with elements of the communication transmission model, describe the considerations that make communication in community engagement work by addressing the message, channel/feedback loops, sender, and receiver. These theories can contribute to explaining how communication in community engagement works and inform future programming by presenting practical recommendations.