How do high-performing child and youth health organisations in Canterbury, New Zealand increase equity in health outcomes? A realist informed study

While there is widespread evidence of inequities in health, few studies examine how organisations improve equity in healthcare. We aimed to examine the interventions and mechanisms that increase equity in access to care and health outcomes among child health providers in Canterbury, New Zealand using a realist informed methodology. A regional child health advisory group ranked nine high- performing child health services and selected the three highest scorers for case study. We interviewed 13 families, frontline providers and decision-makers. We analysed transcripts using reflexive thematic analysis with a realist lens to consider the contexts, mechanisms and outcomes. We found that strong relationships of families with a frontline health worker formed a springboard for six mechanisms key to positive and more equitable outcomes: feeling safe, forming a working relationship with a frontline worker, feeling mana (agency) enhanced, feeling capable, feeling free from concerns about basic needs such as food security and feeling belonging. These led to increased access to healthcare and improved wellbeing. We used the six context-mechanism-outcome hypotheses to develop a final programme theory. This small study suggests contexts and mechanisms that improve equitable health outcomes for children in Aotearoa New Zealand and underline further research is required.