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Table 2 Assessment of exposure to intervention, key intermediate mechanisms (commitment and efficacy), and outcomes of the 10 talukas of Tumkur

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

  Classroom participation 1 Mentoring2 Retention of mentoring3 Organizational commitment 4 Self-efficacy5 Supportive supervision 6 Intention to change7 Stability of team8 Net change in budget utilisation9 Net change in CS rate10 Net change in stillbirth rate11 Development index12
Gubbi 0.7 0.7 High AC 2.66 68 2.5 50 Moderate 2 1 -16 0.95
NC 2.47
CC 2.42
Tumkur 0.7 0.7 Moderate AC 2.85 68 2.6 75 Low 6 1.5 -8 1.21
NC 2.46
CC 2.69
CN Halli 0.6 0.5 Moderate AC 2.75 70 2.2 100 High 4 0.1 0 1.02
NC 2.29
CC 2.71
Turuvekere 0.6 0.4 Low AC 2.81 68 2.4 83 High 5 5.8 -4 1.06
NC 2.80
CC 2.47
Tiptur 0.5 0.5 Moderate AC 2.25 86 2.5 75 Low -4 12.6 -1 1.25
NC 2.33
CC 3.17
Koratagere 0.4 0.5 Low AC 2.87 71 2.3 20 Moderate 3 1.8 -3 0.89
NC 2.73
CC 3.07
Madhugiri 0.5 0.5 Low AC 2.50 83 2.4 40 High 4 1.3 -1 0.82
NC 2.03
CC 2.50
Pavagada 0.6 0.5 Moderate AC 2.50 79 2.3 0 High 6 0 1 0.78
NC 2.05
CC 2.28
Kunigal 0.6 0.5 High AC 2.12 83 2.2 75 Moderate 2 4.9 -4 0.96
NC 2.59
CC 2.83
Sira 0.7 0.9 High AC 1.80 68 2.2 100 Moderate 6 8.3 2 0.81
NC 2.00
     CC 2.67         
  1. 1Average of degree of classroom participation of all participants from a taluka, based on assessment of attendance and classroom activity (assessed by observation notes) expressed on a scale of 0 to 1.
  2. 2Average of degree of mentoring received based on attendance of participants at mentoring sessions (0 to 1.0).
  3. 3Qualitative assessment of the taluka’s ability to retain interest of the mentor expressed as high, moderate, and low.
  4. 4Three dimensions of organisational commitment: Affective commitment (AC), normative commitment (NC), and continuance commitment (CC). Individual commitment measures for each of these three dimensions were computed and the averages of these were calculated by taluka. Commitment scores are on a scale of 0 to 5.
  5. 5Self-efficacy scores expressed on a scale of 0 to 100.
  6. 6Style of supervision largely assessing supportive nature of supervision (1 to 5; 1 being most supportive and 5 being most authoritative).
  7. 7Percentage of ever-trained members in the taluka, who expressed intention to make changes based on the capacity building programme.
  8. 8Stability of team assessed based on turnover of health managers in the taluka team from 2009 to 2013 expressed as high, moderate, and low. High indicates stable teams (low turnover).
  9. 9The net change in percentage budget utilization from 2009 to 2012. Budget utilisation for each of the PHCs in the taluka was obtained.
  10. 10The net change in proportion of caesarean sections (CS) among total deliveries from 2009 to 2012. CS at taluka hospitals is at present very low and efforts are on to improve emergency obstetric care at taluka hospitals through ensuring facilities to perform CS.
  11. 11The net change in stillbirth rate (of the total live births in the taluka) from 2009 to 2012. Negative change indicates a fall in stillbirth rate.
  12. 12The socio-economic development index for the taluka. Scores less than 1 are considered very poor and such talukas have been designated “backward” [51].
  13. The tools for measuring organizational commitment, self-efficacy, and supportive supervision notes on their validity in Indian settings are discussed elsewhere [39].