Short Abstract

We report learnings from deployment of realist and participatory approaches with limited resources and time-constraints to evaluate a multi-faceted intervention in rural Ethiopia to improve health outcomes of podoconiosis patients, improve prevention, care-seeking and access, and reduce stigma.

Description

Podoconiosis (endemic non-filarial elephantiasis) is a non-infectious disease caused by long-term exposure of bare feet to red clay soil derived from volcanic rock. Since 2023, Malaria Consortium has been implementing a project called “Happy Feet: Strengthening Community-based Podoconiosis Prevention and Control in Ethiopia”. The project involves a community-based, innovative intervention package, including training and support for health providers to improve access and quality of morbidity management, disability prevention and psychological support services; community messaging campaigns (billboards, radio messages and community events) to improve preventative and care-seeking behaviours, and reduce stigma against patients; and distribution of customised shoes to aid physical recovery. To evaluate this multi-faceted intervention, and provide usable evidence of what worked, for whom and in which contexts, we will employ aspects of realist and participatory approaches: adapted Ripple Effects Mapping will first be undertaken with providers, community members and patients to understand anticipated and unanticipated outcomes, and to challenge and add to the existing theoretical mechanisms and pathways to these outcomes. These theories and hypotheses will then be further tested with quantitative surveys carried out at households and health centres, allowing for analysis by gender and other factors. Finally, a participatory feedback and reflection event with local and national stakeholders will be held, following all data capture and preliminary analysis, to feed into final conclusions. Both participatory and realist approaches have challenges as they require expertise and time to implement, they have also not been widely used in African settings. In this session we will report on lessons learned from implementing this theory-driven evaluation in a rural Ethiopian setting, with limited resources and time-constraints. The lessons will be recorded systematically and prospectively throughout the evaluation (November 2025-March 2026) through individual, team and participant reflections.