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