Skip to main content

Table 1 Identifying context-mechanism-outcome frames based on the programme theory of the intervention

From: Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India

Programme inputs (IPT) and how they were supposed to work Key assumptions identified during the refining of IPT Supporting theory Key contextual factor (C) Outcome of interest (O) Plausible mechanism (M)
Contact classes work through improving knowledge and/or skills, resulting in improved performance An attitudinal change among the participants is needed to achieve the desired results Outcomes of training programmes accrue through four hierarchical levels: reaction (to training programme), learning, behaviour, and impact [48] Team dynamics affect the individual’s intention for positive change Intention to make positive changes Motivation of the participant towards positive organisational change – a “can-do” attitude
Socio-political environment in the taluka/district
Mentoring participants at workplace facilitates application of knowledge and skills Targeting individuals will produce impact through teams Workplace environment in healthcare organisations has been identified as an important element explaining application of learning from training programmes [49] Nature of supervision and district’s openness to “allow” change Identify/seek opportunities to make positive change in the organisation’s performance Nature of commitment to organisation
Decentralised action plans and decision-making at district and lower levels. State and higher levels’ openness to change proposals Improved annual action plans – better situation analysis, problem identification, allocation and utilisation of resources Self-efficacy
A capacitated health manager can become an agent of positive organisational change Capacity leads to performance High commitment management literature shows the potential for change by committed staff in settings where resources could be mobilised [50] Change proposals by districts are in line with state (or central) vision and address local needs (allocation and strategic alignment with external environment per Champ et al.’s conceptual framework) [29] Taluka and district plans improve. They identify more needs, mobilise more resources from state, and utilise them better Claiming and utilising decision spaces; organisational commitment and self-efficacy in negotiating with superiors and community leaders
  The programme could benefit from alignment with existing policy initiatives