Designing a multi case realist evaluation of parenting support services using an ecosystemic approach to parental empowerment

Background The first 1,000 days represent a critical developmental window, during which social, material, and relational environments exert a lasting influence on children’s health, well-being, and developmental trajectories. Social health inequalities emerge early in life, when families experience unequal access to resources, support networks, and spaces of social participation. In France, parenting support policies have recently been strengthened; yet interventions remain largely centred on the individual parent, potentially overlooking the structural and contextual determinants that shape parenting experiences. Fostering parental empowerment requires a genuinely ecosystemic approach to parenting support. This article describes the design of a realist evaluation that will examine the conditions under which parenting support services promote the development of parental empowerment. Methods This study draws on a realist evaluation of nine parenting support services implemented in diverse institutional, territorial, and organisational contexts in France. Realist evaluation seeks to understand how and why interventions work (or do not work), for whom, and under what conditions, based on Context-Mechanism-Effects (CME) configurations. Data collection includes approximately 80 semi-structured interviews with parents and professionals, as well as two minimal participant observations in each service. A thematic and configurational analysis will be conducted using NVivo following an iterative logic: separate coding for parents and professionals, cross-case analyses, and the progressive reconstruction of contextual and individual Context-Mechanism-Effects configurations in order to develop middle-range theories. Discussion This study will identify the conditions that support the development of parental empowerment from an ecosystemic and a health promotion perspective. The realist approach will also make it possible to identify unintended or potentially iatrogenic effects, which are often overlooked in conventional evaluations, thus informing decisions regarding how to implement and scale-up parenting support services. The findings will provide transferable recommendations that will guide professional practices and public policies towards more systemic, inclusive, and capacity-building forms of support.